The contribution of bone scintigraphy in occupational health or medical insurance claims: a retrospective study

Patients with a suspicion of bone damage following an industrial or traffic accident are often referred for bone scintigraphy as part of an occupation al health or medical insurance investigation. The aim of this study was to assess the contribution and the potential role of bone scintigraphy compare d with X-ray investigations in the aforementioned situation. To this end we evaluated 70 consecutive patients referred for bone scintigraphy during 19 96 and 1997 by occupational health or medical insurance physicians. The mos t common reasons for referral were the exclusion of occult fractures of han ds and feet, whiplash injuries, reflex sympathetic dystrophy or avascular n ecrosis, or the differentiation between an old and a recent vertebral fract ure. X-rays were only available for comparative review of 53 patients, so o nly those were analysed. The results of bone scintigraphy were compared wit h X-rays, and their contribution and potential role in occupational health or medical insurance investigations assessed. In 31 out of the 53 patients investigated, bone scintigraphy findings concurred with X-rays as to the nu mber and location of abnormalities. For 19 of the 53 patients, bone scintig raphy showed clinically relevant additional foci when compared with X-rays, predominantly involving lesions to hands/wrists and feet/ankles. Among the se 19 patients, scintigraphic diagnoses were subsequently confirmed in ten cases by means of X-ray or computed tomography. In four patients, supplemen tary radiological investigations revealed no abnormalities, and in five pat ients no further investigations were undertaken. Finally, in three of the 5 3 patients, X-rays revealed bone damage (burst fractures) whilst the corres ponding bone scintigraphy was negative, thus excluding recent injury. In co nclusion, in 22 patients, representing 42% of the cases analysed, bone scin tigraphy was conclusive compared with X-ray imaging in the final diagnosis and in this way in detecting occult or excluding active bone damage after a traffic or industrial accident. This makes bone scintigraphy a useful inve stigation in situations where a full or partial disablement claim has to be confirmed, extended or terminated.