Fracture healing assessment comparing stiffness measurements using radiographs

Area of Science:

• Orthopedics
• Radiology
• Biomedical Engineering

Background:

• Radiographs are commonly used to assess fracture healing.
• Published reports suggest radiographs may be unreliable as a sole measure of fracture healing.

Purpose of the Study:

• To correlate radiographic fracture healing assessments with objective fracture stiffness measurements.
• To evaluate the reliability of different radiographic assessment methods for fracture healing.

Main Methods:

• 100 plain radiographs of fractures with corresponding fracture stiffness measurements were assessed by 92 observers.
• Observers were divided into three groups, using general appearance or cortical callus bridging to determine healing.
• Fracture stiffness > 15 nm/degrees defined union.

Main Results:

• All observer groups performed poorly in correctly predicting fracture healing.
• No significant difference in prediction accuracy between assessment methods was observed.
• Substantial intraobserver variability was noted, though cortical bridging showed a trend toward improved reliability.

Conclusions:

• Radiographs are unreliable as a sole measure of fracture healing.
• Cortical callus bridging assessment showed a trend toward improved reliability but did not overcome poor overall performance.
• Observer reliability decreased with metaphyseal extension to diaphyseal fractures.