The Journal of Bone and Joint Surgery, Vol 76, Issue 4 561-572, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Undiagnosed fractures in severely injured children and young adults. Identification with technetium imaging
SD Heinrich, D Gallagher, M Harris and JM Nadell
Department of Orthopaedics, Children's Hospital, New Orleans, Louisiana 70118.
A whole-body bone scan was performed to search for undetected fractures in
forty-eight patients who had multiple injuries or a head injury, or both,
and who were less than twenty-two years old. The study took place from
January 1991 to July 1992. Radiographs had been made of all areas of
suspected skeletal trauma at the time of admission. Follow-up plain
radiographs were made of all areas where unexpected abnormal tracer
activity was noted. Forty-two of these areas were noted in eighteen
skeletally immature patients and fifty-two, in twelve skeletally mature
patients. Nineteen previously unrecognized fractures were identified in the
subsequent radiographic analysis. Four skeletally immature and two
skeletally mature patients had an alteration in treatment on the basis of
the identification of a previously undiagnosed injury. Each of these six
patients had a cast applied. A fracture was identified three weeks or more
after the injury in two skeletally mature patients. These fractures would
have been treated (one with a cast and the other with open reduction and
internal fixation) if they had been diagnosed earlier. We believe that this
analysis demonstrates the usefulness of technetium radionucleotide
bone-imaging, as an adjuvant to the orthopaedic examination, in the
identification of undiagnosed musculoskeletal injuries in a patient who is
less that twenty-two years old and who has sustained a head injury or
multiple injuries, or both.
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