J Korean Orthop Assoc.  1976 Dec;11(4):720-727. 10.4055/jkoa.1976.11.4.720.

The clinical Significance of Osteomedullography in the Fracture of Tibial Shaft

Abstract

It has been well known that the incidence of delayed or nonunion of tibial shaft fracture is high and in order to improve methods of treatment and to get satisfactory final results in these fractures, it is important to find out as early as possible whether the fracture is healing normally or not. The fracture healing is closely related to the circulatory conditions at the fracture site, however, in contrast to animal experiments it is impossible to visualize directly the circulatory conditions at the fracture site. There have been many efforts to visualize indirectly these vascular re-establishments through angiography. Kaski(1974) reported a paper concerning osteomedullography of tibial fracture with phlebocompression and noticed 5 types of veins related to the process of healing. We performed 54 cases of osteomedullography in 41 tibial fracture at 3 months after treatment and the following results were obtained: 1. The sinusoidal vein in the proximal fragment was observed most frequently and the next were intra-osseous crossing vein, periosteal callus vein, ascending branch of main efferent vein, and periosteal veins of proximal fragment in decreasig frequency. 2. The rate of positive finding in osteomedullography at 3 months after treatment was lower, and periosteal callus veins were observed more frequently in the group treated with only cast immobilization than in the group treated with plate and screws. 3. In the group treated with compression plate and screws, osteomedullographs were positive in all 3 cases within 3 months after operation and sinusoidal veins in the proximal fragment were visualized in all cases, however periosteal callus vein was not visualized at all. 4. After bone graft, the differentiation of periosteal callus from grafted bone was not easy in plain X-ray film, but osteomedullography was very useful in these cases. Positive findings were noticed in 2~3 months in all cases following bone graft. 5. The authors found that the ideal time of performing osteomedullography was 3 months following treatment. If found to be negative after 4 months following treatment, bone graft was necessary.

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