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Updated: Feb 13, 2026

Assessment of Bone Fracture Healing Using Micro-Computed Tomography
Published on: December 9, 2022
Can we assess healing of surgically treated long bone fractures on radiograph?
V Perlepe1, P Omoumi2, A Larbi3
1Cliniques universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium.
Purpose:
To determine the frequency and causes for limitations in the radiographic evaluation of surgically treated long bone fractures.
Materials And Methods:
Six readers separately scored 140 sets of antero-posterior (AP) and lateral radiographs of surgically treated long bone fractures, using a radiographic union score (RUS). We determined the rate of assessability of the fracture edges at each of the four cortical segments (n=560) seen tangentially on the two radiographs and the causes for non-assessability. The rate of feasibility of the RUS (more than two fracture edges assessable per fracture) was determined and compared according to different parameters.
Results:
Fracture edges were visible in 71% to 81% of the 560 cortical segments. Metal hardware superimposition was the most frequent cause for non-assessability (79-95%). RUS values could be calculated in 58% to 75% of fractures. Scoring was statistically significantly less frequently calculable in plated (31-56%) than in nailed fractures (90-97%), in distal (47-61%) than in proximal (78-89%) bones and in upper (27-49%) than in lower (76-91%) limb bones (P≤0.01).
Conclusions:
The type of stabilization hardware is the main limiting factor in the radiographic assessment of surgically treated long bone fractures. Scoring was feasible in only 31% to 56% of plated fractures.
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