We performed a retrospective study of the results of two-phase technetium-99m hydroxymethylene diphosphonate bone scans in 88 patients with severe
frostbite of the extremities. All patients were evaluated within 48 h after
rewarming and all underwent a first bone scan (BS1) within 5 days after
rewarming (median, day 2) (group 1). An excellent correlation was found between absence of tracer uptake in the phalanges and later
amputation; this correlation was especially strong during the bone phase of the scans (specificity = 0.99, sensitivity = 0.96, positive predictive value = 0.92). Normal or high uptake in the phalanges was a reliable
indicator of ultimate healing (negative predictive value = 0.99). The sensitivity of the examination was enhanced by performing a second scan (BS2) more than 5 days (median, day 8) after
rewarming (group 2, n = 36). A comparative analysis of BS1 and BS2 demonstrated that some of the lesions continued to evolve between day 2 and day 8. This suggests that the lesions could still be modified during this period. On the basis of the findings it is recommended that bone scan be performed close to day 2 in all patients who present with lesions extending proximally to include the entirety of one or more phalanges. In the case of
severe sepsis, the results of the first bone scan, BS1, can serve as an indication for emergency
amputation. BS2 should be performed close to day 8 only if there is an area of low or absent uptake on BS1. It is concluded that scintigraphy is an excellent means of evaluating patients with severe
frostbite of the extremities: as early as day 2 after the injury it can indicate whether
amputation is necessary, and between days 2 and 8 it provides valuable information on the efficacy of treatment.