Skeletal Trauma

  • L. P. Connolly
  • S. T. Treves

Abstract

Owing to its high sensitivity for detecting skeletal injury, skeletal scintigraphy is a valuable tool for evaluating traumatic conditions. This chapter addresses applications of skeletal scintigraphy for assessing skeletal injuries during childhood and adolescence: injuries associated with skeletal stress, injuries associated with learning to walk upright, and injuries associated with child abuse.

Keywords

Radionuclide Sarcoma Osteosarcoma Gadolinium Hypothyroidism 

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References

  1. 1.
    Albanese M, Pizzutillo PD, Family study of spondylolysis and spondylolisthesis. J Pediatr Orthop 1982;2:496–499.PubMedCrossRefGoogle Scholar
  2. 2.
    Amato M, Totty WG, Gilula LA. Spondylolysis of the lumbar spine: demonstration of defects and laminai fragmentation. Radiology 1984;153:627–629.PubMedGoogle Scholar
  3. 3.
    Bellah RD, Summerville DA, Treves ST, et al. Low back pain in adolescent athletes: detection of stress injuries to the pars interarticularis with SPECT. Radiology 1991;180:509–512.PubMedGoogle Scholar
  4. 4.
    Birch JG, Herring JA, Maravilla KR. Splitting of the intervertebral disc in spondylolisthesis: a magnetic resonance imaging finding in 2 cases. J Pediatr Orthop 1986;6:609–611.PubMedCrossRefGoogle Scholar
  5. 5.
    Blank S. Transverse tibial stress fractures: a special problem. Am J Sports Med 1981;9:322–325.CrossRefGoogle Scholar
  6. 6.
    Blumberg K, Patterson RJ. The toddler’s cuboid fracture. Radiology 1991;179:93–94.PubMedGoogle Scholar
  7. 7.
    Brodsky AE, Khalil MA. Talar compression syndrome. Am J Sports Med 1988;14:472–476.CrossRefGoogle Scholar
  8. 8.
    Busch MT. Sports medicine. In: Morrisy RT, Weinstein SL, eds. Lovell and Winter’s Pediatric Orthopedics. 4th ed. Philadelphia: Lippincott-Raven; 1996:1181–1228.Google Scholar
  9. 9.
    Carter DR. Mechanical loading histories and cortical bone remodelling. Calcif Tissue Int 1984;36:19–24.CrossRefGoogle Scholar
  10. 10.
    Carry HM. Fractures caused by child abuse. J Bone Joint Surg [Br] 1993;75-B:849–857.Google Scholar
  11. 11.
    Cochrane GM. Osteitis pubis in athletes. Br J Sports Med 1971;5:233–235.CrossRefGoogle Scholar
  12. 12.
    Conway JJ. Further comments on the role of the radionuclide skeletal survey in the diagnosis of the suspected abused child. Radiology 1983;148:574–575.Google Scholar
  13. 13.
    Conway JJ, Collins M, Tanz RR, et al. The role of bone scintigraphy in detecting child abuse. Semin Nucl Med 1993;23:321–333.PubMedCrossRefGoogle Scholar
  14. 14.
    Dunbar JS. Obscure tibial fracture of infants—the toddlers fracture. J Can Assoc Radiol 1964;15:136–140.PubMedGoogle Scholar
  15. 15.
    Elliot S, Hutson MA, Wastie ML. Bone scintigraphy in the assessment of spondylolysis in patients attending a sports injury clinic. Clin Radiol 1988;39:269–272.Google Scholar
  16. 16.
    Fakharzadeh FF. Stress fracture of the finger in a bowler. J Hand Surg [Am] 1989;14:241–243.CrossRefGoogle Scholar
  17. 17.
    Feldman KW, Brewer DK. Child abuse, cardiopulmonary resuscitation, and rib fractures. Pediatrics 1984;73:339–341.PubMedGoogle Scholar
  18. 18.
    Fernbach SK, Wilkinson RH. Avulsion injuries of the pelvis and proximal femur. AJR 1981;137:581–586.PubMedGoogle Scholar
  19. 19.
    Fredrickson BE, Baker D, McHolick WJ. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg [A] 1984;66:699–707.Google Scholar
  20. 20.
    Freiberger R, Hersh A, Harrison M. Roentgen examination of the deformed foot. Semin Roentgenol 1970;5:341–353.CrossRefGoogle Scholar
  21. 21.
    Fullerton LR, Snowdy HA. Femoral neck stress fractures. Am J Sports Med 1988;16:365–377.PubMedCrossRefGoogle Scholar
  22. 22.
    Gelfand MJ, Ball WS, Oestreich AE, et al. Transient loss of femoral head Tc-99m diphosphonate uptake with prolonged maintenance of femoral head architecture. Clin Nucl Med 1983;8:347–354.CrossRefGoogle Scholar
  23. 23.
    Gelfand MJ, Strife JL, Graham FJ, et al. Bone scintigraphy in slipped capital femoral epiphysis. Clin Nucl Med 1983;8:613–615.PubMedCrossRefGoogle Scholar
  24. 24.
    Goldman AB, Pavlov H. Radionuclide bone scanning in subtalar coalitions: differential considerations. AJR 1982;138:427–432.PubMedGoogle Scholar
  25. 25.
    Grogan JP, Hemminghytt S, Williams AL, et al. Spondylolysis studied with computed tomography. Radiology 1982;145:737–742.PubMedGoogle Scholar
  26. 26.
    Hajek MR, Noble HB. Stress fractures of the femoral neck in joggers. Am J Sports Med 1982;10:112–116.PubMedCrossRefGoogle Scholar
  27. 27.
    Hamilton WG. Foot and ankle injuries in dancers. Clin Sports Med 1988;1:143–173.Google Scholar
  28. 28.
    Hanson PG, Angevine M, Juhl JH. Osteitis pubis in sports activities. Phys Sports Med 1978;6:111–114.Google Scholar
  29. 29.
    Heinrichs EH, Senske BJ. Stress fracture of the ulnar diaphysis in athletes: case report and review of the literature. South Dakota J Med 1988;41:5–8.Google Scholar
  30. 30.
    Hershman EB, Mailly T. Stress fractures. Clin Sports Med 1990;1:183–214.Google Scholar
  31. 31.
    Hobbs CJ. Skull fracture and the diagnosis of abuse. Arch Dis Child 1984;59:246–252.PubMedCrossRefGoogle Scholar
  32. 32.
    Holder LE, Michael RH. The specific scintigraphic pattern of “shin splints in the lower leg.” J Nucl Med 1984;25:865–869.PubMedGoogle Scholar
  33. 33.
    Howard JL, Barron BJ, Smith GG. Bone scintigraphy in the evaluation of extraskeletal injuries from child abuse. Radiographics 1990;10:67–81.PubMedGoogle Scholar
  34. 34.
    Jackson DW, Wiltse LL, Cirincoine RJ. Spondylolysis in the female gymnast. Clin Orthop 1976;117:68–73.PubMedGoogle Scholar
  35. 35.
    Jaudes PK. Comparison of radiography and radionuclide bone scanning in the detection of child abuse. Pediatrics 1984;73:166–168.PubMedGoogle Scholar
  36. 36.
    Johnson DW, Farnum GN, Latchaw RE, et al. MR imaging of the pars interarticularis. AJR 1989;152:327–332.PubMedGoogle Scholar
  37. 37.
    Kaltsas DS. Stress fractures of the femoral neck in young adults. J Bone Joint Surg [B] 1981;63:33–37.Google Scholar
  38. 38.
    Kehl DK. Slipped capital femoral epiphysis. In: Morrisy RT, Weinstein SL, eds. Lovell and Winter’s Pediatric Orthopedics. 4th ed. Philadelphia: Lippincott-Raven; 1996:993–1022.Google Scholar
  39. 39a.
    Khoury MB, Kirks DR, Martines S, et al. Bilateral avulsion fractures of the anterior superior iliac spines in sprinters. Skeletal Radiol 1995;13:65–67.CrossRefGoogle Scholar
  40. 39b.
    Kleinman PK. Diagnostic Imaging of Child Abuse. Baltimore: Williams & Wilkins; 1987.Google Scholar
  41. 40.
    Kleinman PK. Diagnostic imaging in infant abuse. AJR 1990;155:703–712.PubMedGoogle Scholar
  42. 41.
    Kleinman PK. Imaging of child abuse: an update. In: Kirks DR, ed. Emergency Pediatric Radiology. Reston, VA: American Roentgen Ray Society; 1995:189–195.Google Scholar
  43. 42.
    Kleinman PK, Blackbourne BD, Marks SC, et al. Radiologic contributions to the investigation and prosecution of cases of fatal infant abuse. N Engl J Med 1989;320:507–511.PubMedCrossRefGoogle Scholar
  44. 43.
    Kleinman PK, Marks SC, Blackbourne B. The metaphyseal lesion in abused infants: a radiologic-histopathologic study. AJR 1986;146:895–905.PubMedGoogle Scholar
  45. 44.
    Kleinman PK, Marks SC, Richmond JM, et al. Inflicted skeletal injury: a postmortem radiologic-pathologic study in 31 infants. AJR 1995;165:647–650.PubMedGoogle Scholar
  46. 45.
    Lanyon LE. Functional strain as a determinant for bone remodelling. Calcif Tissue Int 1984;35:56–61.CrossRefGoogle Scholar
  47. 46.
    Lanyon LE. Functional strain in bone tissue as an objective, and controlling stimulus for adaptive bone remodelling. J Biomech 1987;20:1083–1093.PubMedCrossRefGoogle Scholar
  48. 47.
    Laor T, Jaramillo D, Oestrich A. Skeletal system. In: Kirks DR, ed. Practical Pediatric Imaging. Diagnostic Radiology of Infants and Children. 3rd ed. Philadelphia: Lippincott-Raven; 1997:327–510.Google Scholar
  49. 48.
    Lateur LM, Van Hoe LR, Van Ghillewe KV, et al. Subtalar coalition: diagnosis with the C sign on lateral radiographs of the ankle. Radiology 1994;193:847–851.PubMedGoogle Scholar
  50. 49.
    Lawson JP. Symptomatic radiographic variants in extremities. Radiology 1985;157:625–631.PubMedGoogle Scholar
  51. 50.
    Lonstein JE. Spondylolysis and spondylolisthesis. In: Morrisy RT, Weinstein SL, eds. Lovell and Winter’s Pediatric Orthopedics. 4th ed. Philadelphia: Lippincott-Raven; 1996:717–737.Google Scholar
  52. 51.
    Lowe J, Schachner E, Hirschberg E, et al. Significance of bone scintigraphy in symptomatic spondylolysis. Spine 1984;9:653–655.PubMedCrossRefGoogle Scholar
  53. 52.
    Lusins JO, Elting JJ, Cicoria AD, et al. SPECT evaluation of lumbar spondylolysis and spondylolisthesis. Spine 1994;19:608–612.PubMedCrossRefGoogle Scholar
  54. 53.
    Maffuli N, King JB. Effects of physical activity on some components of the skeletal system. Sports Med 1992;13:393–407.CrossRefGoogle Scholar
  55. 54.
    Martire JR. The role of nuclear medicine bone scans in evaluating pain in athletic injuries. Clin Sports Med 1987;6:713–737.PubMedGoogle Scholar
  56. 55.
    Matheson GO, Clement DB, McKenzie DC, et al. Scintigraphic uptake of 99mTc at nonpainful sites in athletes with stress fractures. The concept of bone strain. Sports Med 1987;4:65–75.PubMedCrossRefGoogle Scholar
  57. 56.
    Matheson GO, Clement DB, McKenzie DC, et al. Stress fractures in athletes. A study of 320 cases. Am J Sports Med 1987;15:46–58.PubMedCrossRefGoogle Scholar
  58. 57.
    Matin P. The appearance of bone scans following fractures, including immediate and long term studies. J Nucl Med 1979;20:1227–1231.PubMedGoogle Scholar
  59. 58.
    Matin P. Basic principles of nuclear medicine techniques for detection and evaluation of trauma and sports medicine injuries. Semin Nucl Med 1988;18:90–112.PubMedCrossRefGoogle Scholar
  60. 59.
    McKee BW, Alexander WJ, Dunbar JS. Spondylolysis and spondylolisthesis in children: a review. J Can Assoc Radiol 1971;22:100–109.Google Scholar
  61. 60.
    Merten DF, Radkowski MA, Leonidas JC. The abused child: a radiological reappraisal. Radiology 1983;146:377–381.PubMedGoogle Scholar
  62. 61.
    Michael RH, Holder LE. The soleus syndrome. A cause of medial tibial stress (shin splints). Am J Sports Med 1985;13:87–94.PubMedCrossRefGoogle Scholar
  63. 62.
    Miller JH, Sanderson RA. Scintigraphy of toddlers fracture. J Nucl Med 1988;29:2001–2003.PubMedGoogle Scholar
  64. 63.
    Morgan RC, Cranford AH. Surgical management of tarsal coalition in adolescent athletes. Foot Ankle 1986;7:183–193.PubMedGoogle Scholar
  65. 64.
    Mubarak SJ, Gould RN, Lee YF, et al. The medial tibial stress syndrome. Am J Sports Med 1982;10:201–205.PubMedCrossRefGoogle Scholar
  66. 65.
    Noakes TD, Smith JA, Lindenberg G, et al. Pelvic stress fractures in long distance runners. Am J Sports Med 1985;13:120–123.PubMedCrossRefGoogle Scholar
  67. 66.
    Orava S, Jormakka E, Hulkko A. Stress fractures in young athletes. Acta Orthop Trauma Surg 1981;98:271–274.CrossRefGoogle Scholar
  68. 67.
    Ozonoff MB. Pediatric Orthopedic Radiology. 2nd ed. Philadelphia: W.B. Saunders; 1992.Google Scholar
  69. 68.
    Papanicolaou N, Wilkinson RH, Emans JB, et al. Bone scintigraphy and radiology in young athletes with low back pain. AJR 1985;145:1039–1044.PubMedGoogle Scholar
  70. 69.
    Pavlov H. Roentgen examination of groin and hip pain in the athlete. Clin Sports Med 1987;6:829–843.PubMedGoogle Scholar
  71. 70.
    Read MT. Single photon emission computed tomography (SPECT) scanning for adolescent back pain. A sine qua non? Br J Sports Med 1994;28:56–57.PubMedCrossRefGoogle Scholar
  72. 71.
    Rettig AC, Shelbourne KD, McCarroll JR, et al. The natural history and treatment of delayed union stress fractures of the anterior cortex of the tibia. Am J Sports Med 1988;16:250–255.PubMedCrossRefGoogle Scholar
  73. 72.
    Roach PJ, Cooper RA, Watson AS. Arm splints seen on bone scan in a volleyball player. Clin Nucl Med 1993;18:900–901.PubMedCrossRefGoogle Scholar
  74. 73.
    Rosen PR, Micheli LJ, Treves ST. Early scintigraphic diagnosis of bone stress and fractures in athletic adolescents. Pediatrics 1982;70:11–15.PubMedGoogle Scholar
  75. 74.
    Rupani HD, Holder LE, Espinola DA, et al. Three–phase radionuclide bone imaging in sports medicine. Radiology 1985;156:187–196.PubMedGoogle Scholar
  76. 75.
    Sedlak AJ, Broadhurst DD. Executive Summary of the Third National Incidence Study of Child Abuse and Neglect. Washington, DC: Government Printing Office; 1996.Google Scholar
  77. 76.
    Sella EJ, Lawson JP, Ogden JA. The accessory navicular synchondrosis. Clin Orthop 1986;209:280–285.PubMedGoogle Scholar
  78. 77.
    Semon RL, Spengler D. Significance of lumbar spondylolysis in college football players. Spine 1981;6:172–174.PubMedCrossRefGoogle Scholar
  79. 78.
    Smergel EM, Harcke T, Pizzutillo PD, et al. Use of bone scintigraphy in the management of slipped capital femoral epiphysis. Clin Nucl Med 1987;12:349–353.PubMedCrossRefGoogle Scholar
  80. 79.
    Smith FW, Gilday DL, Ash JM, et al. Unsuspected costovertebral fractures demonstrated by bone scanning in the child abuse syndrome. Pediatr Radiol 1980;10:103–106.PubMedCrossRefGoogle Scholar
  81. 80.
    Starshak RJ, Simons GW, Sty JR. Occult fracture of the calcaneus—another toddlers fracture. Pediatr Radiol 1984;14:37–40.PubMedCrossRefGoogle Scholar
  82. 81.
    Stoskopf CA, Hernandez RJ, Kelikian A, et al. Evaluation of tarsal coalition by computed tomography. J Pediatr Orthop 1984;4:365–369.PubMedCrossRefGoogle Scholar
  83. 82.
    Sty JR, Starshak RJ. The role of bone scintigraphy in the evaluation of the suspected abused child. Radiology 1983;146:369–375.PubMedGoogle Scholar
  84. 83.
    Sty JR, Wells RG. Child abuse: extraosseous abdominal bone imaging uptake. Clin Nucl Med 1994;19:1011.PubMedCrossRefGoogle Scholar
  85. 84.
    Sty JR, Wells RG, Conway JJ. Spine pain in children. Semin Nucl Med 1993;23:296–320.PubMedCrossRefGoogle Scholar
  86. 85.
    Sty JR, Wells RG, Starshak RJ, Gregg D. The musculoskeletal system. In: Sty J, Wells R, Starshak R, Gregg D, eds. Diagnostic Imaging of Infants and Children. Vol. 3. Gaithesburg: Aspen; 1992:233–405.Google Scholar
  87. 86.
    Sugimoto H, Ohsawa T. Ulnar collateral ligament in the growing elbow: MR imaging of normal development and throwing injuries. Radiology 1994;192:417–422.PubMedGoogle Scholar
  88. 87.
    Sullivan JA. The childs foot. In: Morrisy RT, Weinstein SL, eds. Lovell and Winter’s Pediatric Orthopedics. 4th ed. Philadelphia: Lippincott–Raven; 1996:1077–1135.Google Scholar
  89. 88.
    Sundar M, Carty H. Avulsion fractures of the pelvis in children: a report of 32 fractures and their outcome. Skeletal Radiol 1994;23:85–90.PubMedCrossRefGoogle Scholar
  90. 89.
    Taylor JA, Sartoris DJ, Huang GS, et al. Painful conditions affecting the first metatarsal sesamoid bones. Radiographics 1993;13:817–830.PubMedGoogle Scholar
  91. 90.
    Thomas SA, Rosenfield NS, Leventhal JM, et al. Long bone fractures in young children: distinguishing accidental injuries from child abuse. Pediatrics 1991;88:471–476.PubMedGoogle Scholar
  92. 91a.
    Toridis TG. Stress analysis of the femur. J Biomech 1969;2:163–174.PubMedCrossRefGoogle Scholar
  93. 91b.
    Treves ST, Connolly LP, Kirkpatrick JA, et al. Bone. In: Treves ST (ed) Pediatric Nuclear Medicine. 2nd ed. New York: Springer–Verlag 1995:233–301.Google Scholar
  94. 92.
    Tullos HS, Erwin WD, Woods GW, et al. Unusual lesions of the pitching arm. Clin Orthop 1972:88:169–182.PubMedCrossRefGoogle Scholar
  95. 93.
    van den Oever M, Merrick MV, Scott JH. Bone scintigraphy in symptomatic spondylolysis. J Bone Joint Surg [B] 1987;69:453–456.Google Scholar
  96. 94.
    Veselko M, Smrkolj V. Avulsion of the anterior–superior iliac spine in athletes: case reports. J Trauma 1994;36:444–446.PubMedCrossRefGoogle Scholar
  97. 95.
    Wechsler RJ, Schweitzer ME, Deely DM, et al. Tarsal coalition: depiction and characterization with CT and MR imaging. Radiology 1994;193:447–452.PubMedGoogle Scholar
  98. 96.
    Wilkinson RH, Hall JE. The sclerotic pedicle: tumor or pseudotumor. Radiology 1974;111:683–688.PubMedGoogle Scholar
  99. 97.
    Wiltse LL. The etiology of spondylolisthesis. J Bone Joint Surg [A] 1963;44:539–569.Google Scholar
  100. 98.
    Wolfgang GL. Stress fracture of the femoral neck in a patient with open femoral capital epiphyses. J Bone Joint Surg [A] 1977;59:680–681.Google Scholar
  101. 99.
    Wynne-Davies R, Scott JH. Inheritance and spondylolisthesis; a radiolographic family survey. J Bone Joint Surg [B] 1979;61:301–305.Google Scholar
  102. 100.
    Zwas ST, Elkanovitch R, Frank G. Interpretation and classification of bone scintigraphic findings in stress fractures. J Nucl Med 1987;28:452–457.PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York Inc. 1998

Authors and Affiliations

  • L. P. Connolly
    • 1
    • 2
  • S. T. Treves
    • 1
    • 2
  1. 1.Division of Nuclear MedicineChildren’s HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA

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