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Intraoperative assessment of femoral head vascularity after femoral neck fracture. 1998

T J Gill, and J B Sledge, and A Ekkernkamp, and R Ganz
Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.

OBJECTIVE To develop an intraoperative technique to predict the development of avascular necrosis after internal fixation of femoral neck fractures. METHODS Prospective study. METHODS All patients were treated at the same hospital. METHODS Sixty-four patients who presented for internal fixation of a femoral neck fracture were enrolled in the study. METHODS A 2.0-millimeter drill was used to assess the presence and character of bleeding from the femoral head at open reduction and internal fixation of a femoral neck fracture. METHODS Patients were evaluated postoperatively by history, examination, and roentgenography for the development of avascular necrosis of the femoral head fragment. A minimum two-year follow-up with radiography was required for entry into the study, with an average follow-up of 3.2 years. RESULTS None of the fifty-six patients with bleeding from the drill holes in the femoral head fragment developed avascular necrosis. Eight of eight patients with no bleeding after reduction developed avascular necrosis. There were no infections or nonunions. CONCLUSIONS Intraoperative drilling of the femoral head is a highly sensitive and specific predictor for the development of avascular necrosis after femoral neck fractures.

UI MeSH Term Description Entries
D007432 Intraoperative Period The period during a surgical operation. Intraoperative Periods,Period, Intraoperative,Periods, Intraoperative
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D011237 Predictive Value of Tests In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e., has the disease), is referred to as the predictive value of a positive test; whereas, the predictive value of a negative test is the probability that the person with a negative test does not have the disease. Predictive value is related to the sensitivity and specificity of the test. Negative Predictive Value,Positive Predictive Value,Predictive Value Of Test,Predictive Values Of Tests,Negative Predictive Values,Positive Predictive Values,Predictive Value, Negative,Predictive Value, Positive
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D001863 Bone Screws Specialized devices used in ORTHOPEDIC SURGERY to repair bone fractures. Bone Screw,Screw, Bone,Screws, Bone
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D005265 Femoral Neck Fractures Fractures of the short, constricted portion of the thigh bone between the femur head and the trochanters. It excludes intertrochanteric fractures which are HIP FRACTURES. Femur Neck Fractures,Femoral Neck Fracture,Femur Neck Fracture
D005270 Femur Head The hemispheric articular surface at the upper extremity of the thigh bone. (Stedman, 26th ed) Femoral Head,Femoral Heads,Femur Heads,Head, Femoral,Head, Femur

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