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The value of technetium 99 scintigraphy in the prognosis of amputation in severe frostbite injuries of the extremities: A retrospective study of 92 severe frostbite injuries

  • Author Footnotes
    1 From the Department of Mountain Medicine and Trauma, Chamonix Hospital, Chamonix, France.
    Emmanuel Cauchy
    Correspondence
    Reprint requests: Emmanuel Cauchy, MD, Département de Médecine et de Traumatologie de Montagne, Hôpital de Chamonix, 509 route des Pélerins, BP30 Les Bossons, 74400 Chamonix, France.
    Footnotes
    1 From the Department of Mountain Medicine and Trauma, Chamonix Hospital, Chamonix, France.
    Affiliations
    Chamonix, France
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  • Author Footnotes
    1 From the Department of Mountain Medicine and Trauma, Chamonix Hospital, Chamonix, France.
    Bernard Marsigny
    Footnotes
    1 From the Department of Mountain Medicine and Trauma, Chamonix Hospital, Chamonix, France.
    Affiliations
    Chamonix, France
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  • Author Footnotes
    1 From the Department of Mountain Medicine and Trauma, Chamonix Hospital, Chamonix, France.
    Guy Allamel
    Footnotes
    1 From the Department of Mountain Medicine and Trauma, Chamonix Hospital, Chamonix, France.
    Affiliations
    Chamonix, France
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  • Author Footnotes
    1 From the Department of Mountain Medicine and Trauma, Chamonix Hospital, Chamonix, France.
    Rik Verhellen
    Footnotes
    1 From the Department of Mountain Medicine and Trauma, Chamonix Hospital, Chamonix, France.
    Affiliations
    Chamonix, France
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  • Author Footnotes
    1 From the Department of Mountain Medicine and Trauma, Chamonix Hospital, Chamonix, France.
    Eric Chetaille
    Footnotes
    1 From the Department of Mountain Medicine and Trauma, Chamonix Hospital, Chamonix, France.
    Affiliations
    Chamonix, France
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  • Author Footnotes
    1 From the Department of Mountain Medicine and Trauma, Chamonix Hospital, Chamonix, France.
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      We report a retrospective study of the prognostic value of 2-phase technetium 99m bone scanning performed in 92 patients who presented to Chamonix Hospital with severe frostbite of the extremities in the past 12 years. The results of this study show that an initial bone scan (as early as day 3) has excellent specificity in evaluating the severity of frostbite injury. There was a direct correlation between the demarcation zone of uptake in the phalanges and the eventual level of amputation (positive predictive value, 0.84). A second scan on approximately day 7 was even more sensitive and informative. A strong correlation existed between positive uptake and eventual healing (negative predictive value, 0.99). This study showed that 99mTc bone scanning in the first few days after frostbite injury indicates the level of amputation in severe frostbite in more than 84% of cases. We propose an algorithm based on the results of this study that can be used to evaluate new medical and surgical management of frostbite injury.

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