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A twelve-year-old boy, had an accident 7 years ago. His left knee is injured; popliteal artery and muscles possibly concerned. Since then his left lower limb is shorter; the left shin is shorter.

He is lame in the left leg, the musculature of his shin is atrophic. The whole length is 3cm shorter there, than in the right one. The movement of the knee joint is normal, knee is stable.

He has been referred to the Nuclear Medicine Department for a bone scan by the orthopaedist. The following scan was obtained:

Based on osteoblast activity, the growth fugue of the left tibia fails 10% to the right one.

ROI data:

left femur 33602/356 =94.4/pix
right femur 33257/359 =92.6/pix
left tibia 20332/263=77.3/pix
right tibia 22047/261=84.5/pix
left femur/right femur: 1,01
left tibia/right tibia: 0,92
left femur/left tibia: 1,65
right femur/right tibia: 1,51

What is the diagnosis? What do you suggest to solve the problem?

This case was sent to us by Lajos Szabados M.D., from the Debrecen Medical and Health Science Center Dept. of Nuclear Medicine.

-Imre