Diagnosis of infection in ununited fractures. Combined imaging with indium-111-labeled leukocytes and technetium-99m methylene diphosphonate.
The results of combined scintigraphy in which indium-111-labeled leukocytes and technetium-99m methylene diphosphonate were used were compared with the results of cultures of open bone at 102 sites of delayed union or non-union, to determine the effectiveness of this combination as a preoperative indicator of osteomyelitis. There were twenty-five true-positive, fifty-nine true-negative, eleven false-positive, four false-negative, and three indeterminate interpretations, yielding, for the diagnosis of osteomyelitis, a sensitivity of 86 per cent, a specificity of 84 per cent, an accuracy of 82 per cent, a positive predictive value of 69 per cent, and a negative predictive value of 94 per cent. There were few false-negative scans; false-positive results were most likely at a metaphyseal site adjacent to a joint in which there was post-traumatic arthropathy, at the site of a failed arthrodesis, and at the site of an unstable delayed union or non-union.
Nepola
J V
JV
Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City.
Seabold
J E
JE
Marsh
J L
JL
Kirchner
P T
PT
el-Khoury
G Y
GY
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005189:False Positive Reactions; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging; D005599:Fractures, Ununited / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D007205:Indium Radioisotopes; D007962:Leukocytes; D008297:Male; D010019:Osteomyelitis / Q000150:complications / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D012784:Shoulder Fractures / Q000000981:diagnostic imaging; D013669:Technetium Tc 99m Medronate; D013978:Tibial Fractures / Q000000981:diagnostic imaging
D007205:Indium Radioisotopes; D013669:Technetium Tc 99m Medronate