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Comparison of bone scintigraphy uptake patterns may guide nonunion treatment
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Based on a retrospective study published in Orthopedics, bone scintigraphy with radiography can be used to assess biological activity in patients with nonunions.
“Bone scintigraphy is useful in assessing biological activity in fracture nonunions in addition to radiographic assessment,” the authors wrote in the study.
For the investigation, researchers from Kobe, Japan, assessed 48 consecutive patients who presented with nonunions from July 2008 onward and used the medical charts to identify patients with five clavicle, four humerus, one radius, 16 femur, 21 tibia and one fibula fracture(s). Ten patients underwent conservative treatment and 38 patients previously had surgery.
The researchers reviewed at least four bone scintigraphies for each patient that were performed prior to nonunion surgery, each of which was performed 3 hours after the patients underwent intravenous injection of Tc-99m hydroxy methylene diphosponate or Tc-99m methylene diphosphonate. Four views were the obtained.
Based on the graded intensity of the uptake, the investigators identified positive uptake in all patients on bone scintigraphy. This included 44% type 1 uptake, 21% type 2A uptake, 14% type 2B uptake and 21% type 3 uptake, according to the results. A comparison performed in patients with a nonunited and a united fracture showed higher uptake in 46% and lower uptake in 27% of them. All patients with hypertrophic nonunion and about half of patients with oligotrophic nonunion demonstrated type 1 uptake.
“Poor callus visualization may not preclude biological activity,” the authors wrote. “Long duration from injury may not equate to declines in biological activity. Comparing uptake in nonunions and united fractures in the same patient may help to assess biological activity.” – Renee Blisard Buddle
Disclosures: The authors have no relevant financial relationships to disclose.
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