PURPOSE To determine the value of bone scintigraphy in predicting avascular necrosis following femoral neck fracture, and to analyze of relationship between pintract sign (increased radioactivity along the pins) and avascular necrosis after multiple pinning of femoral neck fracture. MATERIALS AND METHODS We analyzed 20 femoral neck fractures, which were fixed with cannulated screws(14 cases) or Knowles pins(6 cases). The follow-up period was longer than 18 months, and bone scintigraphy was carried out at postoperative 3 weeks, 3 months interval to 1 year, 6 months interval to 2 years, and then every 1 year. RESULTS There were 14 cases with positive pin-tract sign and increased uptake of femoral head on bone scintigraphy performed at the postoperative 3 weeks, and I case with positive pin-tract sign and partially decreased uptake of femoral head. None of them developed avascular necrosis. There was I case with negative pin-tract sign and partially decreased uptake of femoral head, which showed increased uptake later and didn't develop avascular necrosis. There were 4 cases with negative pin-tract sign and generally decreased uptake of the femoral head, and all of them developed avascular necrosis. CONCLUSION Bone scintigraphy is a useful method predicting the avascular necrosis following femoral neck fracture, and pin-tract sign may be an early postoperative sign indicating that there is little possibility of development of avascular necrosis.
PURPOSE To evaluate the effectiveness of bone scintigraphy using 99mTc-methylene diphosphonate(99mTc-MDP) for prediction of viability of femoral head in femur neck fracture that have been treated with osteosynthesis. MATERIALS AND METHOD Thirty two patients were included in this study who underwent preoperative and postoperative bone scintigraphy using 99mTc-MDP following femur neck fracture. The uptake of istope was estimated visually as either normal or reduced compared with the opposite side. The complications as avascular necrosis and non-union were checked and compared with the preoperative and postoperative bone scintigraphy and the predictive values of positive and negative scintigraphy were calculated. RESULTS Among thirty-two patients, bone union occured in nineteen patients except 12 avascular necrosis and 1 non-union. Average bone union peried was 4.4 months and 50% was occured between 3 and 6 months. In seventeen patients who showed reduced isotope uptake, twelve patients developed complications and predictive value of positive scintigraphy was calculated as 0.76. In fifteen patients shown normal isotope uptake, none developed complications and predictive value of negative scintigraphy was calculated as 1.00. CONCLUSION Preoperative bone scintigraphy using 99mTc-MDP was useful method to evaluate the viability of femoral head following femur neck fracture and to choose the treatment modality of displaced femur neck fracture especially in elderly person.
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Bipolar Hemiarthroplasty for the Femoral Neck Fractures in Elderly Patients Woong-Kyo Jeong, Sang-Won Park, Soon-Hyuck Lee, Jong-Hoon Park, Suk-Ha Lee, Ji-Hoon Kang, Gi-Won Choi, Won Noh Journal of the Korean Fracture Society.2008; 21(1): 8. CrossRef