Table 3 Methods to predict osteonecrosis of femoral head (ONFH) after femoral neck fracture (FNF)
Prediction method | Advantages | Disadvantages |
|---|---|---|
Radiographic imaging | ||
Superselective angiography | Direct vascular visualization | Invasive examination, arterial dissection, thrombosis, and hematoma formation |
SPECT/CT | Noninvasive, unaffected by metal implants, and high sensitivity | Poor specificity, long time for examination, subjective judgment |
Dynamic enhanced MRI | Noninvasive, easy to operate | No consensus on the risk factors of ONFH |
Micro-CT | Noninvasive, high specificity and sensitivity | Expensive, inappropriate to be applied in patients with metal fixators, renal dysfunction, or claustrophobia |
Artificial intelligence | ||
Prediction model | Femoral head intraosseous arteries visualization, highly accurate quantification | Insufficient clinical evidence |
Intraoperative methods | ||
Femoral head drilling | Simple, convenient | Subjective judgment, many confounding factors |
Osteoscopy | Direct | Hard to quantify, invasive |
Intramedullary oxygen tension | Simple | Insufficient clinical evidence, invasive |
Doppler-laser flowmetry | Direct | Costly, insufficient clinical evidence, invasive |
Bleeding from the holes of proximal cannulated screws | Simple, convenient | Subjective judgment |
Intraosseous pressure | Easy to operate | Insufficient clinical evidence, invasive |