FURTHER OBSERVATIONS ON THE USE OF RADIOACTIVE PHOSPHORUS (P*SUP 32/) TO DETERMINE THE VIABILITY OF THE HEAD OF THE FEMUR: CORRELATION OF CLINICAL AND EXPERIMENTAL DATA IN 130 PATIENTS WITH FRATURES OF THE FEMORAL NECK

Journal Article · Mon Apr 01 04:00:00 EST 1963 · J. Bone Joint Surg.

OSTI ID:4133352

Boyd, H B; Calandruccio, R A

Attempts were made to develop a radioisotope method to predict in which femoral heads avascular necrosis will develop. A correlation is made of experimental data and clinical results in 130 patients followed for two years or more. In addition, information gained from 82 autoradiograms of femoral heads removed from 82 other patients is presented to aid in the interpretation and discussion of the clinical data. Experiments on dogs revealed that 2 mu C P/sup 32/ per lb of body weight produces a measurable amount of radioactivity in the femoral head and trochanteric region. When the uptake was recorded in the femoral head of dogs, there was a rapid rise in the radioactivity for the first 30 minutes after injection, but after 60 minutes a plateau was established. Uptake was recorded for bone in which the blood supply was partially impaired, as well as in bone with a normal blood supply. In accordance with these findings, patients were given 250 to 300 mu C of a buffered solution of P/sup 32/, and the counts were recorded one hour or more after intravenous injection of the solution. A tube designed for localization of brain tumors was used. The surgical technique for insertion of the probe in the head of the femur is described in detail. Femoral-head specimens from patients with avascular necrosis after fractures of the neck of the femur revealed little or no P/sup 32/ uptake in the region of the bone proved by microscopic examination to be avascular, whereas in the surrounding vascular bone there was uptake. Thus it was shown that if circulation to the femoral head is interrupted there is a lack of uptake for 90 minutes after P/sup 32/ injection. The lack of P/sup 32/ in the femoral head may be interpreted as a sign of nutritional deficiency. Trochanter-to-head ratios obtained from 298 patients showed an incidence of avascular necrosis of 35 to 40%; the ratio of 4.0 was selected, tentatively, as the critical ratio. Autoradiograms of 82 femoral heads obtained from patients with recent fractures (1 day to 8 weeks old) treated initially by insertion of a prosthesis revealed that approximates 1/3 had essentially no uptake of P/sup 32/ except for a small but variable portion in the vicinity of the fovea. Another 1/3 showed absence of P/sup 32/ in portions of the head, and 1/3 demonstrated uptake in the entire head. It is concluded that studies of P/sup 32/ uptake are of prognostic value in 2/3 of patients with displaced fractures of the neck of the femur. (BBB)

• Research Organization: Univ. of Tennessee, Memphis
• NSA Number: NSA-18-005192
• OSTI ID: 4133352
• Journal Information: J. Bone Joint Surg., Journal Name: J. Bone Joint Surg. Vol. Vol: 45A
• Country of Publication: Country unknown/Code not available
• Language: English

Related Subjects

BIOLOGY AND MEDICINE
BLOOD CIRCULATION
BONES
DIAGNOSIS
DISTRIBUTION
DOGS
FEMUR
FRACTURES
MAN
METABOLISM
MICROSCOPY
PHOSPHORUS 32
QUANTITY RATIO
RADIATION DOSES
RADIOACTIVITY
RADIOAUTOGRAPHY
SOLUTIONS
SURGERY
VARIATIONS