An evaluation of nuclear scanning in orthopaedic infections.

Making a diagnosis of osteomyelitis or septic arthritis in its early stages if often difficult but is extremely important if one is to reduce the morbidity of these diseases. Nuclear scintigraphy has been proposed as a means of making this early diagnosis with an accuracy rate in the literature that has varied from 85 to 100%. We reviewed 35 patients with osteomyelitis, septic arthritis, and cellulitis who had had nuclear scanning as a part of their initial workup. While we found a 77% accuracy rate, we found three false positives and five false negatives. In order to interpret the scintigraphic results of nuclear imaging accurately, one must be familiar with the mechanisms, both biochemical and physiological, that affect the variable uptake of the nuclear agents employed. Both "hot" and "cold" scans may have multiple causes.