OTA 1997 Posters - Scientific Basis for Fracture Care

The Use of Magnetic Resonance Imaging in Diagnosing and Managing Non-Unions Complicated by Osteomyelitis

Doreen DiPasquale, MD, James Jelinek, MD, Alessandro Speciale, MD

Arlington, Virginia, USA

Purpose: To illustrate the utility of magnetic resonance imaging in diagnosing, managing and predicting the success of limb salvage procedures for infected long bone non-unions.

Methods: We reviewed the records of ten patients with long bone non-unions and a clinical suspicion of osteomyelitis who underwent MRI. Each study was read by two blinded radiologists and classified according to our modification of Cierny's classification. These findings were then correlated with culture results, intraoperative findings and outcome.

Results: MRI readings and culture results correlated in nine of ten cases and the anatomic information afforded by the study changed our operative plan in a similar percentage of patients. The long segment intramedullary class of osteomyelitis was associated with limb salvage in all instances.

Discussion: Despite much recent literature demonstrating the sensitivity of MRI in diagnosing osteomyelitis, many orthopedic surgeons continue to rely on nuclear medicine scintigraphy when managing patients with suspected bone infection. Together with the anatomical information afforded with MRI, which has proven invaluable in managing other types of orthopedic pathology, the recognition of MRI as a superior study for osteomyelitis is overdue.

Conclusion: MRI is an excellent modalitiy for diagnosing and managing osteomyelitis. In addition to its value as a guide to formulating a pre-operative strategy, it can also be used as an objective criteria when counseling patients on attempts for limb salvage. Eventually, MRI may be used to make decisions about limb salvage and reconstruction procedures.