Ultrasound monitoring of fracture healing: is this the end of radiography in fracture follow-ups?

OBJECTIVE

To compare the efficacy of ultrasonography (US) versus radiography (XR) in monitoring fracture healing.

DESIGN

Prospective diagnostic follow-up study.

SETTING

Department of Orthopaedics, Level II trauma center.

PATIENTS

Forty-eight acute closed tibial mid diaphysis fracture (OTA 42-A and B) treated by closed reduction and internal fixation with a reamed statically locked tibial interlocking nail between October 2011 and October 2012.

INTERVENTION

Evaluation of fracture healing using both US and XR at 2 week intervals.

MAIN OUTCOME MEASUREMENTS

Ultrasonographic criterion for fracture healing was set as progressive appearance of periosteal callus along with progressive decrease in visibility of nail. Radiographic criterion for fracture union was set as the appearance of bridging callus across all 4 cortices.

RESULTS

Thirty-eight of 48 fractures achieved union, 6 developed a delayed union, whereas 4 went onto nonunion. It was observed that using the above-stated criteria, fracture union was diagnosed at an average of 2 weeks earlier with US as compared with XR. Four of the 6 delayed unions and all nonunions declared themselves much earlier on US versus XR.

CONCLUSIONS

Ultrasonography can provide valuable early information about union and predict delayed and nonunions at an earlier time interval than standard plain radiographs.

LEVEL OF EVIDENCE

Diagnostic level II. See Instructions for authors for a complete description of levels of evidence.