Predictive role of scintigraphy (BS) in bone union induction using extracorporeal shock wave treatment (ESWT)

Pseudoarthrosis and delayed bone union are the main complications in the healing process of long bones fractures. The surgical intervention is currently the treatment of choice, but there is a number of non-operative interventions are being developed, such as extracorporeal shock wave therapy (ESWT). There is a range of issues related to the proper qualification, monitoring, and outcome assessment measures. Bone scintigraphy (BS) exclusively allows the assessment of the bone turnover dynamics in non-invasive, semi quantitative method.

The study group comprised of 31 subjects with bone healing complications. The study population was divided in two subgroups as related to the treatment outcome assessed 24 weeks after ESWT procedure. Group I (n = 19) included the cases with no complete bone union. Group II (n = 12) covered the subjects with complete bone union. BS was performed right before ESWT and 2 weeks after the procedure.

Increase of agent uptake after ESWT procedure was noted in both groups which proves that ESWT increases bone metabolism dynamics in most patients. Significantly higher uptake increase was noted in patients with complete bone union. In patients with unsuccessful treatment the agent uptake before ESWT was much higher. Two weeks after ESWT procedure BS reveals an increase in bone metabolism in the area of complicated fracture proving positive reaction of bony tissue on mechanical waves.

Scintigraphy may facilitate qualification patients with bone union disorders for further mode of treatment. One can suppose that positive bone reaction is achievable only in bone where the metabolism is lowered.