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Published on: March 11, 2017
Identifying Patients Who Will Most Benefit from Single Photon Emission Computerized Tomography and Computerized
Wenshuai Fan1, Liang Zhu1, Jifei Chen1
1Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China (mainland).
Insights
Single photon emission computerized tomography and computerized tomography (SPECT/CT) can assess femoral head blood supply after hip fracture. This imaging is most beneficial for elderly patients with displaced fractures within 10 days of injury.
Area of Science:
- Orthopedic Surgery
- Radiology
- Medical Imaging
Background:
- Assessing femoral head blood supply after femoral neck fracture is crucial for treatment.
- Single photon emission computerized tomography and computerized tomography (SPECT/CT) is a valuable tool for this assessment.
- However, routine SPECT/CT use in all patients is not feasible, necessitating identification of specific patient groups.
Purpose of the Study:
- To identify patient subgroups who would most benefit from SPECT/CT examination for femoral neck fractures.
- To determine factors influencing femoral head blood supply after fracture.
Main Methods:
- A decision tree model (C 5.0) was employed.
- Sixty-five patients with unilateral femoral neck fractures treated with closed reduction and internal fixation were analyzed.
- The Fracture/Normal (F/N) ratio was used to reflect femoral head blood supply.
Main Results:
- Fracture type, specifically displacement, was the strongest predictor of the F/N ratio.
- Patient age and time from injury to examination also correlated with blood supply.
- SPECT/CT is most beneficial for displaced fractures in patients over 58 years old, examined within 10 days of injury.
Conclusions:
- Elderly patients with displaced femoral neck fractures are the primary candidates for SPECT/CT.
- SPECT/CT provides timely assessment of femoral head blood supply in this high-risk group.
Abstract:
BACKGROUND Single photon emission computerized tomography and computerized tomography (SPECT/CT) is useful for assessing blood supply within the femoral head after femoral neck fracture, but its use in all femoral neck fracture patients is not feasible. Therefore, the present study aimed to identify the patients for whom SPECT/CT examination will be most beneficial. MATERIAL AND METHODS Sixty-five patients with a unilateral femoral neck fracture who underwent SPECT/CT examination of the hip and were treated via closed reduction and internal fixation with three screws were enrolled between January 2009 and March 2011. A decision tree model (C 5.0) was used to identify the factors that best reflect blood supply and to build a flowchart for identifying patients who would benefit from SPECT/CT. RESULTS Fracture type was most strongly associated with the Fracture/Normal (F/N) ratio, which reflects the blood supply to the fractured femoral head. Age and the time interval from injury to examination were also associated with the F/N ratio. SPECT/CT examination is most beneficial for patients with a displaced fracture, especially if they are over 58 years old and the time interval from injury to examination is less than 10 days. CONCLUSIONS Our results indicate that elderly people with a displaced fracture are most likely to benefit from SPECT/CT examination, which can show the blood supply to the femoral head within a relatively short window of time after the injury.
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