technetium-tc-99m-medronate and Hand-Injuries

We report a retrospective study of the prognostic value of 2-phase technetium 99m bone scanning performed in 92 patients who presented to Chamonix Hospital with severe frostbite of the extremities in the past 12 years. The results of this study show that an initial bone scan (as early as day 3) has excellent specificity in evaluating the severity of frostbite injury. There was a direct correlation between the demarcation zone of uptake in the phalanges and the eventual level of amputation (positive predictive value, 0.84). A second scan on approximately day 7 was even more sensitive and informative. A strong correlation existed between positive uptake and eventual healing (negative predictive value, 0.99). This study showed that (99m)Tc bone scanning in the first few days after frostbite injury indicates the level of amputation in severe frostbite in more than 84% of cases. We propose an algorithm based on the results of this study that can be used to evaluate new medical and surgical management of frostbite injury.

Topics: Adult; Amputation, Surgical; Female; Frostbite; Hand Injuries; Humans; Male; Necrosis; Prognosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Quantitative analysis of three-phase bone scintigrams was done in 70 patients with reflex sympathetic dystrophy (RSD) and in 30 patients who did not have RSD after injury to the hand or wrist. Regions of interest were selected and the uptake ratios (affected/unaffected) were calculated. Significant differences between affected and unaffected patients were seen in the metacarpal area in phase 2 of the scintigrams as well as in the metacarpophalangeal joints and metacarpal bones in phase 3. Combination of these images had the greatest diagnostic value. Sensitivity and specificity of 80% were achieved in the regions of interest in phase 3. The duration of RSD and the predisposing injury significantly affected the results of bone scintigraphy. It was also noted that a fracture may cause increased fixation of the tracer in each phase of three-phase bone scintigraphy in asymptomatic patients.

Topics: Adult; Aged; Female; Hand Injuries; Humans; Male; Middle Aged; Radionuclide Imaging; Reflex Sympathetic Dystrophy; Sensitivity and Specificity; Technetium Tc 99m Medronate; Wrist Injuries

A case of traumatic myositis of the intrinsic muscles of the hand is presented. This is believed to be the first report in which the diagnosis of this type of soft tissue injury was made based upon phases I and II of a three-phase bone scan. An incorrect diagnosis of primary skeletal injury could have been made if delayed, 3-4 hour (phase III) imaging alone had been performed because there was augmented uptake of tracer in the normal bone adjacent to the area of soft tissue hyperemia. This report emphasizes the need to perform three-phase scintigraphy to diagnose nonskeletal injury in patients with suspected bone trauma or pain of unknown etiology.

Topics: Hand Injuries; Humans; Male; Middle Aged; Myositis; Radionuclide Angiography; Technetium Tc 99m Medronate

Three-phase radionuclide scintigraphy of the hand was performed on 116 patients. Normal and abnormal patterns for radionuclide angiography, immediate post-injection blood-pool images, and delayed scans (3-4 hr.) were established. Of 80 patients with normal circulation, 61 (76%) had equal radial and ulnar artery flow bilaterally, while in 19 (24%) either the radial or ulnar artery was dominant. Abnormal studies were grouped into three categories: suspected vascular lesions (Group I), pain of uncertain etiology (Group II), and patients evaluated before and after reconstructive surgery (Group III). The diagnosis was correct in 89% of the patients in Group I (34/38), 89% of those in Group II (57/64), and all of those in Group III (14/14). Three-phase scintigraphy of the hand yields significant information about perfusion and bone metabolism.

Topics: Adolescent; Adult; Aged; Arteriovenous Malformations; Arthritis; Bone Neoplasms; Child; Child, Preschool; Diphosphonates; Female; Hand; Hand Injuries; Hemangioma; Humans; Male; Middle Aged; Radionuclide Imaging; Raynaud Disease; Reference Values; Regional Blood Flow; Technetium; Technetium Tc 99m Medronate; Thrombosis