Intraoperative assessment of femoral head vascularity after femoral neck fracture.
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.
Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
T J
TJ
Gill
J B
JB
Sledge
A
A
Ekkernkamp
R
R
Ganz
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D002648:Child; D005265:Femoral Neck Fractures / Q000150:complications / Q000473:pathology* / Q000601:surgery; D005270:Femur Head / Q000098:blood supply*; D005271:Femur Head Necrosis / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D005593:Fracture Fixation, Internal; D006801:Humans; D007432:Intraoperative Period; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies