Vet Comp Orthop Traumatol 1999; 12(03): 142-150
DOI: 10.1055/s-0038-1632480
Original Research
Schattauer GmbH

Qualitative and Quantitative Scintigraphic Imaging to Predict Fracture Healing

S. M. Averill
1   From the Departments of Veterinary Clinical Medicine
,
Ann L. Johnson
1   From the Departments of Veterinary Clinical Medicine
,
M. Chambers
1   From the Departments of Veterinary Clinical Medicine
,
C. W. Smith
1   From the Departments of Veterinary Clinical Medicine
,
S. Kneller
1   From the Departments of Veterinary Clinical Medicine
,
A. R. Twardock
2   Veterinary Biosciences, College of Veterinary Medicine, University of Illinois, Urbana, IL, USA
,
D. J. Schaeffer
2   Veterinary Biosciences, College of Veterinary Medicine, University of Illinois, Urbana, IL, USA
› Author Affiliations
Further Information

Publication History

Received 14 September 1998

Accepted 07 November 1998

Publication Date:
09 February 2018 (online)

Summary

Purpose: Evaluate the value of 24- hour postoperative quantitative bone scintigraphy to identify devascularized fragments and predict delayed fracture bridging in canine clinical patients; to determine the effect of fracture type, fixation type, age, sex, and weight on fracture bridging and the quantitative scintigraphic ratios; and to evaluate the relationship between qualitative scintigraphic assessment and quantitative scintigraphic ratios. Methods: Forty-two adult dogs, with diaphyseal long bone fractures treated with minimally invasive biological or invasive surgical techniques, were evaluated with 24-hour postoperative bone scintigraphy and six and 12 week postoperative radiographs. Fractured bones were classified as simple, moderately multiple, or severely multiple. Bone scintigrams were qualitatively and quantitatively analyzed. Radiographs were made at six and 12 weeks after the operation and graded as fracture gap(s) bridged or not bridged with bone opacity material. The data was evaluated statistically to determine the relationship between age, sex, and weight of the dogs, fracture type, fixation type, and results of scintigram analysis to fracture bridging at six and 12 weeks. Results: Fourteen of the 42 fractures were bridged at six weeks after the operation and 33 at 12 weeks. Prediction of fracture healing was not possible. There was not any statistical relationship of fracture type, fixation, sex, nor weight to bridged fractures or non-bridged fractures at six and 12 weeks. There was a trend toward more of the fractures with multiple fragments treated with minimally invasive biological techniques to be bridged by 12 weeks when compared to similar fractures treated with invasive techniques. The mean age of dogs with bridged fractures at six and 12 weeks was significantly lower than the mean age of dogs with non-bridged fractures at six and 12 weeks. Qualitative scintigraphic assessment scores were not significantly related to the quantitative scintigraphic ratios or to fracture bridging. Conclusions: Neither qualitative nor quantitative assessment of bone scintigrams 24 hours after the operation could be used to predict fracture bridging at six or 12 weeks postoperatively.

The value of 24-hour postoperative qualitative and quantitative bone scintigraphy to predict fracture bridging by 12 weeks in canine clinical patients with diaphyseal long bone fractures was evaluated. Neither qualitative nor quantitative assessment of bone scintigrams 24 hours after the operation could be used to predict fracture bridging by 12 weeks.

Supported in part by a grant from the AO Vet Centre, Zurich, Switzerland.

 
  • REFERENCES

  • 1 Alavi A, Brighton C, Dalinka M. et al Bone scanning in the evaluation of nonunited fractures. J Nucl Med 1979; 20: 647.
  • 2 Aron DN, Johnson AL, Palmer RH. Biologic strategies and a balanced concept for repair of highly comminuted long bone fractures. Compend Contin Educ Pract Vet 1995; 17: 35-49.
  • 3 Auchincloss JM, Watt I. Scintigraphy in the evaluation of potential fracture healing: a clinical study of tibial fractures. Brit J Rad 1982; 55: 707-13.
  • 4 Bauer GCH, Wendeberg B, Sweden M. External counting of Ca47and Sr85in studies of localised skeletal lesions in man. J Bone Joint Surg 1959; 41B: 558-80.
  • 5 Baumgaertel F, Perren SM, Rahn B. Animal experimental studies of "biological" plate osteosynthesis of multifragment fractures of the femur. Unfallchirurg 1994; 97: 19-27.
  • 6 Binnington AG. Bone remodeling and transplantation. In: Canine orthopedics. Whittick WG. (ed) Philadelphia, PA: Lea and Febiger; 1990: 166-8.
  • 7 Brinker WO, Hohn RB, Prieur WD. et al. Manual of internal fixation in small animals. Berlin: Springer-Verlag; 1984
  • 8 Egger EL, Palmer JL, Lewallen DG. et al Effect of destabilizing rigid external fixation on healing of unstable canine osteotomies. Trans Orthop Res Soc 1988; 13: 302.
  • 9 Gerber C, Mast JW, Ganz R. Biological internal fixation of fractures. Arch Orthop Trauma Surg 1990; 109: 293-5.
  • 10 Gregg PJ, Barsoum MK, Clayton CB. Scintigraphic appearance of the tibia in the early stages following fracture. Clin Orthop Rel Res 1983; 175: 139-46.
  • 11 Gregg PJ, Clayton CB, Fenwick JD. et al Static and sequential dynamic scintigraphy of the tibia following fracture. Injury 1986; 17: 95-103.
  • 12 Gumerman LW, Fogel SR, Goodman MA. et al Experimental fracture healing: evaluation using radionuclide bone imaging: concise communication. J Nuc Med 1978; 19: 1320-3.
  • 13 Harris WR. Fracture healing. In: Canine orthopedics. Whittick WG. (ed) Philadelphia, PA: Lea and Febiger; 1990: 158-65.
  • 14 Hughes SPF. Radionuclides in orthopaedic surgery. J Bone Joint Surg 1980; 62B: 141-50.
  • 15 Hughes SPF. Fractures and bone grafts. In: Radionuclide scintigraphy in orthopaedics. Galasko CSB, Weber DA. (eds) New York, NY: Churchill Livingstone; 1984: 186-99.
  • 16 Hughes SPF. Khan R, Davies R. et al The uptake by the canine tibia of the bonescanning agent99mTc-MDP before and after an osteotomy. J Bone Joint Surg 1978; 60B: 579-82.
  • 17 Hulse D, Hyman W, Nori M. et al Reduction in plate strain by addition of an intramedullary pin. Vet Surg 1997; 26: 451-9.
  • 18 Illingsworth GI, Schiess FA. Strontium 87m in the prognosis of fractures of the tibia. Proc R Soc Med 1971; 64: 633-4.
  • 19 Jacobs RR, Jackson RP, Preston DF. et al Dynamic bone scanning in fractures. Injury 1981; 12: 455-9.
  • 20 Johannsen A. Fracture healing controlled by87mSr uptake. Acta Orthop Scand 1973; 44: 628-39.
  • 21 Johnson AL, Smith CW, Schaeffer DJ. Fragment reconstruction and bone plate stabilization compared with bridging plate fixation for treating highly comminuted femoral fractures: 35 cases (1987-1997). J Am Vet Med Assoc (in press)
  • 22 Kita K, Kawai K, Hirohata K. Changes in bone marrow blood flow with aging. J Orthop Res 1987; 5: 569.
  • 23 Mennen U, Dormehl IC, Goosen DJ. Evaluation of the healing process of bone fractures in the nonhuman primate using sequential99mTc-methylene diphosphonate scintigraphy. S Afr J Surg 1985; 23: 98-101.
  • 24 Mondal A. Bhatnagar A, Sharma R. et al Evaluation of the healing process in fractures using early and delayed bone scanning. Austral Rad 1994; 38: 284-7.
  • 25 Muheim G. Assessment of fracture healing in man by serial 87m strontium-scintimetry. Acta Orthop Scand 1973; 44: 621-7.
  • 26 Oni OOA, Graebe A, Pearse M. et al Prediction of the healing potential of closed adult tibial shaft fractures by bone scintigraphy. Clin Orthop Rel Res 1989; 245: 239-45.
  • 27 Oni OOA, Hui A, Gregg PJ. The healing of closed tibial shaft fractures. J Bone Joint Surg 1988; 70B: 787-90.
  • 28 Perren SM. Concept of biological plating using the limited contact dynamic compression plate. Injury AO/ASIF Scientific Suppl 1991; 22: 1-41.
  • 29 Perren SM, Klaue K, Pohler O. et al The limited contact dynamic compression plate. Arch Orthop Surg 1990; 109: 304-10.
  • 30 Rhinelander FW. The normal microcirculation of diaphyseal cortex and its response to fracture. J Bone Joint Surg 1968; 50A: 784-800.
  • 31 Rhinelander FW. The normal circulation of bone and its response to surgical intervention. J Biomed Mater Res 1974; 8: 87-90.
  • 32 Rhinelander FW, Baragry RA. Microangiography in bone healing. I. Undisplaced closed fractures. J Bone Joint Surg 1962; 44A: 1273-98.
  • 33 Rhinelander FW, Wilson JW. Blood supply to developing, mature, and healing bone. In: Bone in clinical orthopedics. Sumner-Smith G. (ed) Philadelphia, PA: WB Saunders Co; 1982: 81-158.
  • 34 Riggins RS, DeNardo GL, D'Ambrosia R. et al Assessment of circulation in the femoral head by18F scintigraphy. J Nucl Med 1974; 15: 183-6.
  • 35 Smith MA, Jones EA, Strachan RK. et al Prediction of fracture healing in the tibia by quantitative radionuclide imaging. J Bone Joint Surg 1987; 69B: 441-7.
  • 36 Spitz J, Lauer I, Tittel K. et al Scintimetric evaluation of remodeling after bone fractures in man. J Nucl Med 1993; 34: 1403-9.
  • 37 Sumner-Smith G, Bishop HM. Nonunion: pathogenesis and treatment. In: Bone in clinical orthopedics. Sumner-Smith G. (ed) Philadelphia, PA: WB Saunders Co; 1982: 399-427.
  • 38 Tucker FR. Use of radioactive phosphorus in avascular necrosis of the femoral head. J Bone Joint Surg 1950; 32B: 100-7.
  • 39 Unger M, Montavon PM, Heim UFA. Classification of fractures of long bones in the dog and cat: introduction and clinical application. Vet Comp Orthop Traum 1990; 3: 41-50.
  • 40 Wendeberg B. Mineral metabolism of fractures of the tibia in man studied with external counting of Sr85 . Acta Orthop Scand Suppl 1961; 52: 1-79.