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BACKGROUND: Although definitions vary, infected nonunion has been defined as a state of failure of union and persistence of infection at the fracture site for 6 to 8 months.>). Infected nonunions of the supracondylar region of the femur are uncommon and are mostly due to a severe open fracture with extensive comminution and segmental bone loss or after internal fixation of a comminuted closed fracture. Associated factors include exposed bone devoid of vascularized periosteal coverage for more than 6 weeks, purulent discharge, a positive bacteriological culture from the depth of the wound, and histologic evidence of necrotic bone containing empty lacunae. Soft-tissue loss with multiple sinuses, osteomyelitis, osteopenia, complex deformities with limb-length inequality, stiffness of the adjacent joint, polybacterial multidrug-resistant infection, and smoking all complicate treatment and recovery. Although uncommon in incidence, infected ...

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A scintimetric study using Tc-99m MDP was made of 54 patients with delayed union, nonunion, or late segmental collapse of the femoral head, 4-92 months after femoral neck fracture. In radiographically verified collapse, the radionuclide uptake ratio between the femoral head on the fractured and on the intact side (HHR) was significantly higher than in fractures resulting in delayed union or nonunion. On the basis of scintimetric and radiographic findings, the patients with healing disturbances could be divided into three groups, characterized by the following features: (1) Satisfactory post-reduction position of the fracture without subsequent redisplacement and a high HHR, which as a rule turned out to be delayed union; (2) The same radiographic pattern but with a lower HHR, which in most cases resulted in nonunion; (3) Inadequate reduction or early redisplacement of the fracture with a high HHR, which resulted in ...

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Twenty-six patients with late complications following femoral neck fracture were examined with both skeletal and bone marrow radionuclide scintimetry. There was no correlation between the methods with respect to the quantitative assessment of femoral head vascularity based on different uptake ratios comparing the fractured and the intact side. Skeletal scintimetry always had good image quality and permitted reliable differentation between nonunion of the fracture and late segmental collapse, in contrast to bone marrow scintimetry which gave poor image quality. Skeletal scintimetry thus seems superior to bone marrow scintimetry for assessment and differential diagnosis of late complications following femoral neck fracture. It is emphasized that the physiological mechanisms for radionuclide uptake must be taken into account when comparing scintimetric studies using different tracers.

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In this study the distribution of sup(99m)Tc-diphosphonate and tetracycline and histological examination were also investigated in femoral heads obtained during replacement surgery. One hundred patients received scintigraphic examinations immediately after the occurrence of injury and every month thereafter. Ten mCi of sup(99m)Tc-diphosphonate was injected intravenously. Three hours later, detailed scintigrams of the bilateral hip areas were made with a scintillation camera connected to a computer. The uptake of sup(99m)Tc-diphosphonate in the fracture was expressed as a ratio of the counts recorded in one area to those recorded in the other area. A peak value in count ratio was recorded in all patients 4 to 6 weeks after fractures. One hundred patients were classified into a normal healing group and a delayed or non-union group. Namely, sup(99m)Tc-diphosphonate uptake was significantly higher in the delayed or non-union group than in the ...

International Nuclear Information System (INIS)

This study was conducted to search for the type of technical error in DEXA (dual-energy X-ray absorptiometry) and the effect of error to measurement of BMD. The changes of BMD (g/cm2, T-score) by patients information (Age, Weight, Height, Manopause age) input error and Confirming ROI error were investigated. Using spine phantom, we canned 10 times by age (5, 10), weight (10, 20 kg), height (5, 10 cm), manopause age (5, 10) increase and decrease respectively. Scanning region (L-spine, femur, Forearm) of 10 patients was calculated by changing ROI respectively. Analysis of difference for mean (precision 1%) were carried out. There error of patient information (Age, Weight, Height, Manopause age) was not changed differently. In confirming ROI, the BMD and T-score of L-spine involving T-12 was decreased to 0.063 g/cm2, 0.3 and involving L-5 increased to 0.077 g/cm2, 0.5. In narrowing 1 cm of vertical line of ROI, the BMD and T-score decreased to 0.006 g/cm2, 0.1 and in 2 cm, 0.021 g/cm2, ...

International Nuclear Information System (INIS)

A 2-year follow-up regarding healing complications, such as redisplacement, nonunion, and segmental collapse of the femoral head, was performed in 306 patients operated on for femoral neck fracture and examined with "9"9"mTechnetium-MDP scintimetry within 2 weeks postoperatively. Scintimetric evaluation was performed by selecting regions of interest over the femoral head on the fracture side and the intact side and by comparing the uptake. A femoral head ratio fractured/intact side thus was obtained. Of 199 patients with an intact femoral head uptake (ratio #<=# 1.0), 181 showed no signs of healing complications at 2 years, whereas 18 had developed healing complications. Of 107 cases with a deficient femoral-head uptake (ratio < 1.0), 96 had developed healing complications within 2 years from the operation, while 11 cases had no signs of radiographic complications. We conclude that "9"9"mTc-MDP scintimetry performed within 2 weeks from femoral neck fracture ...

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In order to achieve micro-wound, intelligence and high efficiency for fracture setting, intelligent setting system for fracture is proposed in accordance with biomechanics and fracture therapy theory. In the comprehensive medical system based on C-shape-arm X-machine, image processing and analysis is the core, programmable logical controller and stepping motor are important driving parts controlling mechanical parts. Six degree of freedom dynamics sensor ensures to control accurately force and moment. On the foundation of analyzing X-ray image peculiarities, method of processing and analysis is put forward, combining time domain with frequency domain. After mining domain knowledge in depth, setting actions is quantized into three non-continuous steps and is parameterized into two angles and one distance aiming at femoral-neck fracture. Objective features are extracted by virtue of three power polymerization curved surface fitting. Master-slave reference frame is advanced to solve a ...

International Nuclear Information System (INIS)

Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity ...