1
|
Zhou X, Guo S, Pan W, Zhang L, Ji H, Yang Y. The small screw-apex distance is potentially associated with femoral head osteonecrosis in adults with femoral neck fractures treated by closed reduction and percutaneous 3 parallel cannulated screws. BMC Musculoskelet Disord 2024; 25:286. [PMID: 38614975 PMCID: PMC11015589 DOI: 10.1186/s12891-024-07380-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/22/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVE Femoral neck fractures (FNFs) are among the most common fractures in elderly individuals. Surgery is the main treatment for FNFs, and osteonecrosis of the femoral head (ONFH) is one of the unacceptable complications. This study aimed to assess both the clinical and radiological outcomes in patients with FNFs treated with three parallel cannulated screws and to identify relationship between screws position and ONFH. PATIENTS AND METHODS A total of 100 patients who were treated with closed reduction and fixed with 3 parallel cannulated screws met the inclusion criteria between January 2014 and December 2020 at authors' institution. The follow-up duration, age, sex, affected side, and injury-to-surgery interval were collected; the neck-shaft angle of both hips, screw-apex distance (SAD) and the tip-apex distance (TAD)were measured; and the Garden classification, quality of reduction and presence of ONFH were evaluated. RESULTS The sample consisted of 37 males and 63 females, with 60 left and 40 right hips affected. The mean age of patients was 54.93 ± 12.24 years, and the mean follow-up was 56.3 ± 13.38 months. The overall incidence of ONFH was 13%. No significant difference was observed in the incidence of ONFH by affected side, age, fracture displacement, injury-to-surgery interval, neck-shaft angle deviation, or reduction quality. The SAD was significantly shorter in ONFH patients than in normal patients for all three screws (p = 0.02, 0.02, and 0.01, respectively). CONCLUSIONS The short SAD of all screws is associated with femoral head necrosis of FNFs treated with 3 cannulated screws. The short SAD indicated that screws malpositioning in the weight-bearing area of the femoral head, potentially harming the blood supply and compromising the anchorage of the primary compressive trabeculae in this region.
Collapse
Affiliation(s)
- Xiaoxiao Zhou
- Department of Orthopedics, Jiangwan Hospital of Hongkou District of Shanghai, Shanghai, China
| | - Shengyang Guo
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Wenjun Pan
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No. 150 Ximen Street, Linhai City, 317000, Zhejiang Province, China
| | - Linyuan Zhang
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Houlin Ji
- Jinji Lake Community Health Service Center of Suzhou Industrial Park, Jiangsu, 215000, China
| | - Yang Yang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No. 150 Ximen Street, Linhai City, 317000, Zhejiang Province, China.
| |
Collapse
|
2
|
Gondim Teixeira PA, Dubois L, Hossu G, Gillet R, Badr S, Cotten A, Blum A. Quantitative dynamic contrast-enhanced MRI of bone marrow perfusion at the proximal femur: influence of femoral head osteonecrosis risk factor and overt osteonecrosis. Eur Radiol 2023; 33:2340-2349. [PMID: 36394602 DOI: 10.1007/s00330-022-09250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/23/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the MRI perfusion changes in patients with risk factors for osteonecrosis and normally appearing femoral heads prior to overt femoral head osteonecrosis. METHODS Fifty-eight patients (105 hips) were prospectively included in this ethics committee-approved study. There were 46 hips with no image anomalies and no risk factors for osteonecrosis of the femoral head (ONFH) risk factors, 38 with ONFH risk factors and no image abnormalities, and 21 with overt ONFH. All patients underwent DCE-MRI. Semi-quantitative (peak enhancement [PE], area under the curve [AUC], time to maximum enhancement [TME]) and quantitative perfusion parameters (volume plasma, KTRANS, and KEP) were calculated. Excessive alcohol consumption, corticosteroid use, and trauma were considered major risk factors for osteonecrosis of the femoral head. RESULTS Measured at the femoral neck and compared to the healthy hips without OFNH risk factors, PE was significantly lower in the hips of patients with OFNH risk factors. Moreover, the difference was greater in females with risk factors, who presented significantly lower PE values (p = 0.0096). A PE threshold of 1.4% yielded a 92% sensitivity and 54% specificity for the presence of associated ONFH risk factors. The hips with overt OFNH compared to those with normally appearing showed an increase of PE of 45% in the neck (p < 0.014). Various epiphyseal femoral head perfusion parameters (PE, TME, AUC, and Ktrans) presented statistically significant differences in hips with ONFH and those without (p < 0.0001). CONCLUSION DCE-MRI can identify perfusion marrow changes related to the presence of ONFH risk factors and adjacent to osteonecrosis areas. KEY POINTS • Bone marrow perfusion changes may occur prior to overt ONFH and extend beyond the osteonecrosis area to the entire femoral head and neck. • Peak enhancement values were significantly reduced in patients with ONFH risk factors, compared to those without. • The presence of ONFH led to a significant increase in marrow perfusion adjacent to the osteonecrosis area.
Collapse
Affiliation(s)
- Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France. .,Université de Lorraine, Inserm, IADI, F-54000, Nancy, France.
| | - Lauriane Dubois
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
| | - Gabriela Hossu
- Université de Lorraine, Inserm, IADI, F-54000, Nancy, France
| | - Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
| | - Sammy Badr
- CHU Lille, Department of Radiology and Musculoskeletal Imaging, Centre de Consultations et Imagerie de l'Appareil Locomoteur, F-59000, Lille, France
| | - Anne Cotten
- CHU Lille, Department of Radiology and Musculoskeletal Imaging, Centre de Consultations et Imagerie de l'Appareil Locomoteur, F-59000, Lille, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
| |
Collapse
|
3
|
Pascart T, Falgayrac G, Cortet B, Paccou J, Bleuse M, Coursier R, Putman S, Quinchon JF, Bertheaume N, Delattre J, Marchandise P, Cultot A, Norberciak L, Kerckhofs G, Budzik JF. Subchondral involvement in osteonecrosis of the femoral head: insight on local composition, microstructure and vascularization. Osteoarthritis Cartilage 2022; 30:1103-1115. [PMID: 35568111 DOI: 10.1016/j.joca.2022.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine changes of subchondral bone composition, micro-structure, bone marrow adiposity and micro-vascular perfusion in end-stage osteonecrosis of the femoral head (ONFH) compared to osteoarthritis (OA) using a combined in vivo and ex vivo approach. DESIGN Male patients up to 70 years old referred for total hip replacement surgery for end-stage ONFH were included (n = 14). Fifteen patients with OA were controls. Pre-operative MRI was used to assess bone perfusion (dynamic contrast-enhanced (DCE) sequences) and marrow fat content (chemical shift imaging). Three distinct zones of femoral head subchondral bone - necrotic, sclerotic, distant - were compared between groups. After surgery, plugs were sampled in these zones and Raman spectroscopy was applied to characterize bone mineral and organic components (old and newly-formed), and contrast-enhanced micro-computed tomography (CE-μCT) to determine bone micro-structural parameters and volume of bone marrow adipocytes, using conventional 2D histology as a reference. RESULTS In the necrotic zone of ONFH patients compared to OA patients: 1) the subchondral plate did not exhibit significant changes in composition nor structure; 2) the volume fraction of subchondral trabecular bone was significantly lower; 3) type-B carbonate substitution was less pronounced, 4) collagen maturity was more pronounced; and 5) bone marrow adipocytes were significantly depleted. The sclerotic zone from the ONFH group showed greater trabecular thickness, and higher DCE-MRI AUC and Ktrans. Volume fraction of subchondral bone, trabecular number, and Kep were significantly lower in the distant zone of the ONFH group. CONCLUSIONS This study demonstrated alterations of subchondral bone microstructure, composition, perfusion and/or adipose content in all zones of the femoral head.
Collapse
Affiliation(s)
- T Pascart
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France; Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France.
| | - G Falgayrac
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France
| | - B Cortet
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR 4490, Department of Rheumatology, 59000 Lille, France
| | - J Paccou
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR 4490, Department of Rheumatology, 59000 Lille, France
| | - M Bleuse
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France
| | - R Coursier
- Department of Orthopaedic Surgery, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - S Putman
- Department of Orthopaedic Surgery, CHU Lille, Lille University, Lille, France
| | - J-F Quinchon
- Department of Anatomopathology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - N Bertheaume
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France
| | - J Delattre
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France
| | - P Marchandise
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France
| | - A Cultot
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - L Norberciak
- Department of Research, Biostatistics, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - G Kerckhofs
- Biomechanics Lab - Institute of Mechanics, Materials, and Civil Engineering, Louvain-la-Neuve, UCLouvain, Belgium; IREC - Institute of Experimental and Clinical Research, UCLouvain, Woluwe, Belgium; Department Materials Engineering, Leuven, KU Leuven, Belgium; Prometheus, Division for Skeletal Tissue Engineering, Leuven, KU Leuven, Belgium
| | - J-F Budzik
- Univ. Lille, CHU Lille, Univ. Littoral Côte D'Opale, ULR 4490 - MABLab- Adiposité Médullaire et Os, F-59000 Lille, France; Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| |
Collapse
|
4
|
Cultot A, Norberciak L, Coursier R, Putman S, Cortet B, Paccou J, Pascart T, Budzik JF. BONE PERFUSION AND ADIPOSITY BEYOND THE NECROTIC ZONE IN FEMORAL HEAD OSTEONECROSIS: A QUANTITATIVE MRI STUDY. Eur J Radiol 2020; 131:109206. [PMID: 32871293 DOI: 10.1016/j.ejrad.2020.109206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/29/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe bone perfusion and adiposity beyond the necrotic zone with quantitative MRI techniques in osteonecrosis of the femoral head (ONFH). METHOD In this cross-sectional multicentre study, we recruited patients suffering from late-stage ONFH or hip osteoarthritis. Hip MRI included quantitative MRI sequences: chemical-shift imaging and dynamic contrast-enhanced MRI. We drew regions of interest inside the necrotic zone (inner necrosis and its border) and outside (femoral head, neck and greater trochanter) in ONFH. In the control group, regions of interest were drawn in the femoral head, femoral neck and the greater trochanter. For each region of interest, we measured fat fraction, and calculated semi-quantitative (area under the curve, initial slope) and pharmacokinetic perfusion parameters (Ktrans and Kep). RESULTS Thirty-two male adults (mean age 58 ± 9 years, range 38-74 years) were included. Sixteen patients formed the ONFH group and fifteen the control group; one was excluded. In the normal-appearing non-necrotic part of the femoral head, fat fraction was not significantly different in comparison with controls (p = 1), but Ktrans was significantly lower than in controls (0.012 ± 0.018 vs. 0.027 ± 0.045; p = 0.05). This perfusion parameter reflects exchanges between blood microvessels and bone marrow. CONCLUSIONS Our results question the concept of adipose toxicity on the macroscopic scale, and bring up the concept of regional ischemic penumbra that goes beyond the visible necrotic zone. Further studies are required to test these hypotheses in larger populations and earlier disease states.
Collapse
Affiliation(s)
- Aurélie Cultot
- Diagnostic and interventional imaging department, Lille Catholic University Hospital Group, Lille, France.
| | - Laurène Norberciak
- Biostatistics, Clinical research department, Lille Catholic University Hospital Group, Lille, France.
| | - Raphaël Coursier
- Orthopaedic surgery department, Lille Catholic University Hospital Group, Lille, France.
| | - Sophie Putman
- Orthopaedic surgery department, Roger Salengro hospital, Lille University Hospital, France.
| | - Bernard Cortet
- Rheumatology department, Roger Salengro hospital, Lille University Hospital, France; UR 4490 - PMOI - PMOI (Physiopathologie des Maladies Osseuses Inflammatoires)/MABLab (Marrow Adiposity and Bone Laboratory), Lille, France.
| | - Julien Paccou
- Rheumatology department, Roger Salengro hospital, Lille University Hospital, France; UR 4490 - PMOI - PMOI (Physiopathologie des Maladies Osseuses Inflammatoires)/MABLab (Marrow Adiposity and Bone Laboratory), Lille, France.
| | - Tristan Pascart
- UR 4490 - PMOI - PMOI (Physiopathologie des Maladies Osseuses Inflammatoires)/MABLab (Marrow Adiposity and Bone Laboratory), Lille, France; Rheumatology department, Lille Catholic University Hospital Group, Lille, France.
| | - Jean-François Budzik
- Diagnostic and interventional imaging department, Lille Catholic University Hospital Group, Lille, France; UR 4490 - PMOI - PMOI (Physiopathologie des Maladies Osseuses Inflammatoires)/MABLab (Marrow Adiposity and Bone Laboratory), Lille, France.
| |
Collapse
|
5
|
Proximal femur fat fraction variation in healthy subjects using chemical shift-encoding based MRI. Sci Rep 2019; 9:20212. [PMID: 31882855 PMCID: PMC6934523 DOI: 10.1038/s41598-019-56611-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/10/2019] [Indexed: 12/11/2022] Open
Abstract
The objective of this study was to describe the normal variation of bone marrow fat content in the proximal femur considering the influence of side, age, sex and body mass index using fat fraction MRI. From September 2012 to July 2016, the MRI of 131 patients (258 hips) considered to have a normal MRI appearance were retrospectively evaluated. Patient records were searched to allow calculation of the body mass index (BMI). Water-fat based chemical shift MRI was available for all patients included. Proton density fat fraction maps were calculated, and measurements were performed in the femoral epiphysis, intertrochanteric region, and greater trochanter. The influence of patient age, sex, hip side and BMI on fat fraction values was assessed. Fat fraction was significantly different in the different locations evaluated (P = 0.0001). Patient sex and age significantly influenced fat fraction values in all regions evaluated (P < 0.02) with the exception of the epiphysis for sex (p = 0.07). In all locations, PDFF values were higher in men compared to women (3.3%, 4.4% and 13.1% higher in the epiphysis, greater trochanter and intertrochanteric region respectively). The intertrochanteric region presented the lowest fat fraction values with the highest variation compared to the greater trochanter and the epiphysis. BMI only influenced fat fraction values in the intertrochanteric region of females over 42 years old (P = 0.014). The interobserver variability of the measurements performed was considered to be excellent (ICC = 0.968). In conclusion, patient sex, age, and measurement location significantly influenced fat fraction values indicating that specific standards of reference are needed depending on these factors.
Collapse
|
6
|
Li X, Johnson CP, Ellermann J. 7T bone perfusion imaging of the knee using arterial spin labeling MRI. Magn Reson Med 2019; 83:1577-1586. [PMID: 31872919 DOI: 10.1002/mrm.28142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/06/2019] [Accepted: 12/02/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate the feasibility of arterial spin labeling (ASL) imaging of epiphyseal bone marrow in the distal femoral condyle of the knee at 7T MRI. METHODS The knees of 7 healthy volunteers were imaged with ASL using a 7T whole body MRI scanner and a 28-channel knee coil. ASL imaging used a flow-sensitive alternating inversion recovery method for labeling and a single-shot fast spin echo sequence for image readout. ASL imaging with a single oblique transverse slice was performed at 2 slice positions in the distal femoral condyle. Blood flow was measured in 2 regions of interest: the epiphyseal bone marrow and the overlying patellofemoral cartilage. To analyze perfusion SNR, 200 noise images were also acquired using the same ASL imaging protocol with RF pulses turned off. RESULTS Knee bone marrow perfusion imaging was successfully performed with all volunteers. The overall mean of blood flow in the knee bone marrow was 32.90 ± 2.41 mL/100 g/min, and the blood flow was higher at the more distal slice position. We observed significant B0 and B 1 + inhomogeneities, which need to be addressed in the future to improve the quality of ASL imaging and increase the reliability of knee bone marrow perfusion measurements. CONCLUSION Bone marrow perfusion imaging of the distal femoral condyle is feasible using ASL at 7T. Further technical development is needed to improve the ASL method to overcome existing challenges.
Collapse
Affiliation(s)
- Xiufeng Li
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota
| | - Casey P Johnson
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota
| | - Jutta Ellermann
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|