strontium-radioisotopes and Femoral-Neck-Fractures

Topics: Aged; Cementation; Female; Femoral Neck Fractures; Femur; Femur Head Necrosis; Fluorides; Follow-Up Studies; Fracture Fixation, Internal; Fractures, Ununited; Humans; Joint Dislocations; Joint Prosthesis; Male; Ossification, Heterotopic; Radioisotopes; Retrospective Studies; Scintillation Counting; Strontium Radioisotopes; Technetium; Wound Infection

1. A new tracer method is described for the non-invasive measurement of bone formation in the proximal femur. The method is based on our previously described whole-body method using 85Sr as the tracer (Reeve, J., Hesp, R. & Wootton, R. Calcif. Tissue Res. 1976; 22, 191-206). It allows correction to be made for long-term exchange processes within the skeleton. 2. The method has been applied in a study of regional and whole-body bone formation in 12 rehabilitated patients who had previously suffered a fracture of the proximal femur. Twelve healthy control subjects were studied, who were selected for their good health and continued physical activity. The aim was to explore the relationship between bone formation and physical activity. 3. Bone formation was similar in the two groups, both regionally and in the whole body. Based on analyses of four cadaver specimens, bone formation in the proximal femur was about one and two-thirds times that in the whole skeleton when related to mass of calcium in the region of interest. 4. Whole-body bone resorption, estimated from five measurements per subject of hydroxyproline excretion in relation to creatinine excretion, was significantly higher in the fracture patients (P < 0.01, Wilcoxon's test). 5. Estimates of current physical activity (and immediate pre-fracture physical activity) were made with a newly devised questionnaire. Historical levels of physical activity (at ages 15-45 years) were determined with Astrom's questionnaire. No bone formation index correlated with any index of physical activity. Urinary hydroxyproline excretion correlated inversely both with current physical activity and historical physical activity (for both regression coefficients P < 0.01). 6. The results are discussed in the light of our current understanding of the control of bone remodelling by the discrete basic multicellular units of bone. The opportunity to study regional bone resorption by the additional use of serial dual X-ray absorptiometry of the same region will in future allow the direct monitoring of the effects of therapeutic interventions which have been designed to prevent contralateral hip fracture.

Topics: Aged; Bone and Bones; Bone Density; Bone Remodeling; Bone Resorption; Creatinine; Female; Femoral Neck Fractures; Humans; Hydroxyproline; Middle Aged; Movement; Osteogenesis; Strontium Radioisotopes

Two patients with femoral neck fractures, one displaced and one undisplaced, are presented. Preoperative intravital staining with tetracycline and Tc-MDP scintimetry both showed intact femoral head circulation while Tc-MDP-scintimetry 1 week after operation showed pronounced circulatory deficiency. Sr85-scintimetry performed at the same time was inconclusive. Segmental collapse was observed radiographically, 8 and 12 months postoperatively. The major vascular injury resulting in avascularity most probably occurred during the procedure of osteosynthesis, and Tc-MDP-scintimetry was found suitable for early postoperative recognition of avascular necrosis in both fractures.

Topics: Adult; Aged; Bone Nails; Diphosphonates; Female; Femoral Neck Fractures; Femur Head Necrosis; Fracture Fixation, Internal; Humans; Male; Radionuclide Imaging; Strontium Radioisotopes; Technetium; Technetium Tc 99m Medronate; Tetracycline; Time Factors

Forty femoral neck fractures were followed for 5 years in a prospective clinical, roentgenographic and scintimetric investigation. Thirteen cases had uncomplicated healing, 22 necrosis and five non-union. The diagnostic value of radiographic changes was analysed with reference to development of necrosis of the femoral head or non-union. Sclerosis of the femoral head, and compression and displacement of the fracture were compatible with eventual healing and clinical recovery. Subchondral fracture and collapse of the load-bearing surface, diagnostic for necrosis, were observed in only 7 of 22 cases at 1 year and as late as 3-5 years in three cases. By contrast, four out of five non-union cases were established radiographically within 1 year. Patients needing an arthroplasty after fracture of the femoral neck should be identified on clinical grounds after early radionuclide scintimetry. Waiting for radiographic documentation of necrosis in cases with pain will increase the risk for physical and social impairment associated with poor function of the hip.

Topics: Adult; Aged; Femoral Neck Fractures; Femur Head Necrosis; Follow-Up Studies; Fractures, Ununited; Humans; Middle Aged; Osteosclerosis; Prospective Studies; Radiography; Radionuclide Imaging; Strontium Radioisotopes; Wound Healing

In 40 patients with fracture of the femoral neck 85Sr scintimetry was performed at the time of nailing and 4 months postoperatively. The fractures were radiographed repeatedly for 5 years; thirteen fractures healed without complications, 22 developed necrosis of the femoral head, and 5 pseudarthrosis. The early isotope measurement did not distinguish between normal and necrosis cases even with detailed analysis. The 4 months activities were high in osteonecrosis and low pseudarthrosis. The latter observation is interpreted as evidence that non-union of a femoral neck fracture is due to severe permanent vascular damage.

Topics: Adult; Aged; Femoral Neck Fractures; Femur Head; Femur Head Necrosis; Humans; Middle Aged; Pseudarthrosis; Radiography; Scintillation Counting; Strontium Radioisotopes

Topics: Adult; Aged; Evaluation Studies as Topic; Female; Femoral Neck Fractures; Femur Head Necrosis; Humans; Male; Middle Aged; Postoperative Complications; Radiography; Radionuclide Imaging; Strontium Radioisotopes; Technetium; Time Factors

By clinical, radiographic and scintigraphic means we attempted to examine, whether the implantation of a simple head-endoprosthesis after fractures of the femoral neck still has to be considered as an appropriate operating method or whether on principle, primary endoprosthesis should be used. The results prove that in suitable cases and with correct technique the head-endoprosthesis still has justification, especially as the "protrusio acetabuli", known only as complication of pure head-endoprosthesis, is mostly avoidable. Reference to the choice of cases, operating conditions and appropriate methods of examination are given.

Topics: Aged; Evaluation Studies as Topic; Femoral Neck Fractures; Follow-Up Studies; Fracture Fixation; Hip Joint; Humans; Joint Prosthesis; Middle Aged; Movement; Postoperative Complications; Radionuclide Imaging; Strontium Radioisotopes

Topics: Bone Diseases; Female; Femoral Fractures; Femoral Neck Fractures; Fractures, Spontaneous; Humans; Middle Aged; Radionuclide Imaging; Stress, Mechanical; Strontium Radioisotopes

Topics: Acetabulum; Aged; Female; Femoral Neck Fractures; Femur Head; Follow-Up Studies; Humans; Joint Prosthesis; Male; Middle Aged; Pelvic Bones; Postoperative Complications; Radionuclide Imaging; Strontium Radioisotopes

Topics: Age Factors; Aged; Blood Vessels; Female; Femoral Neck Fractures; Femur Head; Humans; Male; Middle Aged; Strontium Radioisotopes