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Predictive value of single photon emission computerized tomography and computerized tomography in osteonecrosis after femoral neck fracture: a prospective study

International Orthopaedics volume 39, pages 1417–1422 (2015)Cite this article

Abstract

Purpose

Osteonecrosis of the femoral head (ONFH) is a very common complication after femoral neck fracture. The purpose of this study was to assess the femoral head vascularity after femoral neck fracture using single photon emission computerized tomography and computerized tomography (SPECT/CT), and to evaluate its value in predicting ONFH.

Methods

Between January 2008 and March 2011, 120 patients diagnosed with femoral neck fracture underwent SPECT-CT before the internal fixation. The fracture was classified according to the Garden classification. The ratios of the radionuclide uptake of the fractured femoral head to that of the contralateral femoral head (F/N) were calculated to assess the femoral head vascularity. After a minimum of two years’ follow-up, magnetic resonance imaging (MRI) was used as the “gold standard” for the diagnosis of possible ONFH.

Results

A total of 114 patients completed the study. The SPECT/CT examination showed that the F/N ratios of Garden I, II, III and IV were 2.6, 1.8, 0.8, and 0.6, respectively. At the time of the most recent follow-up, osteonecrosis developed in two of the 27 patients who had a Garden Stage-II fracture, in eight of the 34 patients who had a Garden Stage-III fracture, and nine of the 27 patients who had a Garden Stage-VI fracture. With a cutoff of 0.55 from the receiver operating characteristic (ROC) curve, F/N ratio showed a sensitivity of 97 %, a specificity of 79 %, a positive predictive value of 95 %, and a negative predictive value of 19 %.

Conclusion

SPECT-CT proved to be reliable and valid for predicting ONFH after femoral neck fracture.

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Conflicts of interest

This study was supported by The National Natural Science Foundation of China (No. 81371966) and International Cooperation Project of Shanghai Science and Technology Committee (No. 12410710200)

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Author notes

    Affiliations

    1. Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China

      Heng-feng Yuan, Feng Shen, Jing Zhang & Zuo-qin Yan

    2. Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China

      Hong-cheng Shi & Yu-shen Gu

    Authors
    1. Heng-feng Yuan
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    2. Feng Shen
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    3. Jing Zhang
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    4. Hong-cheng Shi
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    Corresponding author

    Correspondence to Zuo-qin Yan.

    Additional information

    Heng-feng Yuan and Feng Shen contributed equally to this work

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    Cite this article

    Yuan, Hf., Shen, F., Zhang, J. et al. Predictive value of single photon emission computerized tomography and computerized tomography in osteonecrosis after femoral neck fracture: a prospective study. International Orthopaedics (SICOT) 39, 1417–1422 (2015). https://doi.org/10.1007/s00264-015-2709-7

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    • DOI: https://doi.org/10.1007/s00264-015-2709-7

    Keywords

    • SPECT-CT
    • Femoral neck fracture
    • Avascular necrosis
    • Prediction