A Predictive Method for Subsequent Avascular Necrosis of the Femoral Head (AVNFH) by Observation of Bleeding From the Cannulated Screw Used for Fixation of Intracapsular Femoral Neck Fractures

Abstract

It seems that bleeding from the holes of proximal cannulated screws is a simple and accurate perfusion assessment technique for predicting the development of AVNFH after a femoral neck fracture. Given that assumption, primary arthroplasty might be an appropriate choice as a treatment method in a nonbleeding-group patient whose treatment choice is ambivalent or who might not be able to undergo additional surgery should he or she develop a subsequent AVNFH after internal fixation of femoral neck fracture.

Risk Stratification for Avascular Necrosis of the Femoral Head After Internal Fixation of Femoral Neck Fractures by Post-Operative Bone SPECT/CT

“…The time interval from injury to surgery was not significantly related to AVN of the femoral head in our study. A few previous studies reported that early surgical treatment is associated with a decreased incidence of AVN [35][36][37], whereas other studies found no significant relationship between the time interval and AVN [27,[38][39][40]. Our results show that transient perfusion defects of the femoral head followed by revascularization in the immediate postoperative period do not cause AVN.…”

Osteoscopy for Assessment of Blood Supply to the Femoral Head

“…11 Additionally, these techniques often do not provide such detailed and accurate information as the intraoperative techniques, which albeit invasive, have been preferred and used recently. 11,12,21 A major limitation of the intraoperative invasive techniques, however, is that assessment of vascularity in the femoral head is often not sufficiently quantitative for routine clinical use. 21 In view of these findings, the aim of our study was to develop a minimally invasive endoscopic procedure capable of accurately and quantitatively assessing arterial circulation to the femoral head at the time of definitive surgery.…”

“…Thus, a viable femoral head can be successfully maintained by osteosynthesis, whereas in the absence of proper blood supply to the femoral head, the proposed treatment is an arthroplasty. [11][12][13][14][15] The accurate assessment of femoral head circulation is helpful when deciding the most effective treatment in the case of femoral neck fracture. [11][12][13]16,17 Although bone imaging techniques, including scintigraphy and magnetic resonance imaging, have been used by some investigators to determine the blood supply available to the femoral head before surgery, [18][19][20] these techniques have not been successful.…”

“…[11][12][13][14][15] The accurate assessment of femoral head circulation is helpful when deciding the most effective treatment in the case of femoral neck fracture. [11][12][13]16,17 Although bone imaging techniques, including scintigraphy and magnetic resonance imaging, have been used by some investigators to determine the blood supply available to the femoral head before surgery, [18][19][20] these techniques have not been successful. 11 Additionally, these techniques often do not provide such detailed and accurate information as the intraoperative techniques, which albeit invasive, have been preferred and used recently.…”

A Study of Internal Fixation of Intracapsular Fracture Neck of Femur in Adults by Multiple Cannulated Cancellous Lag Screews

“…(8,9,10) Post-operative: ISO metric quadriceps exercises were advised. Suture removed was done on 10 th post OP day.…”