Prediction of the healing potential of closed adult tibial shaft fractures by bone scintigraphy.

Fifty unilateral closed adult tibial shaft fractures treated by closed methods were studied prospectively using bone scintigraphy to predict the healing potential of individual fractures. Dynamic and static scintigrams, using 99mtechnetium methylene diphosphonate, were obtained at zero, six, and 12 weeks after fracture. The data were analyzed according to the methods of recent workers in this field. Forty-one fractures united normally at 20 weeks and nine fractures developed delayed union. Analysis of results showed significant differences in uptake ratios, mean net counts, and an osteogenesis index between fractures with normal and delayed union. Of particular value was a ratio of uptake over the fracture site to an adjacent site in the same bone obtained at six weeks. A ratio greater than 2 indicated the potential to heal normally. The findings suggest that a single static scintigram at six weeks is strongly predictive of subsequent healing.