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

Retroperitoneal haematoma is rarely described in the context of bone scintigraphy, as it is usually an incidental discovery on bone scan carried out for another purpose. We report a case of a right retroperitoneal haematoma detected on Tc-99m-methylene diphosphonate bone scintigraphy taken in an elderly patient presenting with a mechanical fall and a right acetabular fracture.

Topics: Accidental Falls; Aged; Female; Hematoma; Hip Fractures; Humans; Peritoneal Diseases; Radionuclide Imaging; Radiopharmaceuticals; Retroperitoneal Space; Technetium Tc 99m Medronate

I present 10 cases of spongious bone injury of the femoral head induced by physical stress. All patients were young military recruits who complained of hip pain from weight bearing which had started during physical exertion. Increased uptake in a radionuclide bone scan was regarded as the criterion for stress osteopathy. 7 hips were radiographically normal. In 3 cases a subcortical lateral cystic lesion of the femoral head was observed. MRI was performed in 6 cases. A decreased signal intensity in T1-weighted images in 5 cases and high signals in T2-weighted and IR signals (2 patients) indicated bone marrow edema. A lateral osteophyte of the femoral head developed in 1 case during 8 years' follow-up. After a median of 6 years, 9 patients still had occasional slight hip pain.

Topics: Adult; Femur Head; Follow-Up Studies; Fractures, Stress; Hip Fractures; Humans; Magnetic Resonance Imaging; Male; Military Personnel; Pain; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Weight-Bearing

Three-dimensional bone scintigraphic images were made and their usefulness and limitations discussed.. After usual bone scan procedures, single-photon emission computed tomography (SPECT) data were taken and reconstructed into three-dimensional images. Volume rendering methods were used.. Three cases of three-dimensional bone scintigraphy were obtained; one of a normal patient, one of a case of transplanted kidney and incomplete fracture of the left femoral head, and one of a case of degenerative joint disease (DJD) on the left temporomandibular joint (TMJ). The three-dimensional structure of the skeletal system was depicted more clearly by the three-dimensional images than by a conventional bone scan.. Three-dimensional bone scintigraphs were thought to provide additional information for better understanding of the nature of bone lesions. Some technical improvements including automated threshold level determination and feature extraction for detecting abnormal high uptake are required before routine use can be envisaged.

Topics: Adult; Bone and Bones; Female; Femur Head; Hip Fractures; Humans; Image Processing, Computer-Assisted; Kidney Transplantation; Middle Aged; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders; Tomography, Emission-Computed, Single-Photon

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

We performed single-photon-emission CT (SPECT) and planar bone scans to assess femoral head vascularity in ten patients with displaced intracapsular hip fracture. The heads were labelled with tetracycline and after excision at hemiarthroplasty were assessed for tetracycline uptake distribution by fluorescence under UV light. The four which had the greatest tetracycline uptake were normal on SPECT and planar imaging. In two cases the planar bone scans were normal although SPECT suggested avascularity thus giving false-negative results. Surgeons should be aware of this; SPECT may prove to be a more accurate method of assessing vascularity of the femoral head in fractures of the femoral neck.

Topics: Arthroplasty; Femur Head; Hip Fractures; Humans; Technetium Tc 99m Medronate; Tetracycline; Tomography, Emission-Computed, Single-Photon

Topics: Aged; Aortic Aneurysm, Abdominal; Female; Hip Fractures; Humans; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

During the past 4 years, three-phase bone scintigraphy using 99mTc-MDP has been studied in 68 patients suffering from hemi-lateral hip-joint disorders. We were impressed on abnormal uptake of the shaft of femur on the involved side. 99mTc-MDP uptake in the shaft of femur is compared with between involved leg and normal leg of 68 cases with hemi-lateral hip-joint disorders (76 examinations). We excluded cases of osteomyelitis, cases of malignant tumor, and post-operative cases. In early images, the 99mTc-MDP uptake is not always increased in involved side. But in delayed images, there are no patients whose normal side's 99mTc-MDP uptake is increased. The 99mTc-MDP uptake in early image is not related only with blood flow of the thigh but with the amount of soft tissue of the thigh. And the 99mTc-MDP uptake in delayed image is related with disuse osteoporosis.

Topics: Adult; Aged; Child; Female; Femur; Hip Dislocation; Hip Fractures; Humans; Legg-Calve-Perthes Disease; Male; Middle Aged; Osteoarthritis, Hip; Osteonecrosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Bone and Bones; Female; Hematoma; Hip Fractures; Humans; Middle Aged; Pelvis; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

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

In 20 cases of fresh cervical hip fracture, treated with primary prosthetic replacement, preoperative 99mTc-MDP scintimetry was compared with histologic findings of the extracted femoral heads. The radionuclide uptake was classified into three types according to the activity distribution; overall increase, focal decrease, and overall decrease. Histologically, the location and extent of ischemic necrosis in the femoral heads were closely related to the distribution of decreased activity.

Topics: Aged; Aged, 80 and over; Female; Femur Head; Hip Fractures; Humans; Ischemia; Male; Middle Aged; Necrosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Of 693 elderly patients admitted with suspected hip fractures, 43 had normal radiographs and were investigated by isotope bone scan. The 30 patients (70%) with normal scans were mobilised and none developed a fracture. All 13 of the patients with specific bone scan abnormalities were subsequently proved to have fractures, five of which became displaced. Clearly conventional radiography does not exclude fracture of the femoral neck in elderly patients; bone scanning is advisable in doubtful cases.

Topics: Aged; Aged, 80 and over; Bone and Bones; Hip Fractures; Hip Joint; Humans; Middle Aged; Prospective Studies; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

A review was made of the records of 24 consecutive trauma patients (aged 55-94 years) who had under gone radiographic examinations and a positive bone image of the femur or pelvis. There was considerable discordance between the radiographs and the bone images. Initially, 25% of the radiographs were interpreted as positive. Even after additional radiographs and retrospective. review, only 38% of the x-ray studies were positive. Bone imaging was a useful adjunct in these patients, both to confirm or exclude suspected fractures and to detect occult fractures. The necessity of delaying bone imaging for several days after the trauma was discussed.

Topics: Aged; Female; Fractures, Bone; Hip Fractures; Humans; Male; Middle Aged; Pelvic Bones; Radionuclide Imaging; Technetium Tc 99m Medronate

Three-phase radionuclide bone (TPB) imaging was performed on 238 patients with sports-related injuries. A wide variety of lesions was encountered, but the most frequent lesions seen were stress fractures of the lower part of the leg at the junction of the middle and distal thirds of the posterior tibial cortex (42 of 79 lesions). There were no differences in the type, location, or distribution of lesions between males and females or between competitive and noncompetitive athletes. In 110 cases, bone stress lesions were often diagnosed when radiographs were normal, whereas subacute or chronic soft-tissue abnormalities had few specific scintigraphic features. TPB imaging provides significant early diagnostic information about bone stress lesions. Normal examination results (53 cases) exclude underlying osseous pathologic conditions.

Topics: Adolescent; Adult; Aged; Athletic Injuries; Back Pain; Bone and Bones; Child; Connective Tissue Diseases; Diphosphonates; Female; Fibula; Follow-Up Studies; Foot Injuries; Fractures, Bone; Hip Fractures; Humans; Leg Injuries; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sports; Technetium; Technetium Tc 99m Medronate; Tibial Fractures; Time Factors

Osteopenic bones in patients on chronic steroid therapy are often difficult to assess for occult fractures. Such patients are also at greater risk for fractures. Technetium 99m bone scan is currently thought to represent the most sensitive method of diagnosing these lesions. We present a case of failure of diagnosis of a subtle fracture by Tc-99m bone scan and speculate on the role of steroid therapy in the mechanism of this failure.

Topics: Adult; Diphosphonates; Female; Fractures, Spontaneous; Hip Fractures; Humans; Immunosuppressive Agents; Kidney Transplantation; Prednisone; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

A prospective study of the development of necrosis of the femoral head was performed in 34 patients with fractures of the femoral neck. Technetium-99m MDP images of the hip regions were obtained immediately after nailing of the hip and at four, eight and 12 months. There was a good correlation between qualitative and numeric evaluation of isotope uptake in the femoral heads. Comparison of the activity level in the femoral head on the fracture side with that in the contralateral control site showed activity ratios to vary between < 1.0 for those heads showing a general reduction in activity on conventional images to > 1.4 with a mean of 2.0 for those showing increased activity. The initial postoperative images in 2/7 undislocated fractures showed a marked depression in femoral head activity on the fracture side; 13/21 dislocated fractures showed a similar defect suggesting a significant loss of bone remodeling. Normal Tc-99m activity in the femoral head (category 2) was observed in two fracture cases imaged within 24 hours of fracture, just prior to nailing. Repeat studies within one week of fracture and nailing demonstrated a marked depression in activity (category 0). Radiographic evidence of collapse later developed in both patients. The perfusion and blood pool images were useful for identifying femoral heads with deficient circulation. This investigation has demonstrated that the nailing procedure may threaten the vascular condition of the femoral head in hip fracture, that a dead head may be radiographically normal and clinically asymptomatic, and that the metabolic condition of the femoral head may be expressed in numeric terms suitable for statistical analysis.

Topics: Adult; Aged; Bone Nails; Diphosphonates; Female; Femur Head; Femur Head Necrosis; Hip Fractures; Humans; Joint Dislocations; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate