When is a fracture healed? Radiographic and clinical criteria revisited

Selecting the most appropriate outcome measures can be especially burdensome in trials studying fracture healing, because the process of fracture healing is subjective and without a gold standard. Although a wide variety of radiographic modalities are available, plain radiography remains the most common approach for healing assessment. Radiographic criteria, however, do not correlate well with fracture strength and stiffness. Additional challenges include a lack of consensus in what radiographic measures are most appropriate in the assessment of healing. In this article, we provide an overview of the most commonly used radiographic and clinical criteria for defining fracture healing. The validity and reliability of alternative approaches is also discussed.