Skip to main content
SpringerLink
Log in

Quantitative early phase scintigraphy in the prediction of healing of tibial fractures

  • Articles
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Imaging with technetium-99m methylene diphosphonate (99mTc-MDP) is established in the diagnosis of infection, neoplasia and ischaemic necrosis in orthopaedic practice, but its role in fracture healing is less well-defined. Previous studies have shown a relationship between fracture site activity (region A), activity in adjacent normal bone (region C) and time to union. The predictive value of the A/C ratio of the image obtained 300–800 s after injection was assessed in a prospective study of 50 patients with closed tibial fractures managed with plaster casts, external fixators and intramedullary nails. There were significant differences in absolute uptake and A/C ratio between the three groups (P<0.05), but this was not related to time to union. Reamed nailing alters the distribution of 99m-Tc-MDP uptake so as to reduce the A/C ratio (1.10+0.20), but there is a promising role for early phase bone scanning in non-operative (A/C=1.40+0.21) or externally fixed (A/C=1.26+0.22) fractures in conjunction with other non-invasive methods of monitoring the biomechanical environment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Auchincloss JM, Watt I (1982) Scintigraphy in the evaluation of potential fracture healing: a clinical study of tibial fractures. Br J Radiol 55:707

    Google Scholar 

  2. Benirschke SK, Mirels H, Jones DJ, Tencer AF (1991) The use of resonant frequency measurements for the noninvasive assessment of mechanical stiffness of the healing tibia. Trans Orthop Res Soc 37:176

    Google Scholar 

  3. Castronovo FP, Guiberteau MJ, Berg G, McKusick KA, Callahan RJ, Potsaid MS (1977) Pharmacokinetics of technetium-99m diphosphonate. J Nucl Med 18:809

    Google Scholar 

  4. Chao EYS, Aro HT, Lewallen DG, Kelly PJ (1989) The effects of rigidity on fracture healing in external fixation. Clin Orthop 241:24

    Google Scholar 

  5. Cheal EJ, Mansmann KA, DiGioia AM, Hayes WC, Perren SM (1991) Role of interfragmentary strain in fracture healing: ovine model of a healing osteotomy. J Orthop Res 9:131

    Google Scholar 

  6. Court-Brown CM, Christie J, McQueen MM (1990) Closed intramedullary tibial nailing: its use in closed and type I open fractures. J Bone Jt Surg [Br] 72:605–611

    Google Scholar 

  7. Cunningham JL, Evans M, Kenwright J (1989) Measurement of fracture movement in patients treated with unilateral external skeletal fixation. J Biomed Eng 11:118

    Google Scholar 

  8. Einhorn TA, Vigorita VJ, Aaron A (1986) Localization of technetium-99m methylene diphosphonate in bone using microautoradiography. J Orthop Res 4:180

    Google Scholar 

  9. Goodship AE, Kenwright J (1985) The influence of induced micromovement upon the healing of experimental tibial fractures. J Bone Jt Surg [Br] 67:650

    Google Scholar 

  10. Gregg PJ, Barsoum MK, Clayton CB (1983) Scintigraphic appearances of the tibia in the early stages following fracture. Clin Orthop 175:139

    Google Scholar 

  11. Gregg PJ, Clayton CB, Fenwick JD, Ions GK, Miller SWM, Smith SR (1986) Static and sequential dynamic scintigraphy of the tibia following fracture. Injury 17:95

    Google Scholar 

  12. Hammer R, Edholm P, Lindholm B (1984) Stability of union after tibial shaft fracture: analysis by a non-invasive technique. J Bone Jt Surg [Br] 66:529

    Google Scholar 

  13. Hughes S (1980) Radionuclides in orthopaedic surgery. J Bone Jt Surg [Br] 62:141

    Google Scholar 

  14. Hughes SPF, Davies DR, Bassingthwaighte JB, Knox FG, Kelly PJ (1977) Bone extraction and blood clearance of diphosphonate in the dog. Am J Physiol 232:H341

    Google Scholar 

  15. Hughes SPF, Khan R, Davies R, Lavender P (1978) The uptake by the canine tibia of the bone-scanning agent Tc-99m MDP before and after an osteotomy. J Bone Jt Surg [Br] 60:579

    Google Scholar 

  16. Jacobs RR, Jackson RP, Preston DF, Williamson JA, Gallagher J (1981) Dynamic bone scanning in fractures. Injury 12:455

    Google Scholar 

  17. Kay PR, Ross ERS, Powell ES (1989) Development and clinical application of an external fixator monitoring system. J Biomed Eng 11:240

    Google Scholar 

  18. Kessler SB, Hallfeldt KKJ, Perren SM, Schweiberer L (1986) The effects of reaming and intramedullary nailing on fracture healing. Clin Orthop 212:18

    Google Scholar 

  19. Lavender JP, Khan RAA, Hughes SPF (1979) Blood flow and tracer uptake in normal and abnormal canine bone: comparisons with Sr-85 microspheres, Kr-81m, and Tc-99m MDP. J Nucl Med 20:413

    Google Scholar 

  20. McCarthy ID, Hughes SPF (1984) Extraction of Tc-99m methylene diphosphonate as a function of bone blood flow. In: Arlet J, Ficat RP, Hungerford DS (eds) Bone circulation. Williams and Wilkins, Baltimore, p 167

    Google Scholar 

  21. Michel MC, Schneider E, Genge M, Perren SM (1991) Loading history of an interlocking femoral nail subsequent to fracture treatment. Trans Orthop Res Soc 37:141

    Google Scholar 

  22. Nutton RW, Fitzgerald RH, Kelly PJ (1985) Early dynamic bone-imaging as an indicator of osseous blood flow and factors affecting the uptake of Tc-99m hydroxymethylene diphosphonate in healing bone. J Bone Jt Surg [Am] 67:763

    Google Scholar 

  23. Oni OA, Mahabir JP, Iqbal SJ, Gregg PJ (1989) Serum osteocalcin and total alkaline phosphatase as prognostic indicators in tibial shaft fractures. Injury 20:37

    Google Scholar 

  24. Oni OA, Graebe A, Pearse M, Gregg PJ (1989) Prediction of the healing potential of closed adult tibial shaft fractures by bone scintigraphy. Clin Orthop 245:239

    Google Scholar 

  25. Panjabi MM, Walter SD, Karuda M, White AA, Lawson JP (1985) Correlations of radiographic analysis of healing fractures with strength: a statistical analysis of experimental osteotomies. J Orthop Res 3:212–218

    CAS  PubMed  Google Scholar 

  26. Rhinelander FW (1968) The normal microcirculation of diaphyseal cortex and its response to fracture. J Bone Jt Surg [Am] 50:784

    Google Scholar 

  27. Riggs SA, Wood MB, Cooney WP, Kelly PJ (1984) Blood flow and bone uptake of Tc-99m-labeled methylene diphosphonate. J Orthop Res 1:236

    Google Scholar 

  28. Ritchie IK, Kulkarni V (1990) Impedence osteography: clinical applications of a new method of imaging fractures. J Biomed Eng 12:369

    Google Scholar 

  29. Rommens P, Schmit-Neuerburg KP (1987) Ten years of experience with the operative management of tibial shaft fractures. J Trauma 27:917

    Google Scholar 

  30. Shaffer JW, Field GA, Wilber RG, Goldberg VM (1987) Experimental vascularized bone grafts: histopathologic correlations with postoperative bone scan: the risk of false-positive results. J Orthop Res 5:311

    Google Scholar 

  31. Smith MA, Jones EA, Strachan RK, Nicoll JJ, Best JJK, Tothill P, Hughes SPF (1987) Prediction of fracture healing in the tibia by quantitative radionuclide imaging. J Bone Jt Surg [Br] 69:441

    Google Scholar 

  32. Smith SR, Bronk JT, Kelly PJ (1990) Effect of fracture fixation on cortical bone blood flow. J Orthop Res 8:471

    Google Scholar 

  33. Wallace AL, Draper ERC, Strachan RK, McCarthy ID, Hughes SPF (1991) The effect of devascularisation upon early bone healing in dynamic external fixation. J Bone Jt Surg [Br] 73:819

    Google Scholar 

  34. Weissman SL, Herold HZ, Engelberg M (1966) Fractures of the middle two-thirds of the tibial shaft. J Bone Jt Surg [Am] 48:257

    Google Scholar 

  35. Winquist RA, Hansen ST (1980) Comminuted fractures of the femoral shaft treated by intramedullary nailing. Orthop Clin North Am 11:633

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Edinburgh Medical School, Edinburgh

    A. L. Wallace M.B.B.S. (Hons) & R. K. Strachan F.R.C.S. (Ed)

  2. Department of Medical Radiology, University of Edinburgh, Royal Infirmary, Edinburgh

    A. Blane D.C.R. & J. J. K. Best F.R.C.P. F.R.C.R.

  3. Department of Orthopaedic Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK

    S. P. F. Hughes M.S., F.R.C.S., F.R.C.S. (Ed)

Authors
  1. A. L. Wallace M.B.B.S. (Hons)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. K. Strachan F.R.C.S. (Ed)
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Blane D.C.R.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. J. K. Best F.R.C.P. F.R.C.R.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. P. F. Hughes M.S., F.R.C.S., F.R.C.S. (Ed)
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wallace, A.L., Strachan, R.K., Blane, A. et al. Quantitative early phase scintigraphy in the prediction of healing of tibial fractures. Skeletal Radiol. 21, 241–245 (1992). https://doi.org/10.1007/BF00243065

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00243065

Key words

Search

Navigation