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

A series of 19 patients, who were clinically suspected of developing avascular necrosis of bone following fracture, were entered into a pilot study comparing the use of bone marrow scintigraphy with conventional skeletal scintigraphy. Two-phase bone scintigraphy, using 600 MBq of 99Tcm-HMDP, and perfusion and late-phase nanocolloid scintigraphy, using 370 MBq of 99Tcm-nanocolloid, were performed on each patient. In both methods, photon deficiency at the site of interest was taken to indicate avascularity. The perfusion phase of both methods was found to be unhelpful. Agreement between methods was obtained in 18 patients (95%). Six patients had abnormal nanocolloid scans, one of which was normal on the conventional bone scintigram. The remaining 13 patients had no evidence to suggest avascularity in either method. Three of the patients with abnormal scans have had hip replacement surgery following which avascularity of the femoral head was confirmed. 99Tcm-nanocolloid scintigraphy is thus shown to be a very sensitive method of demonstrating avascularity of bone following trauma.

Topics: Adult; Aged; Bone and Bones; Bone Marrow; Female; Femoral Neck Fractures; Femur Head Necrosis; Humans; Male; Middle Aged; Osteonecrosis; Pilot Projects; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate

In a prospective randomized investigation, AO screws (53 cases) and hook-pins (57 cases) were used for femoral neck fracture fixation in 110 cases. The results of the one-week postoperative scintimetry and a four-month radiographic follow-up were analysed. The femoral head vitality according to scintimetry was similar in the two groups, whether undisplaced or displaced fractures. Within four months from the operation, six cases with screw fixation had been subjected to total hip arthroplasty while only one with hook-pins, all because of fracture redisplacement. However, at the four-month control, another more fracture operated on with screws and five more operated on with hook-pins were scheduled for hip arthroplasty. Thus, no difference between the two methods regarding postoperative femoral head vitality or complications in short term follow-up, was noted.

Topics: Adult; Aged; Aged, 80 and over; Bone Nails; Bone Screws; Female; Femoral Neck Fractures; Follow-Up Studies; Fracture Fixation, Internal; Humans; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Random Allocation; Technetium Tc 99m Medronate; Time Factors

In 94 patients with femoral neck fracture the vitality of the femoral head was determined pre- and postoperatively with 99mTc-MDP-scintimetry. In half of the fractures a Thornton nail was used, in the other half three Scand hip pins. Irrespective of the displacement, no difference was noted in the two groups. In half of the operations in each group the fracture was impacted by hammer at the end of the operation. In displaced fractures, impaction caused a decrease in femoral head vitality.

Topics: Aged; Blood Vessels; Female; Femoral Neck Fractures; Femur Head; Fracture Fixation, Internal; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Technetium Tc 99m Medronate

With the aid of Tc-MDP-scintimetry 1-2 weeks after nailing of femoral neck fractures, it is possible to distinguish fractures liable to complications. Due to the suspicion that frequent peroperative vascular damage was caused by the four-flanged nail (Rydell), a less traumatizing cylindric nail (Hansson) with an insertion instrument was used. In a prospective investigation in January 1981-February 1982, which included all intracapsular femoral neck fractures, the two above-mentioned methods of osteosynthesis were used randomly. Intravital staining with tetracycline showed the peroperative circulation equivalent in Rydell and Hansson groups. A significant difference in postoperative isotope uptake could be noted between the two groups in 37 patients with undisplaced fractures. In 34 of 45 displaced fractures in the Rydell group evidence of circulatory deficiency appeared in the postoperative scintimetry but in only 23 of 52 of the displaced fractures in the Hansson group, a statistically significant difference. The latter figure corresponds well to the incidence of peroperatively registered severe vascular injury evaluated by tetracycline labelling.

Topics: Adult; Aged; Bone Nails; Diphosphonates; Female; Femoral Neck Fractures; Fracture Fixation, Internal; Humans; Male; Middle Aged; Prognosis; Prospective Studies; Radionuclide Imaging; Random Allocation; Technetium; Technetium Tc 99m Medronate

To evaluate the predicting value of. Pinhole bone scan of patients with metallically fixed femoral neck fracture from 2001 to 2015 were retrospectively reviewed. Initial pinhole bone scan was obtained within 2-3 weeks after surgery. Findings of initial pinhole bone scan were divided in to 4 groups. Group CU included cold defect in affected femoral head, group HU with no cold defect. Group PP with increased uptake along the inserted screws and group PN with no increased uptake along the inserted screws. More than 6 months of follow-up with pinhole bone scan and clinico-radiological evidence for ONFH was reviewed.. 72 patients (mean age 54.01 years, male 22, female 50) were included. 19 patients were in group CU, 53 in group HU. 60 patients were in group PP, 12 in group PN. During the follow-up, 13 patients were diagnosed as ONFH. 9 (47.36%) patients in group CU developed ONFH and 4 (7.5%) in group HU. 4 (6.66%) patients in group PP developed ONFH and 9 (75%) in group PN.. To predict ONFH of femoral head followed by neck fracture, many imaging techniques with variable results were known. In this study, cold defect in early postoperative pinhole bone scans could predict ONFH, and loss of increased uptake along screw inserted site could be a strong indicative sign of ONFH. Further evaluation with a larger population is necessary.

Topics: Adult; Bone Screws; Female; Femoral Neck Fractures; Femur Head; Femur Head Necrosis; Fracture Fixation, Internal; Humans; Male; Middle Aged; Postoperative Complications; Predictive Value of Tests; Radiography; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate

We prospectively performed gamma correction pinhole bone scan (GCPBS) and histopathologic verification study to make simultaneous morphobiochemical diagnosis of trabecular microfractures (TMF) occurred in the femoral head as a part of femoral neck fracture.Materials consisted of surgical specimens of the femoral head in 6 consecutive patients. The specimens were imaged using Tc-99m hydroxymethylene diphosphonate (HDP) pinhole scan and processed by the gamma correction. After cleansing with 10% formalin solution, injured specimen surface was observed using a surgical microscope to record TMF. Morphological findings shown in the photograph, naive pinhole bone scan, GCPBS, and hematoxylin-eosin (H&E) stain of the specimen were reciprocally correlated for histological verification and the usefulness of suppression and enhancement of Tc-99m HDP uptake was biochemically investigated in TMF and edema and hemorrhage using gamma correction.On the one hand, GCPBS was able to depict the calcifying calluses in TMF with enhanced Tc-99m HDP uptake. They were pinpointed, speckled, round, ovoid, rod-like, geographic, and crushed in shape. The smallest callus measured was 0.23 mm in this series. On the other hand, GCPBS biochemically was able to discern the calluses with enhanced high Tc-99m HDP uptake from the normal and edema dipped and hemorrhage irritated trabeculae with washed out uptake.Morphobiochemically, GCPBS can clearly depict microfractures in the femoral head produced by femoral neck fracture. It discerns the microcalluses with enhanced Tc-99m HDP uptake from the intact and edema dipped and hemorrhage irritated trabeculae with suppressed washed out Tc-99m HDP uptake. Both conventional pinhole bone scan and gamma correction are useful imaging means to specifically diagnose the microcalluses naturally formed in TMF.

Topics: Aged; Aged, 80 and over; Cancellous Bone; Female; Femoral Neck Fractures; Femur Head; Fractures, Stress; Humans; Male; Radiopharmaceuticals; Technetium Tc 99m Medronate

Subchondral insufficiency fracture of the femoral head may be confused with osteonecrosis, mainly because of radiological overlap. SPECT/CT with Tc-99 m hydroxymethylene diphosphonate images in 7 patients with subchondral insufficiency fracture were retrospectively reviewed and compared with those from 11 patients with symptomatic early osteonecrosis. In all of the hips with subchondral insufficiency fracture, SPECT/CT showed increased uptake at the subchondral lesions of the femoral head. On the other hand, in all of the hips with osteonecrosis, absence of uptake was confirmed at the subchondral lesions. SPECT/CT may assist in differentiating subchondral insufficiency fracture from osteonecrosis.

Topics: Aged; Diagnosis, Differential; Female; Femoral Neck Fractures; Femur Head Necrosis; Humans; Male; Middle Aged; Multimodal Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The objective of our study was to compare the accuracy of planar scintigraphy alone versus planar scintigraphy with SPECT for the initial evaluation of femoral neck stress fractures in a young military population.. We retrospectively identified 38 patients who had undergone planar scintigraphy and 33 patients who had undergone planar scintigraphy and SPECT before MRI of the hips over a 6-month period for evaluation of suspected femoral neck fracture. Data were analyzed regarding the sensitivity and specificity of bone scanning alone and with SPECT for detecting femoral neck stress fracture and grading fractures as low grade (grades I and II) or high grade (grades III and IV).. Twelve fractures were identified in the group who underwent planar scintigraphy alone and 13 in the group who underwent planar scintigraphy with SPECT. The sensitivities of planar scintigraphy alone and with SPECT were 50% and 92.3%, respectively (p = 0.03). The accuracy of each technique for the detection of high-grade fractures was 12.5% and 70%, respectively (p = 0.025).. Planar scintigraphy with SPECT had a higher sensitivity and accuracy in assessing the grade of femoral neck stress fractures than planar scintigraphy alone. The results of this study suggest that SPECT should be performed with planar bone scintigraphy for the evaluation of patients with suspected femoral neck stress fractures.

Topics: Adolescent; Adult; Aged; Female; Femoral Neck Fractures; Fractures, Stress; Gamma Cameras; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Military Personnel; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

To evaluate the role of preoperative bone scintigraphy in determining the operative treatment method for femoral neck fracture, we reviewed the data of 83 patients who underwent preoperative bone scanning after femoral neck fracture. Fractures were classified using the Garden staging system. Radioisotope uptake in femoral heads was evaluated visually. Of 28 patients with Garden stage I or II, radioactivity of the femoral head was normal in 26, partially reduced in one, and generally reduced in one patient. Twenty-seven patients were treated by closed reduction and multiple pinning, and one patient was treated by bipolar hemiarthroplasty. Of 55 patients with Garden stage III or IV, femoral-head radioactivity was normal in three, partially reduced in seven and generally reduced in 45 patients. Fifty-four patients were treated by bipolar hemiarthroplasty or total hip arthroplasty, and one patient was treated by closed reduction and multiple pinning. In only one of the 83 cases was the operative method changed because of bone scan findings. Isotope uptake of the femoral head after femoral neck fracture generally corresponded with the degree of fracture displacement. Preoperative bone scans appear to have no significant role to play in determining the operative treatment method for femoral neck fracture.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Femoral Neck Fractures; Femur Head; Femur Neck; Humans; Male; Middle Aged; Preoperative Care; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

A retrospective review of our radiology database revealed five elderly patients, seen over a 12-month period, whose findings were judged positive for hip fractures on the basis of their bone scans, but whose MR imaging findings were negative.. The presence of collar osteophytes around the femoral neck caused a false diagnosis of hip fracture for these patients, as revealed on radionuclide bone scans. CT or MR imaging correlation is needed where collar osteophytes may have caused an incorrect diagnosis of hip fracture based on a bone scan.

Topics: Aged; False Positive Reactions; Female; Femoral Neck Fractures; Humans; Magnetic Resonance Imaging; Male; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Quantitative bone scanning of the hip was carried out in 50 patients, 45 with unilateral disorders, and 5 with no symptoms and normal radiographs. The uptake ratio of the involved femoral head was calculated in the perfusion and static phases. In the patients with no symptoms the difference in the uptake ratio between the right and left hips averaged less than 0.02 in both phases. In 5 patients with a unilateral endoprosthesis the average was 0.52 in the perfusion and 0.34 in the static phase. In 10 patients with intertrochanteric fractures, 9 with undisplaced femoral neck fractures and 7 with osteoarthritis, each uptake ratio averaged more than 1.1 in both phases. In 9 patients with displaced femoral neck fractures, the mean ratio was 0.76 in the perfusion and 0.92 in the static phase. In 5 patients with avascular necrosis the ratio was 0.82 in the perfusion and 1.57 in the static phase. Quantification of uptake in both phases provides objective data reflecting bone blood flow and metabolism in various disorders of the hip.

Topics: Adult; Aged; Aged, 80 and over; Female; Femoral Neck Fractures; Femur Head; Hip Fractures; Humans; Male; Middle Aged; Osteoarthritis; Osteonecrosis; Radionuclide Imaging; Regional Blood Flow; Technetium Tc 99m Medronate

A follow-up study regarding the occurrence of segmental collapse of femoral head has been done in 53 patients of united femoral neck fracture including a periodic examination by 99mTc-MDP scintimetry. The results showed that the sequential variations in the nuclide uptake ratio of the femoral heads could reflect the histological repairing process and metabolic level in the femoral head. A sustainedly high nuclide uptake in 12 months after operation often denotes that there are defects in the repairing process of the ischemic femoral head, and that the segmental collapse of the femoral head will ensue.

Topics: Adolescent; Adult; Aged; Female; Femoral Neck Fractures; Femur Head; Femur Head Necrosis; Follow-Up Studies; Humans; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Medronate

We performed 99m-Tc diphosphonate scintimetries in 40-elderly patients who had undergone screw fixation for a recent subcapital femoral fracture and analyzed their preoperative radiographs. The data were subjected to a logistic regression analysis. Both comminution of the calcar femorale and reduced scintimetric uptake were predictive for failure of the osteosynthesis during the first year. Fracture comminution was more predictive for early failures during 3 months and scintimetry for the later failures.

Topics: Aged; Aged, 80 and over; Female; Femoral Neck Fractures; Femur Neck; Fracture Healing; Humans; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Regression Analysis; Technetium Tc 99m Medronate; Treatment Failure

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

A prospective study was undertaken to determine the value of scintigraphy in predicting nonunion or necrosis of the femoral head following femoral neck fractures. Scintigraphy was carried out in 49 patients before operation and in 37 one week after operation; in 18 it was done before and after operation. The uptake of isotope was estimated visually as either normal or reduced compared to the opposite side. All the patients were followed up for at least 2 years. The results indicate that pre-operative bone scintigraphy is useful in elderly patients to predict nonunion and necrosis, and therefore is recommended to select those patients who will benefit from primary arthroplasty instead of fixation of the fracture.

Topics: Aged; Female; Femoral Neck Fractures; Femur; Femur Head Necrosis; Fracture Fixation, Internal; Hip Prosthesis; Humans; Male; Postoperative Complications; Predictive Value of Tests; Prognosis; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Aged; Aged, 80 and over; Female; Femoral Neck Fractures; Fractures, Spontaneous; Humans; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

Forty patients with fresh femoral neck fractures treated with closed reduction and internal fixation were included in a prospective study of nonunion and osteonecrosis by preoperative and postoperative scintimetry. Correlated roentgenographic follow-up studies were continued for two years postoperatively. The aim of the study was to determine the relative prognostic accuracy of preoperative versus postoperative scintimetry. A ratio between the radionuclide uptake over the femoral head on the fracture side and the contralateral side exceeding 1.9 at the preoperative scintimetry and 1.2 at the postoperative scintimetry was associated with a high incidence of union, whereas a lower ratio often predicted subsequent complications (redisplacement, nonunion, or late segmental collapse). Prognostic accuracy was higher for scintimetry of fractures treated with closed reduction and internal fixation (0.70) than for untreated fractures (0.53). These results suggest that scintimetry is useful postoperatively to complement roentgenographic examination in assessing the prognosis of femoral neck fractures.

Topics: Aged; Aged, 80 and over; Female; Femoral Neck Fractures; Follow-Up Studies; Fracture Fixation, Internal; Fractures, Ununited; Hip Prosthesis; Humans; Male; Manipulation, Orthopedic; Middle Aged; Postoperative Period; Predictive Value of Tests; Preoperative Care; Prognosis; Prospective Studies; Radiography; Radionuclide Imaging; Reoperation; Technetium Tc 99m Medronate

Bone scintigraphy was performed before or after osteosynthesis or both in 11 children aged 9 to 14 years with femoral neck fractures. The role of bone scintigraphy in predicting development of femoral head necrosis with subsequent collapse was studied. Scintigraphy was not a useful study for this purpose. The explanation of this may be that reposition and osteosynthesis jeopardize the blood supply to the femoral head and invalidates the findings at the pre-operative scan. The childhood femoral head also has a strong potential for revascularization and complete reconstruction of the necrotic bone.

Topics: Child; Female; Femoral Neck Fractures; Femur Head; Femur Head Necrosis; Fracture Fixation, Internal; Humans; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

Five case reports demonstrate the value of bone scintigraphy in trauma. The bone scans clearly demonstrated fractures of the hip and pelvis that were not radiologically evident or the presence of which was doubtful, and also identified a number of unsuspected fractures in a patient with multiple injuries.

Topics: Aged; Aged, 80 and over; Female; Femoral Neck Fractures; Fractures, Bone; Hip Fractures; Humans; Male; Middle Aged; Pelvic Bones; Radionuclide Imaging; Sacroiliac Joint; Technetium Tc 99m Medronate

Four young patients who developed a fatigue fracture of the femoral neck are presented. The clinical features of pain with movement are described. The role of nuclear medicine is discussed with emphasis on its importance in the early diagnosis of this entity. The radiologic stages based on the site and time of presentation are analyzed: 1) normal, 2) sclerotic bands perpendicular to the trabeculations, 3) incomplete fracture, 4) complete fracture.

Topics: Adult; Cumulative Trauma Disorders; Female; Femoral Neck Fractures; Humans; Male; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

In 34 femoral neck fractures, CT was performed within 1-32 days after internal fixation. All the cases except one showed an increased distance between the femoral neck and the anterior aspect of the joint capsule as compared with the intact side, indicating varying degrees of hip joint effusion and/or synovitis. Hip joint aspiration in 11 patients revealed increased intracapsular pressure varying between 10 and 112 mmHg and volumes of aspirated joint effusion up to 23 ml. Pain relief and increased joint motion after drainage of the intracapsular effusion was observed in 3 patients whose postoperative mobilization was facilitated.

Topics: Aged; Exudates and Transudates; Female; Femoral Neck Fractures; Fracture Fixation, Internal; Hemarthrosis; Hip Joint; Humans; Male; Middle Aged; Postoperative Complications; Pressure; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Predictive clinical value of scintigraphical classification of the femoral head in intracapsular fracture of the femoral neck, as classified by Hirano, et al. in 1987, was investigated by long-term follow-up (mean; 4 years and 7 months). Normal healing was achieved in 21 of 24 patients. In those cases, early 99mTc-MDP scintigraphy revealed an over-all increase of radionuclide uptake (Type A) and band-like decrease along the fracture (Type B1). Late segmental collapse of the femoral head was found in 3 patients who showed either a decrease in the weight-bearing area (Type B2) or over-all decrease of radionuclide uptake (Type C). The results of fracture healing were well correlated to each type of scintigraphical classification. The changes of radionuclide uptake in the fracture site were also followed by serial 99mTc-MDP scintigraphy.

Topics: Adult; Aged; Aged, 80 and over; Female; Femoral Neck Fractures; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Wound Healing

A 2-year follow-up regarding healing complications, such as redisplacement, nonunion, and segmental collapse of the femoral head, was performed in 306 patients operated on for femoral neck fracture and examined with 99mTechnetium-MDP scintimetry within 2 weeks postoperatively. Scintimetric evaluation was performed by selecting regions of interest over the femoral head on the fracture side and the intact side and by comparing the uptake. A femoral head ratio fractured/intact side thus was obtained. Of 199 patients with an intact femoral head uptake (ratio greater than or equal to 1.0), 181 showed no signs of healing complications at 2 years, whereas 18 had developed healing complications. Of 107 cases with a deficient femoral-head uptake (ratio less than 1.0), 96 had developed healing complications within 2 years from the operation, while 11 cases had no signs of radiographic complications. We conclude that 99mTc-MDP scintimetry performed within 2 weeks from femoral neck fracture can predict the outcome of the healing course with a prognostic accuracy of 91 per cent.

Topics: Adolescent; Adult; Aged; Female; Femoral Neck Fractures; Humans; Male; Middle Aged; Prognosis; Radionuclide Imaging; Technetium Tc 99m Medronate; Wound Healing

Nine patients with nondisplaced femoral neck fracture were evaluated with preoperative Tc-MDP-scintimetry, ultrasonography, and measurement of the intracapsular pressure. The intracapsular pressure in straight neutral position of the hip exceeded normal hip pressure in all cases. Patients with an intracapsular pressure greater than 80 mm Hg had a low scintimetric rate, indicating a risk for segmental collapse of the femoral head. Intracapsular tamponade may contribute to the development of segmental collapse in some patients with nondisplaced femoral neck fracture, but further investigations are needed to determine whether evacuation of the hemarthrosis should be recommended.

Topics: Aged; Female; Femoral Neck Fractures; Femur Head; Humans; Male; Middle Aged; Pressure; Radionuclide Imaging; Regional Blood Flow; Technetium Tc 99m Medronate; Ultrasonography

Thirty-one femoral neck fractures which united without complications (nonunion or late segmental collapse) were included in a prospective sequential scintimetric study. Roentgenologically, three subgroups with different healing rates could be distinguished: rapid union, normal union, and delayed union. All fractures showed a rapid increase in relative femoral head radionuclide uptake after the 1-week scintimetry, followed by a gradual decline after 6 weeks-3 months. However, both the initial rise in activity and the time for maximal uptake tended to differ between the three groups. For rapid union and normal union the peak activity was registered at 6 weeks and for delayed union at 3 months. It is concluded that sequential scintimetric assessment of femoral head uptake can identify different healing rates and that this difference can be partly explained by a transient impairment of vascular supply to the femoral head in fractures with delayed healing.

Topics: Adult; Aged; Female; Femoral Neck Fractures; Fractures, Ununited; Humans; Male; Middle Aged; Prognosis; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors; Wound Healing

Forty-five patients with recent cervical hip fractures were included in a prospective, clinical, radiographic and sequential scintimetric study. Striking changes in radionuclide uptake over the entire hip region on the fracture side were found during the first 5 postoperative months. Fractures that healed without complications showed the highest relative femoral head uptake at 1 week and a peak value at 6 weeks, followed by a gradual decline at the subsequent examinations. Fractures with complications (redisplacement, nonunion, or late segmental collapse) showed a lower initial uptake and a more gradual increase and only a slight tendency towards increased uptake after 3 months. The accuracy in predicting nonunion with scintimetric examination alone is high both at 1 and at 6 weeks, and the accuracy is almost equally high with combined scintimetric, radiographic, and clinical assessment 3-5 months postoperatively.

Topics: Aged; Female; Femoral Neck Fractures; Femur Head; Femur Neck; Follow-Up Studies; Fractures, Ununited; Hip; Humans; Male; Prognosis; Prospective Studies; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors; Wound Healing

In order to determine the value of scintimetry as a tool for quantitative measurement of femoral head vascularity, the results of postoperative scintigraphic and histologic examination of surgically removed femoral head specimens were compared with those of preoperative radionuclide scintigraphy in 19 failed femoral neck fractures. Following intravenous administration of 600 MBq of Tc-99m MDP before hip replacement, the activity distribution in femoral head sections was recorded with a gamma camera and the area of isotope uptake calculated. A correlation was found between the results of preoperative noninvasive radionuclide scintigraphy and the assessment of isotope uptake in the removed femoral head specimens (r = 0.83, p less than .001) and was confirmed by the results of histologic examination. There is a risk, however, of overestimating the ratio of isotope uptake between the femoral head on the fracture side relative to the contralateral side with respect to quantitative assessment of femoral head vascularity, due to the general increase in isotope owing to accumulation in the injured hip region. The calculations, however, reflect the levels of radionuclide uptake and the varying degrees of femoral head vascularity.

Topics: Aged; Femoral Neck Fractures; Femur Head; Hip Prosthesis; Humans; Middle Aged; Technetium Tc 99m Medronate; Tomography, Emission-Computed

A prospective study of 17 patients with fracture neck of femur was undertaken to study the vascularity of the femoral head by bone scan using Technetium-99m MDP, as well as to study the viability of the femoral head by histopathology, and therefore determine correlation, if any, between these two methods. Treatment was by primary endoprosthetic replacement (Moore's Arthroplasty). In 16 of the 17 patients the bone scan showed decreased vascularity of the head, but histopathological examination could not confirm non-viability of the head. It is likely that, since the majority of the patients were operated on within 4 days, there was insufficient time for histopathological evidence of ischemia to develop, prior to removal of the femoral heads.

Topics: Aged; Female; Femoral Neck Fractures; Femur Head; Femur Head Necrosis; Fracture Fixation, Internal; Hip Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Medronate

Before operation, 99mTc-MDP scintimetry was performed in 103 patients with femoral neck fractures. There was a significant correlation (r = 0.63, p less than .01) between osteoporosis and fracture displacement, but no correlation (r = 0.07, p greater than .01) between femoral neck trabecular bone patterns and femoral head viability and no correlation (r = 0.11, p less than .01) between fracture displacement and femoral head viability.

Topics: Female; Femoral Neck Fractures; Femur Neck; Humans; Joint Dislocations; Osteoporosis; Radionuclide Imaging; Technetium Tc 99m Medronate

In eight undisplaced intracapsular fractures of the femoral neck, an intracapsular hematoma was diagnosed by computed tomography. 99mTc-MDP scintimetry revealed markedly reduced or absent blood supply to the head of femur. The intracapsular pressure was 23 (2.7-43) kPa with the hip in neutral position. Following aspiration of 12 (0.5-36) ml of blood, pressure was reduced to zero, and postaspiration scintimetry revealed restitution of blood supply to the femoral head. Hip joint tamponade in these patients has caused femoral head ischemia, reversible by aspiration.

Topics: Aged; Aged, 80 and over; Femoral Neck Fractures; Femur Head; Hemarthrosis; Hip Joint; Humans; Ischemia; Middle Aged; Pressure; Radionuclide Imaging; Suction; Technetium Tc 99m Medronate; Time Factors; Tomography, X-Ray Computed

Different sized ROIs within the femoral head and different modes of calculation were used in [99mTc]MDP scintimetry after femoral neck fracture. In preoperative scintimetry, correction for increased trochanteric uptake gave the best discrimination, whereas in postoperative scintimetry the direct ratio fractured/intact femoral head was superior. The change in ROI size had little influence.

Topics: Aged; Diphosphonates; Female; Femoral Neck Fractures; Femur; Femur Head; Humans; Male; Middle Aged; Postoperative Care; Preoperative Care; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Quantitative assessment of bone scintigraphy was performed in fifty-six patients with hip joint disease including femoral neck fracture, aseptic necrosis of the femoral head, traumatic dislocation of the hip, Perthes disease, and transient synovitis of the hip. In the static study, bone scintigraphy was obtained 3 hours after injection of 99mTc-MDP by gamma camera equipped with a computer and uptake ratios were calculated. In the dynamic study, bone scintigraphy was performed in one, 3 and 5 hours after injection of radionuclide. Femoral head uptake ratio was markedly decreased in osteonecrosis following femoral neck fracture and characteristically increased in aseptic necrosis of the femoral head but prolonged retention of 99mTc-MDP could be observed. Uptake ratios of epiphysis were decreased in Perthes disease but normal in transient synovitis of the hip. Static and dynamic study of bone scintigraphy may be useful for early diagnosis and treatment in the hip joint disease.

Topics: Adult; Aged; Child; Child, Preschool; Diphosphonates; Female; Femoral Neck Fractures; Femur Head Necrosis; Hip Dislocation; Hip Joint; Humans; Joint Diseases; Male; Middle Aged; Osteochondritis; Radionuclide Imaging; Synovitis; Technetium; Technetium Tc 99m Medronate

A retrospective study was made of all radionuclide (RN) bone images performed at our institution over a two-year period to evaluate femoral head viability after nonpathologic fracture of the femoral neck. Twelve patients had avascular femoral heads during the perioperative period, of which nine had adequate follow-up. Seven of these nine patients had follow-up bone images. Revascularization occurred in four patients, while three had persistent absence of femoral head uptake. With clinical follow-up ranging from four to 29 months (median: 14 months), only two of these nine patients developed clinical or radiographic evidence of osteonecrosis. RN bone imaging performed in the perioperative period does not reliably predict the development of post-traumatic osteonecrosis of the femoral head and, at present, should not be used to determine prospectively method of treatment of femoral neck fracture.

Topics: Adult; Bone Transplantation; Diphosphonates; Femoral Neck Fractures; Femur Head Necrosis; Follow-Up Studies; Fracture Fixation, Internal; Hip Prosthesis; Humans; Middle Aged; Postoperative Complications; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

In 22 patients with femoral neck fractures 99mTc-MDP scintimetry was performed before operation and again shortly after operation; in 17 of these patients the investigation was repeated after four months. Six patients with increased uptake in the femoral head before operation and eight with decreased uptake had similar results at the first postoperative investigation. Of eight patients with an intermediate uptake before operation, two showed increased and six decreased femoral head uptake after operation. It is concluded that for the patients in the group with intermediate femoral head uptake before operation, the operative procedure probably influenced the postoperative blood supply of the femoral head.

Topics: Adult; Aged; Diphosphonates; Female; Femoral Neck Fractures; Femur Head; Femur Neck; Humans; Male; Middle Aged; Pelvis; Postoperative Period; Preoperative Care; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

In 30 fresh fractures of the femoral neck, the preoperative femoral-head tracer uptake in Tc-99m MDP scintimetry was compared with the uptake of peroperatively obtained femoral-head biopsies and correlated to intravital bone staining by tetracycline, infused concurrently. Bone uptakes of Tc-99m MDP and tetracycline were shown to correlate well. Total absence of Tc-99m MDP uptake in the femoral-head biopsy corresponded to a scintigraphic uptake ratio of 0.7 (fractured over contralateral head), whereas a normal Tc-99m MDP biopsy uptake corresponded to a ratio of 1.5. This suggests that in Tc-99m MDP scintimetry of a normal hip, less than half of the emission ascribed to the femoral head is derived from the femoral head itself.

Topics: Adult; Aged; Biopsy; Diphosphonates; Female; Femoral Neck Fractures; Femur Head; Femur Head Necrosis; Humans; Male; Middle Aged; Oxytetracycline; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Femoral neck stress fracture is extremely rare in childhood. We report a case of femoral neck stress fracture in an 11-year-old girl. Differential diagnosis and a brief review of the literature follow.

Topics: Child; Diphosphonates; Female; Femoral Neck Fractures; Humans; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Biological fixation of the Christiansen endoprosthesis takes place gradually as a result of osteogenetic activity in the endosteal wall of the femur, which is subjected to mechanical stimulation by the madreporic shank of this prosthesis. The authors were able to monitor this biological process in 9 patients with the aid of bone scintigraphy.

Topics: Aged; Calcinosis; Diphosphonates; Female; Femoral Neck Fractures; Femur; Hip Prosthesis; Humans; Male; Middle Aged; Osteolysis; Osteoporosis; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Wound Healing

Preoperative 99mTc-MDP-scintimetry was performed in 117 patients with femoral neck fractures. Scintimetry was shown to be superior to visual evaluation. The ratio was calculated of the uptake in the femoral head of the fractured side over that in the unfractured side, with compensation for the increased trochanteric femoral activity found on the fractured side. A ratio above 0.90 correlated well with uneventful healing in both undisplaced and displaced fractures. Preoperative scintimetry is of great value in the choice of primary treatment of femoral neck fractures.

Topics: Adult; Aged; Diphosphonates; Female; Femoral Neck Fractures; Follow-Up Studies; Humans; Male; Middle Aged; Preoperative Care; Prognosis; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Wound Healing

Femoral head vitality was evaluated by tetracycline labeling and 99mTc-MDP scintimetry in 317 femoral neck fractures before and after internal fixation with two hook-pins. The preoperative vitality was about the same as that observed by others using comparable methods. The postoperative vitality was reduced in five of 81 undisplaced fractures and in 76 of 236 displaced fractures. These data would predict a rate of avascular healing complications of 7% in undisplaced and 32% in displaced fractures treated with hook-pins.

Topics: Adult; Aged; Bone Nails; Diphosphonates; Female; Femoral Neck Fractures; Femur Head; Fracture Fixation, Internal; Humans; Male; Middle Aged; Postoperative Complications; Postoperative Period; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tetracyclines; Wound Healing

In seven patients suffering redisplacement, nonunion or segmental collapse after nailing of femoral neck fractures, subsequent changes in the vitality of the femoral head were studied with tetracycline labeling and 99mTc-MDP scintimetry. At reoperation (total hip arthroplasty), the femoral heads were extracted and sawn into slices which were then analyzed. Vitality before nailing was totally lacking (tetracycline labeling) in one case (nonunion), and in the remaining cases moderate reduction was seen, most pronounced in the apical part of the head. In all cases, scintimetry 1-2 weeks after nailing showed reduced femoral head uptake of 99mTc-MDP, but scintimetry some hours before reoperation showed increased femoral head uptake. Isotope analysis of the slices from the extracted femoral heads showed marked reduction of uptake in the apical part of the head, moderate reduction in the distal and anterior parts, and satisfactory uptake in the posterior part of the head and the foveal region, though with individual variations. It was concluded that there is a genuine increase in uptake (revascularization) later in the course in postoperatively avascular heads, and that the apical part of the femoral head sustains the most pronounced vascular damage in femoral neck fracture and is probably the slowest to revascularize.

Topics: Aged; Diphosphonates; Femoral Neck Fractures; Femur Head; Fractures, Ununited; Hip Prosthesis; Humans; Radionuclide Imaging; Reoperation; Technetium; Technetium Tc 99m Medronate; Tetracycline

A scintimetric study using Tc-99m MDP was made of 54 patients with delayed union, nonunion, or late segmental collapse of the femoral head, 4-92 months after femoral neck fracture. In radiographically verified collapse, the radionuclide uptake ratio between the femoral head on the fractured and on the intact side (HHR) was significantly higher than in fractures resulting in delayed union or nonunion. On the basis of scintimetric and radiographic findings, the patients with healing disturbances could be divided into three groups, characterized by the following features: Satisfactory post-reduction position of the fracture without subsequent redisplacement and a high HHR, which as a rule turned out to be delayed union; The same radiographic pattern but with a lower HHR, which in most cases resulted in nonunion; Inadequate reduction or early redisplacement of the fracture with a high HHR, which resulted in nonunion. The fractional precision in discriminating between different types of disturbed fracture healing by means of skeletal scintimetry was 0.86 in this study. This non-invasive and technically simple method would therefore be a valuable complement to radiography in the assessment of healing, more than 4 months after fracture of the femoral neck.

Topics: Adult; Aged; Diphosphonates; Female; Femoral Neck Fractures; Fractures, Ununited; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors; Wound Healing

Twenty-six patients with late complications following femoral neck fracture were examined with both skeletal and bone marrow radionuclide scintimetry. There was no correlation between the methods with respect to the quantitative assessment of femoral head vascularity based on different uptake ratios comparing the fractured and the intact side. Skeletal scintimetry always had good image quality and permitted reliable differentiation between nonunion of the fracture and late segmental collapse, in contrast to bone marrow scintimetry which gave poor image quality. Skeletal scintimetry thus seems superior to bone marrow scintimetry for assessment and differential diagnosis of late complications following femoral neck fracture. It is emphasized that the physiological mechanisms for radionuclide uptake must be taken into account when comparing scintimetric studies using different tracers.

Topics: Aged; Bone Marrow; Diagnosis, Differential; Diphosphonates; Female; Femoral Neck Fractures; Fractures, Ununited; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Time Factors

Radionuclide bone imaging was performed on six patients with various hip conditions. Initial bone images revealed diminished uptake of isotope 99mTc-MDP in the capital femoral epiphysis. Following therapeutic intervention, repeat bone scans revealed normal uptake of 99mTc-MDP in the capital femoral epiphysis. Subsequent radiographs revealed that avascular necrosis had not occurred. There are two types of avascularity: the potentially reversible, and the irreversible. Attempts should be made toward early recognition of the potentially reversible avascular insult. With early recognition, surgical reconstruction prior to osteophyte death may result in revascularization. If this can be accomplished, avascular necrosis can be avoided.

Topics: Arthritis, Infectious; Child; Child, Preschool; Diphosphonates; Female; Femoral Neck Fractures; Femur Head Necrosis; Humans; Infant; Male; Radionuclide Imaging; Synovitis; Technetium; Technetium Tc 99m Medronate; Time Factors; Traction

Topics: Adolescent; Adult; Aged; Diphosphonates; Female; Femoral Neck Fractures; Femur Head; Follow-Up Studies; Fracture Fixation, Intramedullary; Humans; Male; Microscopy, Fluorescence; Middle Aged; Radionuclide Imaging; Spectrometry, Fluorescence; Technetium; Technetium Tc 99m Medronate; Tetracycline; Wound Healing

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

Two cases of operated femoral neck fractures are presented, in whom an intact femoral head isotope uptake was found with conventional Tc-MDP scintimetry. In both patients, emission tomography using the rotating slant-hole technique was diagnostic.

Topics: Aged; Bone Nails; Diphosphonates; Femoral Neck Fractures; Femur Head Necrosis; Humans; Male; Middle Aged; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed