Abstract
IntroductionEarly recognition of a possible infection and therefore a prompt and accurate diagnostic strategy is essential for a successful treatment of posttraumatic osteomyelitis (PTO). However, at this moment there is no single routine test available that can detect osteomyelitis beyond doubt and the performed diagnostic tests mostly depend on personal experience, available techniques and financial aspects. Nuclear medicine techniques focus on imaging pathophysiological changes which usually precede anatomical changes. Together with recent development in hybrid camera systems, leading to better spatial resolution and quantification possibilities, this provides new opportunities and possibilities for nuclear medicine modalities to play an important role in diagnosing PTO.AimIn this overview paper the techniques and available literature results for PTO are discussed for the three most commonly used nuclear medicine techniques: the three phase bone scan (with SPECT-CT), white blood cell scintigraphy (also called leukocyte scan) with SPECT-CT and 18F-fluorodeoxyglucose (FDG)-PET/CT. Emphasis is on how these techniques are able to answer the diagnostic questions from the clinicians (trauma and orthopaedic surgeons) and which technique should be used to answer a specific question. Furthermore, three illustrative cases from clinical practice are described.
Highlights
Recognition of a possible infection and a prompt and accurate diagnostic strategy is essential for a successful treatment of posttraumatic osteomyelitis (PTO)
Essential for a successful treatment of PTO is an early recognition of the possible infection and a prompt and accurate diagnostic strategy
The aim of this paper is to explain the existing nuclear medicine imaging possibilities for diagnosing PTO, how these modalities are able to answer the diagnostic questions from the clinicians and to provide an overview of which nuclear imaging technique should be used at which time point of the diagnostic pathway
Summary
Recognition of a possible infection and a prompt and accurate diagnostic strategy is essential for a successful treatment of posttraumatic osteomyelitis (PTO). This, combined with the typically acute setting in which trauma surgery takes place with possibly contaminated open fractures and concomitant soft tissue injuries leads to a reported incidence of 1 to 19 % of deep infections after surgical fracture care This high infection rate is a concern and due to an increase in surgical procedures over the last decades, fracture related osteomyelitis, referred to as posttraumatic osteomyelitis (PTO), becomes more and more an entity that trauma— and orthopaedic surgeons will have to deal with [1, 2]. It is of invaluable importance to diagnose PTO as early as possible and to start early and specific treatment, since a late recognition or inadequate treatment may
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