strontium-radioisotopes and Fractures--Ununited

The radionuclide investigation of skeletal trauma in the past was confined generally to scintimetry and an occasional bone scan. The development of improved radiopharmaceuticals, including 99mTc-labeled compounds with their enhanced sensitivity, and the refinement of imaging devices offering superior resolution and speed have allowed a more detailed assessment of conditions resulting from trauma. Practical approaches to the diagnosis of subtle bone injury resulting in stress fracture, the differentiation between delayed healing and nonunion, and early recognition of avascular necrosis and osteomyelitis are now available. The changing pattern of radionuclide uptake in bone following damage by radiation and other abnormalities as a consequence of trauma also can be easily studied.

Topics: Adolescent; Adult; Athletic Injuries; Calcium Radioisotopes; Child; Diphosphates; Female; Femur Head Necrosis; Fluorine; Fractures, Bone; Fractures, Spontaneous; Fractures, Ununited; Humans; Male; Middle Aged; Myositis Ossificans; Osteomyelitis; Radiation Injuries; Radionuclide Imaging; Radiotherapy; Strontium Radioisotopes; Technetium

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

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

A total of 203 profile countings were performed on 68 fractures of the tibial shaft, which included 25 normally healing cases, 37 cases of delayed union, and six cases of non-union. The measurements were performed on the 1st and the 7th day after the injection of strontium. In 27 cases the fracture received 2-3 strontium injections with associated profile counting at different stages of the healing process. The cases of normally healing fractures and delayed union showed differences in the average strontium uptake. However, these differences were not distinct enough to enable classification of individual fractures into groups. In cases requiring bone grafting, the transplant was found to accelerate metabolism and increase the accretion of strontium at the site of the fracture. The investigation shows that the real value of strontium profile counting lies in its ability to give information about the osteogenetic activity of the bone, which is a necessary prerequisite for the healing of the fracture.

Topics: Bone Transplantation; Fractures, Ununited; Humans; Strontium Radioisotopes; Tibial Fractures; Time Factors; Wound Healing

Topics: Bone and Bones; Fractures, Ununited; Humans; Scintillation Counting; Strontium Radioisotopes; Technetium; Tibial Fractures

Topics: Adolescent; Child; Female; Femoral Fractures; Fractures, Ununited; Humans; Male; Osteotomy; Pseudarthrosis; Radius; Strontium Radioisotopes; Traction; Ulna