Session IV - Basic Science

Fri., 10/11/13 Basic Science, PAPER #57, 1:52 pm OTA 2013

Ultrasonographic Monitoring of Fracture Healing: Is This the End of Radiography in Fracture Follow-ups?

Sourabh Chachan, MBBS; Barsha Tudu, MBBS, MS (orth); Biswajit Sahu, MBBS, MS (orth);
VSS Medical College, Burla, Sambalpur, Orissa, India

Purpose: This study was conducted with the aim to compare the efficiency of ultrasonography and radiography in monitoring fracture healing process and to further define the role of ultrasonography in following-up fracture cases. The hypothesis was that fracture healing, being a soft-tissue process in the earlier stages with bone formation occurring only in the later stages, should be better monitored by a modality evaluating soft tissues like ultrasonography, unlike radiography, which basically evaluates hard structures like bones.

Methods: A prospective follow-up study was conducted at the department of orthopaedics of a tertiary care center from October 2011 to October 2012. The study included 48 (male = 32, female = 16) cases of acute closed fracture of tibial diaphysis located in the mid-third. All the cases were treated by closed reduction and internal fixation with reamed static locked tibial interlocking nail, as soon as possible. All the patients were followed up for an average period of 24 weeks (range, 14-52 weeks). For every case, fortnightly evaluation was done using both ultrasonography and radiography. Ultrasonographic criterion for fracture healing was set as progressive appearance of periosteal callus with complete disappearance of nail at union. Radiographic criterion for fracture union was set as appearance of bridging callus at all the four cortices.

Results: Most of the cases were in the age group of 22 to 33 years and 80% of the total cases were result of road traffic accidents. 40% of the cases were classified as OTA 42-A2 fractures. Categories OTA 42-A1, A3, B1, and B2 constituted 17%, 23%, 10.5%, and 10.5% of the cases, respectively. Out of 48 cases, 38 achieved union, 4 went into non-union, and 6 developed delayed union. It was observed that using the above criteria, fracture union can be diagnosed at an average of 2 weeks earlier on ultrasonography as compared to radiography. Four out of six cases of delayed union and all nonunion cases also declared themselves much earlier on ultrasonography than radiography.

Conclusion: Use of ultrasonography for monitoring of fracture healing process has a clear advantage over radiography. It provides valuable early information about union and also accurately predicted delayed unions and nonunions at a very early time. Thus it can be presumed that using ultrasonography instead of radiography in follow-up of fracture cases can help in early diagnosis and intervention for unfavorable fracture healing outcomes.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.