Skeletal Radiology

, Volume 38, Issue 6, pp 565–569 | Cite as

Prognostic value of dynamic MRI in assessing post-traumatic femoral head vascularity

Scientific Article



The vascular status of femoral heads in the post-traumatic period of intracapsular femoral neck fracture (ICFNF) remains uncertain until the patient actually develops avascular necrosis (AVN). Several methods for predicting the viability of femoral head have been reported, that are not effective or widely used because of unreliability, potential complications, and technical difficulties. The present study involved the use of Dynamic MRI (DMRI) in assessing femoral head vascularity to predict AVN.

Materials and methods

The role of DMRI was studied prospectively in 30 patients with 31 ICFNF. Fractures were divided in to three types (Type A, B, or C) based on the femoral head vascularity shown by dynamic curve patterns on MRI evaluation. Type A was preserved vascularity, Type B was some decrease in vascularity but still viable while Type C was significantly reduced vascularity. These were followed-up for 6 months to 2 years to observe the final outcome in terms of union, non-union, or AVN.


We found that Type A curves correlate well with vascular status and Type C curves correlate well with poor vascularity of the femoral heads. No AVN was seen in any of Type A (13/31) or Type B (eight out of 31). Five cases showed AVN and all of them were of Type C dynamic curves.


Dynamic MRI is a reliable tool to evaluate vascularity of femoral heads and thus reduces the uncertainty of outcome of treatment of ICFNFs. DMRI can be a useful tool to formulate a treatment algorithm in management of ICFNF.


Intracapsular femoral neck fractures Avascular necrosis Dynamic magnetic resonance imaging 


  1. 1.
    Shah AK, Eissler J, Radomisli T. Algorithms for the treatment of femoral neck fractures. Clin Orthop. 2002; 399: 28–34.PubMedCrossRefGoogle Scholar
  2. 2.
    Konishiike T, Makihata E, Tago T, Sato T, Inoue H. Acute fracture of the neck of the femur: an assessment of perfusion of the head by dynamic MRI. J Bone Joint Surg. 1999; 81B: 596–599.CrossRefGoogle Scholar
  3. 3.
    Garden RS. Mal-reduction and avascular necrosis in sub-capital fractures of femoral neck. J Bone Joint Surg. 1971; 53B: 183–197.Google Scholar
  4. 4.
    Gόmez-Castresana FB, Caballer AP, Portal LF. Avascular necrosis of femoral head after femoral neck fracture. Clin Orthop. 2002; 399: 87–109.CrossRefGoogle Scholar
  5. 5.
    Ficat RP. Idiopathic bone necrosis of femoral head: early diagnosis and management. J Bone Joint Surg. 1985; 67B: 3–9.Google Scholar
  6. 6.
    Gerber C, Strehle J, Ganz R. The treatment of femoral neck fractures. Clin Orthop. 1993; 292: 77–86.PubMedGoogle Scholar
  7. 7.
    Kokubo T, Takatori Y. Magnetic resonance imaging and scintigraphy of avascular necrosis of femoral head: prediction of subsequent segmental collapse. Clin Orthop. 1992; 277: 54–60.PubMedGoogle Scholar
  8. 8.
    Speer KP, Spritzer CE, Harrelson JM, et al. Magnetic resonance imaging of the femoral head after acute intracapsular acute intracapsular fracture of the femoral neck. J Bone Joint Surg. 1990; 72A: 98–103.Google Scholar
  9. 9.
    Woodhouse CF. Tetracycline vascular maps of the femoral heads. J Bone Joint Surg. 1962; 44A: 1029–1034.Google Scholar
  10. 10.
    Nadel SN, Debatin JF, Richardson WJ, et al. Detection of acute avascular necrosis of the femoral head in dogs: dynamic contrast-enhanced MR imaging vs spin-echo and STIR sequences. Am J Roentgenol. 1992; 159(6): 1255–1261.Google Scholar
  11. 11.
    Garden RS. The structure and function of the proximal end of femur. J Bone Joint Surg. 1961; 43: 576–589.Google Scholar

Copyright information

© ISS 2009

Authors and Affiliations

  • Abhishek Kaushik
    • 1
  • Balu Sankaran
    • 2
  • Mathew Varghese
    • 1
  1. 1.Department of OrthopaedicsSt Stephen’s HospitalDelhiIndia
  2. 2.St Stephen’s HospitalDelhiIndia

Personalised recommendations