Bone scan

Bone scans can help identify hidden fractures that cannot be seen in regular x-rays, they can also help detect bone cancer, arthritis, reason for mysterious bone pain and bone infections. In a normal x-ray, the radiation passes through the body and creates an image on the x-ray placed on the other side of the body, whereas in a bone scan the radiation travels to the surface of the body that is in turn detected by a camera. All metal items in contact with the body have to be removed before a bone scan. There are no restrictions on eating and drinking. Bone scans are not performed on pregnant women. You have to arrive 4 hours before the scan and let the tracer settle well into your body.Bone scan procedure involves:

• An injection with tracers is injected into the vein in your arm.
  
• After this you have to wait for 2-4 hours to allow the tracers to circulate and become absorbed by your bones. In organs and tissues such as the bones, this radio nuclide gets accumulated.
  
• You will be asked to drink lots of water to pass out the unabsorbed radioactive material through the urine. The absorbed radioactive material will flush out through the urine by 24 hours.
  
• During the bone scan, you will be made to lie motionless on the table, as a device with an arm-like gadget holding the gamma camera passes above the body. When the tracers enter the body, they emit gamma waves of radiation that can be detected by a special camera.
  
• The camera in turn generates images that can be inferred by radiologists or nuclear medicine specialists.
  
• The scan takes about 30-60 minutes for the entire skeletal and even less if only for specified areas.

When no abnormal area is seen with high or low accumulation of the tracers, the radioactive material is evenly distributed. This indicates that the bone area that is scanned is normal. In abnormal cases, radioactive material accumulates in a particular area of the bone. This is known as a hot spot. Hot spots can indicate a healing fracture, bone cancer, bone infection, arthritis or a disease of an abnormal bone metabolism. Certain spots may indicate less absorption of the radioactive material, they are called cold spots. This could indicate cancer or lack of blood supply to the bone.

Dexa scan

A DEXA scan or Dual Energy X-ray Absortiometry scan is a diagnostic tool that measures bone mineral density. This type of scan is usually prescribed for those at increased risk of osteoporosis. p DEXA or peripheral DEXA is used to measure bones on the periphery of a person such as wrist, fingers and heels. Central DEXA is used to measure bones in the spine and hip. This type of DEXA scan can accurately measure low bone density and is the preferred test for diagnosing osteoporosis. An imager passes over your body, emits radiation from two different sources in alternation. The DEXA scan differs from the regular bone scan in that the use of 2 different x-ray energy sources provides precision and accuracy. Besides it is able to detect loss of bone density much earlier than when it can surface on a regular x-ray. A detector measures the amount of radiation that comes through the bone being examined. This throws light on its density. A Dexa scan usually takes about 20 minutes and involves small amount of radiation.

Femur fracture

The word 'femur' is taken from Latin meaning 'thigh'. The femur is the thigh bone and it is the largest and strongest bone in the human body. The femur bone extends from the hip to the knee joint. A femur fracture can be life threatening. Since the inside of the thigh is a place of major blood vessels, broken femur means break in the artery. Femur fracture is also called femoral shaft fracture, femur injury, femur stress fracture, fractured femur, femur trauma and femoral diaphyseal fracture. Femur is a tremendously strong bone. It usually requires a great deal of force to break the femur bone. The most common causes for femur fractures include:

• Falls from a great height
  
• Blows that are strong in force
  
• Car accidents and Collisions
  
• Severe twists
  
• Bones weakened by osteoporosis, tumor or infection leading to a condition called pathologic femur fracture.
  

Proximal femur fracture: This involves fracture in the uppermost portion of the thighbone adjacent to the hip joint. are further sub divided into different types.

Femoral shaft fracture: The femoral shaft fracture is a severe injury that occurs during high-speed motor vehicle collisions and significant falls. Injuries caused by femoral shaft fractures are usually severe. Treatment of femoral shaft fracture is always with surgery. The common procedure is to insert a metal rod bone, called 'intramedullary rod' down the center of the thigh. The two ends of the bone are connected by the rod. This intramedullary rod usually remains in the bone for the life of the patient but can be removed if it causes pain and other problems.

Supracondylar femur fracture: In this kind of fracture, the injury occurs just above the knee joint. Cartilage surface of the knee joint is usually involved in this fracture. Patients who sustain supracondylar femur fracture are at high risk of developing knee arthritis later. Supracondylar femur fracture is common in patients with severe osteoporosis. Patients who have undergone total knee replacement surgery also run the risk of this fracture. Treatment for supracondylar femur fracture is highly variable. A cast or brace, external fixator, plate, screws or intramedullary rod are used for treatment.

Symptoms of femur fracture include swelling, bruising and severe pain. There may be numbness or paralysis in the leg below the femur fracture. Femur fractures are apparent and visible in many cases. Apart from clinical examination by the orthopaedic, for non-apparent fractures, a bone scan is required. Treatment for fractures of femur depends upon various factors such as the patient's age, type of fracture, location of the break, bone stability in the injured, mechanism of injury, direction of the blow, factors of twisting, existence of internal bleeding and extent of soft tissue damage. Some of the methods of treatment are:

• Reduction or re-alignment
  
• Immobilization whereby the movement is restricted
  
• Insertion of an intramedullary fixation
  
• A cast
  
• External fixation such as a frame on the outside of the leg anchored into the bone using pins.
  

• Pain or arthritis
  
• Rotational deformity due to misalignment
  
• Infections in open fractures
  
• Uneven leg length
  
• Injury of blood vessels
  
• Nerve damage
  
• Compartment syndrome
  
• Amputation
  
• Failure to heal - 'non-union' is also a possibility
  

Intra articular sepsis, arthritis and knee stiffness are some of the permanent complications that can occur among persons who have undergone femur fracture and treatment. Sometimes femur fracture is bound to cause permanent disability in injured persons. This is due to the thigh muscle pull and incorrect reunion of fragments when they overlap. Femur fracture patients should be careful not to put weight on the leg as this can delay the healing process.