Earlier studies on femoral neck fractures have assessed the blood flow in either the pre- or postoperative period and information is lacking regarding changes in vascular flow to the femoral head after injury. Sixty-two adults with low-energy intracapsular femoral neck fractures were studied prospectively. Mean patient age was 57.2 years (range, 45-82 years). All patients underwent positron emission tomography/computed tomography (PET/CT) prior to surgical intervention and 6 weeks after internal fixation. Internal fixation was done using cannulated cancellous titanium screws and serial follow-up radiographs were obtained (at monthly intervals for the first 3 months followed by 3 monthly intervals between radiographs up to 2 years). On the preoperative PET/CT, 13 patients showed intact vascularity, 31 showed total loss of vascularity, and 18 showed partial loss of vascularity of the femoral head. The 6-week postoperative PET/CT scan showed recovery of blood supply in 23 of the 31 patients with total loss of vascularity and 15 of the 18 patients with partial loss of vascularity of the femoral head. Eleven of 62 patients had total or partial avascularity at the 6-week postoperative PET/CT scan and all 11 patients showed evidence of avascular necrosis on plain radiographs at the end of 2 years. The association between the vascular status of the femoral head at 6 weeks and avascular necrosis at the end of 2 years was statistically significant (P<.001). This study shows that the femoral head undergoes temporal variations in blood flow following femoral neck fracture. Decreased or absent vascularity is seen in approximately 75% of the fractures and 80% of the femoral heads with initial vascular compromise seem to regain blood flow within 6 weeks. Thus, prognostication about vascularity based on single-point preoperative imaging is difficult. The 6-week postoperative PET/CT scan seems to be reliable in predicting the future status of the femoral head. However, decision making regarding hemiarthroplasty or internal fixation at the time of injury may have to depend on factors other than the preoperative vascular status of the femoral head.

(1) Background: This cross-sectional study aims to highlight the assessment and foot care practices in an advanced clinical setting, the clinical characteristics of the patients, and to understand the barriers and facilitators for effective foot care from the perspectives of healthcare practices, resources, and patients’ socioeconomic and cultural practices, and other aspects in terms of new technologies for effective foot care such as infrared thermography. (2) Methods: Clinical test data from 158 diabetic patients and a questionnaire to assess the foot care education retention rate were collected at the Karnataka Institute of Endocrinology and Research (KIER) facility. (3) Results: Diabetic foot ulcers (DFUs) were found in 6% of the examined individuals. Male patients were more likely to have diabetes complications, with an odds ratio (OR) of 1.18 (CI = 0.49–2.84). Other diabetes problems raised the likelihood of DFUs by OR 5 (CI = 1.40–17.77). The constraints include socioeconomic position, employment conditions, religious customs, time and cost, and medication non-adherence. The attitude of podiatrists and nurses, diabetic foot education, and awareness protocols and amenities at the facility were all facilitators. (4) Conclusions: Most diabetic foot complications might be avoided with foot care education, regular foot assessments as the standard of treatment, and self-care as a preventive/therapeutic strategy.

Purpose The aim of this study was to use positron emission tomography-computed tomography (PET-CT) imaging as a tool for assessment of viability of femoral head in acetabular fractures and help in early detection of complications like avascular necrosis (AVN) of the femoral head. Methods In our study PET-CT was done pre-operatively and six weeks postoperatively in 31 patients who underwent open reduction and internal fixation (ORIF) of acetabular fractures and fracture-dislocations. There were 26 male and five female patients who were treated in our institute between January 2009 and July 2010. Patients were subsequently followed up with plain radiographs for a mean period of 3.8 years and minimum of two years. Results Although seven out of 31 patients showed avascularity of the femoral head on PET-CT in the pre-operative period, only two patients progressed to AVN at final follow up, whereas the other five patients regained the vascularity at the end of six weeks. There was no statistically significant correlation between vascular status on pre-operative scan and the presence of AVN on final follow-up radiograph. There was a significant correlation between avascularity of the femoral head on the sixth week PET-CT and AVN in the final radiograph. Conclusion PET-CT seems to be useful as a prognostic investigation in the assessment of the vascular status of the femoral head following injuries around the hip. Both pre-operative and postoperative imaging are necessary to understand the timedependent changes in blood flow following injury.

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