technetium-tc-99m-medronate and Femoral-Fractures

Children with an uncomplicated femoral fracture, treated with superimposition of fragments and intentional shortening, usually develop overgrowth of the fractured femur and the ipsilateral tibia which may compensate for the initial shortening and enable the limb in question to reach a length similar to that on the normal side. The overgrowth is evaluated clinically and by scanography. The increased metabolic activity of the growth plates that support this overgrowth has not been documented by any laboratory method. In order to evaluate the metabolic activity of the growth plates, 18 patients (11 males, seven females; mean age 6.1 years) with fractures of the femur were studied at three different time intervals (2-5 months, 6-12 months and 18-24 months). Three-phase bone scintigraphy was performed in all patients. Ten children (five males, five females; mean age 7.5 years) who had had bone imaging for other reasons were used as the control group. Visual analysis of the flow and equilibrium phases was performed for the distal femoral and proximal tibial growth plates. Visual and semi-quantitative analyses of the delayed images were performed for the distal femoral and proximal and distal tibial growth plates. Semi-quantitative analyses yielded the following activity ratios: (a) the distal femoral growth plate of the fractured femur to the contralateral one (FR); (b) the proximal growth plate of the tibia on the side of the fractured femur to the contralateral one (TpR); (c) the distal growth plate of the tibia on the side of the fractured femur to the contralateral one (TdR); and (d) in the control group, the distal growth plates of both femora (FCG) and the proximal (TCGp) and distal (TCGd) growth plates of the tibiae. Visual analysis of the blood flow, equilibrium and delayed images showed increased activity in the distal femoral growth plates during the first and second time intervals, but not during the third. No significant activity changes were found in the proximal and distal tibial growth plates during any of the phases analysed. The mean and standard deviation for FR in the three time intervals were: FRI=1.22+/-0.27, FRII=1.17+/-0.16 and FRIII=1.09+/-0.20. FR values were significantly higher than in the control group (FCG=0.99+/-0.03) (P=0.033). The mean and standard deviation for TpR in the three time intervals were: TpRI=1.08+/-0.18, TpRII=0.94+/-0.09 and TpRIII=0.96+/-0.20. TpR values were not significantly different from those in the control gr

Topics: Bone and Bones; Bone Development; Bone Remodeling; Child; Child, Preschool; Female; Femoral Fractures; Fracture Healing; Growth Plate; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Unanticipated but clinically significant nonosseous findings can be detected during routine bone scintigraphy. We present a case of an 83-year-old man who presented with a pathologic fracture of the right femur. Whole-body bone scintigraphy for osseous staging revealed intense radiotracer accumulation in the kidneys and ureters but no activity within the urinary bladder. The patient had not voided for 14 hours. A Foley catheter was inserted, and more than 2000 mL of urine was drained, most consistent with urinary bladder obstruction. Subsequent repeat images demonstrated marked reduction of the renal and ureteral activity with trace activity in the urinary bladder.

Topics: Aged, 80 and over; Femoral Fractures; Humans; Incidental Findings; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Urethral Obstruction; Urinary Bladder

Bisphosphonates are potent inhibitors of bone resorption and widely used to treat osteoporosis. Extensive studies have shown that therapy with bisphosphonates improves bone density and decreases fracture risk. However, concerns have been raised about potential over-suppression of bone turnover during long-term use of bisphosphonates, resulting in increased susceptibility to and delayed healing of non-spinal fractures. We report a patient who sustained non-traumatic stress fractures in bilateral femoral shafts with delayed healing after long-term bisphosphonate therapy. She underwent open reduction and surgical internal fixation. Although bisphosphonates effectively prevent vertebral fractures, and their safety has been tested in randomized trials, we must emphasize the need for awareness of the possibility that long-term suppression of bone turnover with bisphosphonates may eventually lead to an accumulation of fatigue-induced damage and adverse skeletal effects such as delayed fracture healing.

Topics: Bone Density; Diaphyses; Diphosphonates; Female; Femoral Fractures; Fracture Fixation, Internal; Fracture Healing; Fractures, Spontaneous; Fractures, Stress; Humans; Middle Aged; Osteoporosis; Radiopharmaceuticals; Technetium Tc 99m Medronate; Treatment Outcome; Whole Body Imaging

Topics: Diagnosis, Differential; Femoral Fractures; Hip Joint; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Rheumatic Diseases; Severity of Illness Index; Technetium Tc 99m Medronate

Combined bone scanning and immunoscintigraphy (IS) with 99mTc-monoclonal antigranulocyte antibodies were performed in two patients with suspected reactivation of chronic osteomyelitis of the lower extremity. Because bone scanning and IS were strongly positive, both patients underwent surgical intervention.. Macroscopic findings did not show purulent infection and microbiologic results remained negative, but histology revealed unexpected ectopic bone marrow, explaining the strong uptake on IS. One patient exhibited active hematopoietic bone marrow at the former fracture site of the tibial bone. The second patient presented with interspersed bone marrow in the cortical bone of the femoral diaphysis after several intramedullary surgical procedures.. Unexpected ectopic hematopoietic marrow may occur in the appendicular skeleton after trauma and repeated surgical interventions. The bone marrow shows a physiologic uptake with IS and may be misinterpreted as granulocyte accumulation due to infection. This may lead to false-positive diagnosis in cases of suspected osteomyelitis.

Topics: Adult; Aged; Antibodies, Monoclonal; Bone Marrow; Choristoma; Diagnosis, Differential; Female; Femoral Fractures; Femur; Hematopoiesis; Humans; Male; Osteomyelitis; Radioimmunodetection; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Tibial Fractures

A case is described of a 21 month old infant with a fractured mid-shaft of femur following a fall. While the fracture was clearly visualised on X-ray, radionuclide bone scanning showed diffusely increased uptake throughout the femur with no focal uptake at the fracture site. Fractures of any etiology, including child abuse, should always be considered in the differential diagnosis of diffusely increased long bone uptake on bone scintigraphy in children.

Topics: Child Abuse; Diagnosis, Differential; Femoral Fractures; Femur; Follow-Up Studies; Fracture Fixation; Fracture Healing; Humans; Infant; Male; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Calcinosis; Exostoses; Femoral Fractures; Fractures, Ununited; Humans; Knee; Knee Injuries; Male; Ossification, Heterotopic; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: False Negative Reactions; Femoral Fractures; Follow-Up Studies; Humans; Infant; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Twelve athletes presenting acute knee injury with normal radiological findings underwent both three-phase radionuclide bone imaging (TPBI) and magnetic resonance imaging (MRI). The association of these highly sensitive diagnostic procedures detected occult fractures in all patients. The areas of signal intensity alterations on MRI corresponded to those of increased radionuclide uptake in blood pool images. However, the same areas seemed to be more extended on delayed TPB images. TPBI yielded early diagnostic information about lesion sites and functional activities, while MRI provided better anatomical definition and specific information about associated soft tissue lesions and served to establish the correct therapeutic approach and follow-up.

Topics: Adolescent; Adult; Athletic Injuries; Female; Femoral Fractures; Humans; Knee Injuries; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tibial Fractures

The results of combined scintigraphy in which indium-111-labeled leukocytes and technetium-99m methylene diphosphonate were used were compared with the results of cultures of open bone at 102 sites of delayed union or non-union, to determine the effectiveness of this combination as a preoperative indicator of osteomyelitis. There were twenty-five true-positive, fifty-nine true-negative, eleven false-positive, four false-negative, and three indeterminate interpretations, yielding, for the diagnosis of osteomyelitis, a sensitivity of 86 per cent, a specificity of 84 per cent, an accuracy of 82 per cent, a positive predictive value of 69 per cent, and a negative predictive value of 94 per cent. There were few false-negative scans; false-positive results were most likely at a metaphyseal site adjacent to a joint in which there was post-traumatic arthropathy, at the site of a failed arthrodesis, and at the site of an unstable delayed union or non-union.

Topics: Adolescent; Adult; Aged; Child; False Positive Reactions; Female; Femoral Fractures; Fractures, Ununited; Humans; Indium Radioisotopes; Leukocytes; Male; Osteomyelitis; Radionuclide Imaging; Shoulder Fractures; Technetium Tc 99m Medronate; Tibial Fractures

Seventy-one athletes with 74 stress injuries to the femur were studied using a case-controlled design. Forty-three were females (26.6 yrs) and 28 were males (31.2 yrs). Each patient had exercise-induced pain in the hip, groin or thigh and a Tec-99m-MDP bone scan showing focal uptake of radionuclide in the femur. Running was the most common activity at the time of injury (89.2%) followed by triathlon (4.6%) and aerobic dance (4.6%). Thirty per cent of the runners had increased their training duration immediately prior to their first symptom. Anterior thigh pain was the most frequent site of exercise-induced pain (45.9%) followed by hip pain (27%) and groin pain (8.1%). During the clinical examination, when asked to hop on the affected limb, 70.3% of the patients had pain reproduced in the hip, groin or anterior thigh. There were 39 cases (53%) involving focal uptake of radionuclide in the femoral shaft, 15 (20%) in the lesser trochanter, 11 (15%) in the intertrochanteric region between the femoral neck and the greater trochanter, 8 (11%) in the femoral neck and 1 (1%) in the greater trochanter. Two patients suffered displaced fractures, one at the femoral neck and the other in the shaft of the femur. Neither patient had previously sought medical attention for their leg pain. Of 46 plain radiographs taken, only 11 (24%) were abnormal. The mean time to diagnosis and recovery were 6.6 and 10.4 weeks respectively. Substitution of cycling and water exercise for running were the most common therapeutic interventions.

Topics: Adult; Case-Control Studies; Female; Femoral Fractures; Femoral Neck Fractures; Femur; Femur Neck; Follow-Up Studies; Fracture Healing; Fractures, Stress; Gait; Humans; Male; Pain; Radiography; Radionuclide Imaging; Running; Technetium Tc 99m Medronate

Technetium-99m methylene diphosphonate (99mTc-MDP) bone scintigraphy was performed in 45 patients (42 male and 3 female) with established non-united fractures to predict the healing response to pulsing electromagnetic field stimulation therapy. The bone scans revealed 3 different scintigraphic patterns. The most frequent pattern was an increased uniform uptake of the tracer at the non-union site (group 1). The second pattern was increased activity at the bone ends with a photon-deficient area between the fracture sites (group 2a) or a generalized decrease in the radionuclide concentration in the region of bone fragments (group 2b). When the scintigraphic pattern did not fit either of the two patterns or when the presence of the cold area between the bone fragments could not be judged with certainty, it was called indeterminate (group 3). All patients underwent pulsing electromagnetic field stimulation. The healing rate was 87.5% and 42.8% in group 1 and group 3 patients, respectively. None of the group 2 patients had any evidence of healing, and they all underwent surgical exploration, revealing complicated non-unions. We conclude that 99mTc bone scintigraphy is a useful tool in determining complicated non-unions and selecting the proper therapy mode.

Topics: Adult; Electromagnetic Fields; Electromagnetic Phenomena; Female; Femoral Fractures; Fracture Healing; Fractures, Ununited; Humans; Humeral Fractures; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibial Fractures

Topics: Diagnosis, Differential; Femoral Fractures; Humans; Injections, Intramuscular; Male; Meperidine; Middle Aged; Muscles; Radionuclide Imaging; Technetium Tc 99m Medronate

An exercise-related avulsion injury of the insertion of the pectineus muscle is described. The abnormality was detected on a 4-hour delayed bone scan. Symptomatic injuries of the adductor muscles are uncommon and are not to be confused scintigraphically with a stress fracture of the proximal femoral shaft.

Topics: Diagnosis, Differential; Femoral Fractures; Fractures, Stress; Humans; Leg Injuries; Male; Middle Aged; Muscles; Running; Technetium Tc 99m Medronate; Thigh; Tomography, Emission-Computed, Single-Photon

Forty-nine patients with 50 fracture nonunions 4-48 months after injury underwent technetium-99m methylene diphosphonate (99mTc-MDP) scintigraphy on day 1, combined 99mTc-MDP and indium-111 leukocyte (111In-WBC) scintigraphy on day 2, and gallium-67 (67Ga) scintigraphy on day 3. The results were compared to evaluate the relative abilities of these scintigraphic techniques to detect osteomyelitis. Nine patients had clinical evidence of infection at the time of imaging, and 40 patients (41 fractures) did not. Open-biopsy cultures were performed at all fracture sites and were positive at 21 (42%) of the 50 sites. Combined 99mTc-MDP/111In-WBC images were interpreted with the use of two criteria. A positive study by the first criterion required 111In-WBC localization in the region of the nonunion fracture. A positive study by the second criterion required 111In-WBC localization in bone at the fracture site. The first criterion yielded a sensitivity of 84%, specificity of 72%, and accuracy of 74%; the specificity improved to 97% with an accuracy of 88% when the second criterion was used. Ten (25%) of the 40 patients thought not to have osteomyelitis by clinical criteria at the time of imaging had true-positive 99mTc-MDP/111In-WBC studies by biopsy culture results. Gallium-67 studies were interpreted as nondiagnostic if localization of radioisotope at fracture sites was equal to that with 99mTc-MDP, positive if 67Ga localization was greater than that of 99mTc-MDP, and negative if it was less than that of 99mTc-MDP. Twenty-one 67Ga studies were interpreted as nondiagnostic; 11 (52%) of the 21 had culture-positive fracture sites. The accuracy of 67Ga/99mTc-MDP imaging was 39%. Combined 99mTc-MDP/111In-WBC imaging is useful in the detection of osteomyelitis at fracture nonunion sites and improves the specificity of 111In-WBC imaging by differentiating inflammation/infection in adjacent soft tissue from osteomyelitis at the fracture site. Gallium-67 with 99mTc-MDP imaging is not sufficiently reliable in this clinical setting to be useful as an indicator for osteomyelitis.

Topics: Adult; Aged; Female; Femoral Fractures; Fractures, Ununited; Gallium Radioisotopes; Humans; Humeral Fractures; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibial Fractures

A case of greatly increased blood flow in the region of a fracture with malunion of the left femur, both in the flow and immediate blood pool studies during three phase bone imaging, is presented. The sluggish left femoral artery flow resulted from the greatly increased regional perfusion and is similar to the findings in acute osteomyelitis. The sluggish left femoral artery flow and greatly increased regional perfusion of the site is probably best explained as a regional "neurovascular flush" resulting from the pain caused by the malunion of the fracture and/or hyperemia in the area of the malunion responding to inflammation.

Topics: Aged; Diagnosis, Differential; Femoral Fractures; Fractures, Ununited; Humans; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

Differentiation of occult skeletal injuries from early acute osteomyelitis in infants and young children is important clinically. The Tc-99m MDP scintigraphic findings in six patients who had occult femoral or tibial fractures were reviewed. The images obtained early (at 1-4 days from the onset of symptoms) shared the common characteristic finding of a subtle but definite, generalized increased uptake of the tracer along the entire length of the injured bone. This pattern of uptake was similar regardless of the type of fracture. These were different from the focal abnormalities that have been observed in early acute osteomyelitis. In the absence of an extensive cellulitis or a vascular occlusive disease, a bone image showing a mild diffuse uniform increased uptake along the entire length of the tibia or femur in infants and young children with lower extremity pain of less than 1 week's duration should suggest the diagnosis of occult skeletal fractures.

Topics: Acute Disease; Diagnosis, Differential; Female; Femoral Fractures; Humans; Infant; Infant, Newborn; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibial Fractures; Time Factors

A new system for classification of stress fractures identified by bone scintigraphy was developed and divided into four grades according to lesion dimension, bone extension, and tracer accumulation. The scintigraphic findings were evaluated for severity of lesions by extent of the visualized bone response, ranging from ill-defined cortical lesions with slightly increased activity (I) to well-defined intramedullary transcortical lesions with intensely increased activity (IV). Bone scintigraphies using [99mTc]MDP were obtained in 310 military recruits suspected of having stress fractures. In 235 patients, 391 stress fractures were diagnosed. Forty percent of the lesions were asymptomatic. Most of the lesions were in the tibiae (72%), and 87% of the patients had one or two lesions, while 13% had three to five lesions. Eighty-five percent of the lesions were classified as mild and showed early and more complete resolution on follow-up studies after treatment as compared to the severe grades. Furthermore, specific scintigraphic patterns have been introduced for distinguishing inflammatory shin-splints from stress fractures, allowing for their appropriate early treatment. Thus, early recognition of mild stress fracture scintigraphic patterns representing the beginning of pathologic bone response to stress enabled a prompt and effective treatment to prevent progression of lesions, protracted disability, and complications.

Topics: Adult; Bone Diseases; Diagnosis, Differential; Femoral Fractures; Follow-Up Studies; Fractures, Bone; Humans; Male; Military Personnel; Physical Exertion; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibial Fractures

The effect of a pulse dose of Vitamin D3 on uptake of [99mTc]MDP by fractured and osteoporotic bone, respectively, was compared with D3's effect on uptake by normal bone in rats. At 4, 7, and 14 days, respectively, after femoral fracture, basal uptake was significantly (p less than 0.005) increased at the fracture site by 336.8, 276.1, and 183.5%, respectively, over the contralateral control site. D3-treated rats had lower uptakes than untreated controls at all three fracture sites and at 12 of 15 normal bone sites but analysis of variance showed the uptake differences were not significant. Cortisone-induced osteoporosis caused a significant (p less than 0.05) decrease in basal uptake. The decrease occurred in all nine bone areas studied. D3 caused a significant (p less than 0.05) increase (mean 16.2%) in uptake by these osteoporotic bones, but a significant (0.1 greater than p greater than 0.05) decrease (mean 13.0%) in uptake by the same bones in normal controls. Thus, D3 had an effect on uptake by the bone lesion, osteoporosis, that differed from D3's effect on uptake by fracture or normal bone.

Topics: Animals; Bone and Bones; Cholecalciferol; Cortisone; Diphosphonates; Female; Femoral Fractures; Femur; Male; Osteoporosis; Rats; Rats, Inbred Strains; Technetium; Technetium Tc 99m Medronate; Time Factors

A case of osteomalacia with multiple asymmetrically distributed pseudofractures (Looser's zones) simulating metastases is presented. Radiographic correlation is essential to increase specificity and avoid misinterpretation.

Topics: Aged; Bone Neoplasms; Diagnosis, Differential; Femoral Fractures; Fractures, Spontaneous; Humans; Male; Osteomalacia; Radionuclide Imaging; Rib Fractures; Scapula; Technetium Tc 99m Medronate

A review of 13 cases of suspected child abuse in which radionuclide (RN) scans, radiographic skeletal surveys, and sufficient follow-up were available showed that the RN scans were insensitive, even though fractures were more than 48 hours old at the time of the scan. Frequently missed lesions included skull and extremity fractures. Furthermore, soft tissue and visceral abnormalities that were identified on radiographic examination went undetected on RN scan. We conclude that, although the RN scan may augment the radiographic examination, it should not be used alone to screen for the battered child.

Topics: Battered Child Syndrome; Child Abuse; Child, Preschool; Diphosphonates; False Negative Reactions; False Positive Reactions; Femoral Fractures; Humans; Infant; Infant, Newborn; Male; Radiography; Radionuclide Imaging; Retrospective Studies; Rib Fractures; Skull Fractures; Technetium; Technetium Tc 99m Medronate; Tibial Fractures

Scintimetry with 99Tcm MDP was performed in 32 growth regions in 8 children with localized growth disturbances after surgery or injury. The results were compared with the simultaneously performed growth rate analysis using roentgen stereophotogrammetry. A quantitative and qualitative analysis of the nuclide bone images of the anterior view was performed. Numeric ratios, obtained by comparing count rate levels of injured or operated growth region with the corresponding contralateral region, are presented and a satisfactory correlation with the roentgen stereophotogrammetric growth rate analysis was found. Nuclide bone-imaging of growth regions at the knee and ankle provides valuable and significant information about growth and was found to be a clinically useful method when combined with standard radiographic techniques to evaluate growth conditions.

Topics: Adolescent; Age Determination by Skeleton; Bone and Bones; Bone Development; Child; Computers; Diphosphonates; Female; Femoral Fractures; Femur; Follow-Up Studies; Growth Disorders; Humans; Knee Injuries; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tibia