Fracture healing controlled by 87mSr uptake

Fracture stiffness measurement in tibial shaft fractures: a non-invasive method

This paper presents a non-invasive method of assessing healing by measurement of fracture stiffness. The method works on the principle that if the load (F) applied at a certain known distance (Y) from the fracture is measured, then the moment (M = FY) at the fracture site can be calculated. By measuring the angle/deflection (straight theta) occurring at the fracture site using a suitable instrument (electrogoniometer), the necessary data to calculate fracture stiffness (FY/straight theta) would be available. The method was employed to assess the stiffness in a series of tibial shaft fractures treated conservatively, all of which healed uneventfully. This paper concentrates on a group of tibial shaft fractures in which the radiological criteria for fracture union were not satisfied even after a mean duration of 20 weeks treatment. The non-invasive method of measuring fracture stiffness supported the clinical impression of union in most cases at the first test, but was repeated on two more occasions to confirm the trend of progressive healing. The objective evaluation of fracture healing led to avoidance of surgical intervention in these patients, who went on to sound union.

The 99Tcm-Sn-polyphosphate scintimetric time course of human tibial fractures with delayed union or pseudarthrosis

In 17 fractures of the human tibia, showing delayed union or the development of pseudarthrosis, the amount of callus formed was assessed monthly by scintimetry following intravenous administration of 99Tcm-Sn-polyphosphate. The mean scintimetric time course of the group of fractures with the atrophic type of delayed union was statistically significantly lower between the fourth and fourteenth week than that of fractures with uncomplicated healing. Nearly two-thirds of the fractures showed scintimetric ratios below the lower normal confidence limit (2 s.d.). The mean scintimetric time course of the fractures with the hypertrophic type of delayed union showed a normal scintimetric time course up to the eighth week, but from the tenth week a statistically significantly higher scintimetric ratio than the fractures with uncomplicated healing was found. The scintimetric ratio after the fourteenth week was below 2.5 for fractures with the atrophic type of delayed union, and above 2.5 for fractures with the hypertrophic type. The scintimetric time course of fractures which developed pseudarthroses was not different from those showing delayed union. The scintimetric method allows early detection of a pathological course of fracture healing. It supplies information about the functional state of the healing process and serves as an indicator of the correct treatment.

The time course of 99Tcm-Sn-polyphosphate scintimetry of normally healing tibial fractures in man

In 38 fractures of the human tibia showing radiological consolidation within 6 months, the amount of callus formed was assessed monthly by scintimetry following intravenous administration of 99Tcm-Sn-polyphosphate. The results of the scintimetry were expressed as a ratio (as radioactivity over the fracture divided by that over the contralateral area of the normal leg). The error of the scintimetric ratio within the period of measurements (20-60 minutes after the injection of isotope) was +/- 5 per cent. More isotope accumulated around the fracture in all patients. The scintimetric time course of transverse as well as longitudinal fractures showed a peak value (scintimetric ratio 3.6 +/- 0.6 s.d.) in the fourth to fifth week, whatever the primary treatment, and was of the same magnitude in the two types of fracture. A secondary increase of the scintimetric ratio was found in 70 per cent of the fractures following the start of weight bearing. Infection of a fracture induced a higher scintimetric ratio than that of an uninfected fracture. Re-fractures showed exceptionally high scintimetric ratios in the second to fourth week (twice the values of primary fractures), but the ratios decreased rapidly. Scintimetry is non-invasive, quantitative method of estimating the formation of callus. In this study the scintimetric time course of healing fractures of the tibia was determined. The results are to serve as a basic study of the method's suitability in early diagnosis of pathological healing.

Dynamic bone scanning in fractures

In 20 cases routine static bone scans were no value in the detection of delayed fracture healing. Using the 7.5-15 min net uptake of technetium labelled phosphate, disturbed fracture healing was detected in a series, of 37 cases. Normally healing fractures had an increase of 3 per cent per month and delayed unions less than half that amount. Non-unions had no net uptake.