Case Author(s): David Hillier M.D., Ph.D. and Tom R. Miller, M.D., Ph.D. , 10/10/97 . Rating: #D1, #Q3

Diagnosis: Intertrochanteric hip fracture

Brief history:

73 year-old man with right hip pain.

Images:

Bone scintigraphy

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Anterior and posterior views of pelvis

Pelvis and right hip plain films (not shown) show no fracture

Full history/Diagnosis is available below

Diagnosis: Intertrochanteric hip fracture

Full history:

73 year-old man who fell one week ago and presents with right hip pain.

Radiopharmaceutical:

20.9 mCi Tc-99m methylene diphosphonate

Findings:

1. The pelvis and right hip plain films reveal no evidence of fracture.

2. Bone scinitigraghy reveals uptake in a linear pattern in the intertrochanteric region.

Discussion:

The most common orthopedic operation in the United States is the open reduction and internal fixation of intertrochanteric hip fractures. These fractures, which are common in osteopenic patients, are frequently difficult or impossible to visualize radiographically.

Early scintigraphic change after a fracture reveals diffusely increased uptake, presumably due to hyperemia. The uptake subsequently becomes more focal. Scintigraphy becomes abnormal sooner in younger patients. Approximately 80% of fractures are scintigraphically abnormal by 24 hours, 95% by 3 days and 98% at 1 week.

The time to scintigraphic resolution is variable, depending on fracture site and degree of damage. At least 5 to 7 months is required for a fracture to scintigraphically normalize. 60 to 80% of uncomplicated fractures will become normal in one year and 90 to 95% in 3 years. Increased uptake may be seen for extended periods in cases of displaced fractures, nonunion, prominant callus / bone mass and posttraumatic arthritis.

References:

Datz, et al. Nuclear Medicine, a Teaching File. 1992.

Laskin, et al. Intertrochanteric fractures of the hip in the elderly, a retrospective study of 236 cases. Clin Ortho and related research. 141: pp 188-195, 1979.

Thrall and Ziessman. Nuclear Medicine, the requisites. Mosby. 1995.

Followup:

The patient underwent open reduction and internal fixation.

Differential Diagnosis List

The linear pattern of uptake and history are most consistent with a subradiographic intertrochanteric right hip fracture.

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Effect of Trauma)

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Case number: bs084

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