Of 333 consecutive SPECT/CT studies performed,
107 studies followed a
clear history of trauma.
Hand/wrist specialists made all referrals: Orthopaedic or plastic surgeons.
The mechanism of injuries included: road traffic accidents,
fall onto
outstretched hand,
hyperextension,
overuse injuries related to specific
sports (golf wrists,
martial arts,
tennis),
de-gloving injuries.
Indications included: claustrophobia (precluding MRI imaging),
occult
fractures,
partial union,
non-union,
osteonecrosis,
mechanical response,
loosening (periprosthetic),
bone cysts,
secondary arthropathy,
complex
regional pain syndrome,
capsular injuries and periosteal avulsions,
TFCC
injuries,
biomechanical stress around a prosthesis,
bossing and abutment
secondary to acquired positive ulnar variance,
calcific periarthritis,
VISI/DISI,
post operative surgical bed uptake or metabolically active
healed fractures.
Incidental findings on whole body images included: rib fractures,
femoral
bony contusions,
old scaphoid fractures,
osteoarthritis in neighbouring or
distant joints,
clavicle fractures,
shin-splint syndrome,
sternoclavicular dislocation,
unexpected avulsions or over-use injuries.
Results:
- Anatomical localisation 79% (86 patients)
- Clinical question answered 90% (96 patients)
- Characterisation of the pain generator was possible in 92% (99 patients) eg: Postoperative pain,
synovitis,
infection,
loosening,
non-union,
abutment,
fractures and degeneration
- Final diagnosis 95% (102 patients),
and was equivocal in 5% (5 patients)
- Change in management 89% (95patients)
Conditions where SPECT/CT facilitated diagnosis & changed the management includes:
- Fracture (occult or stress),
- Tumor Metastases/ Osteoid osteoma ( as incidental findings)
- Infection: Osteomyelitis ( in open fractures or post surgical)
- AVN Cold ischemic segment,
Revascularization,
Remodeling,
Impingement
Avoided procedures in 28 patients:
- Diagnostic arthroscopies in 8 patients
- Surgery in 20 patients
Subsequent surgical procedures carried out: 12 patients underwent surgical intervention:
- Trapezectomies
- Tumour excision
- Denervation procedures
- Fusion of joints
- Fixation of non-united fractures