tetracycline and Femoral-Neck-Fractures

The purpose of this study was to assess the utility of tetracycline hydrochloride (HCl) labeling of the femoral head following acute intracapsular fracture of the femoral neck to indirectly assess femoral head viability and vascularity. A standard labeling (1.5-3.0 g) and fixative protocol (70% ethanol) was used. The initial tetracycline dose was given in the emergency room. The time from last dose to bone sampling in the operating room ranged from six to 36 hours (average, 21.2 hours). There was no evidence of tetracycline deposition at the bone-osteoid interface in any of the femoral head specimens or the ipsilateral extracapsular greater trochanter control specimens. Sources of labeling failure are multifactorial: problems with label delivery to the patient, in vivo deposition of the label, and the fixation protocol.

Topics: Aged; Aged, 80 and over; Female; Femoral Neck Fractures; Femur Head; Humans; Male; Middle Aged; Prospective Studies; Tetracycline

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

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

Topics: Age Factors; Aged; Biopsy; Female; Femoral Neck Fractures; Femur Head; Femur Head Necrosis; Humans; Male; Microscopy, Fluorescence; Middle Aged; Regional Blood Flow; Tetracycline

Blood flow to the femoral head was assessed by 18F positron scintigraphy and tetracycline fluorescent labeling in 17 patients undergoing replacement of the femoral head with an endoprosthesis. Radioactivity was absent in the femoral head of 10 patients, normal in 5, and increased in 2. Normal or increased radioactivity indicated presence of blood flow to the femoral head; decreased or absent radioactivity indicated absence of blood flow. Results of 18F scintigraphy correlated with those of tetracycline labeling.

Topics: Acute Disease; Adolescent; Adult; Aged; Arthritis; Female; Femoral Neck Fractures; Femur Head; Fluorine; Humans; Male; Middle Aged; Prostheses and Implants; Radioisotopes; Radionuclide Imaging; Regional Blood Flow; Tetracycline

Fluoride-18 scintigraphy is a simple, safe method for evaluating perfusion to bone, and obviates objections to earlier techniques. The scintillation camera with positron detection represents a unique instrumentation system because of its tomographic effect, relative insensitivity to vascular radioactivity in the surrounding skeleton, and excellent spatial resolution despite low counting efficiency. In 75 patients with avascular disorders about the hip, knee, elbow, foot and hand, the impressions obtained from fluoride-18 scintigraphy were correlated with clinical findings and roentgenograms and when possible confirmed by tetracycline labeling and histological examination. Fluoride-18 scintigraphy was useful: in determining the vascularity of the femoral head following femoral neck fractures; in determining results of treatment; and in diagnosing early the various avascular necrotic disorders of the bone.

Topics: Adolescent; Aged; Bone and Bones; Bone Diseases; Child; Female; Femoral Neck Fractures; Fluorescence; Fluorine; Humans; Male; Necrosis; Osteochondritis; Radioisotopes; Radionuclide Imaging; Tetracycline; Wrist Injuries

Topics: Animals; Barium Sulfate; Dogs; Femoral Neck Fractures; Femur Head; Fracture Fixation; Methods; Osteotomy; Radiography; Rotation; Tetracycline; Wound Healing

Topics: Angiography; Blood Circulation; Coloring Agents; Data Collection; Femoral Neck Fractures; Femur Head; Fluorescence; Fracture Fixation; Humans; Iodine Isotopes; Metabolism; Phosphorus Isotopes; Polarography; Postoperative Complications; Sodium Isotopes; Tetracycline

Topics: Enteritis; Enterocolitis, Pseudomembranous; Femoral Neck Fractures; Femur Neck; Fractures, Bone; Protein Synthesis Inhibitors; Tetracycline