Scintimetric Evaluation in the Assessment of Delayed Union of Skeletal Fractures

Aim: This study aims to analyze the utility of the Scintimetricevaluation in the assessment of delayed union of skeletal fractures in our institution.

Materials and Method: This retrospective study consists of  30 patients who had radiological evidence of complications involving healing of the fracture comprising of 16 males in the age range of 10 - 48 with the mean age of  25.31 ± 12.55 and 14 females in the age range of 8 - 56 with the mean age of 27.36 ± 14.35. Bone scans were done using the Siemens dual head gamma camera-e.cam. The Triple phase bone scan was done first followed by the Whole Body Bone Scans done at 4 & 24 hours after IV Injection of 10 to 25 mCi of 99mTc-MDP. Using Dynamic and Whole Body Acquisition Protocols both Anterior and Posterior view imageswere obtained. The focal hot spots in the processed images were identified in the 4hr and 24hr images using the region- ratio protocol. The maximum counts were calculated by drawing the region of interest area over the skeletal hot spots. The 4hr/24hr Dr. V.Siva’s  retention ratio was calculated, tabulated and analyzed.

Results:Out of 30 cases of delayed /non- union of Skeletal fractures 11( 37%) were found to be Metastatic Pathological fractures and 19(63%) turned out to be due to benign fracture complication like Stress fracture and Benign bone tumors.The 4/24hr rDr. V. Siva’s retention ratio values obtained for the Metastatic  Pathological group had the mean value of 12.5 +/- 3.1 with Standard error estimation +/- 0.61 and the benign group showed the mean value of 6.68 +/- 2.8 error estimation of +/-0.38.The statistical evaluation revealed that there is a significant difference between the two values with the p value of <0.0001.

Conclusion:Thus the Scintimetricevaluation of  thecomplications of fracture healing  helps in the differentiation between Metastatic Pathological and Simple benign causes leading to appropriate management in these  patients.