Current Options for Determining Fracture Union

Abstract

Determining whether a bone fracture is healed is one of the most important and fundamental clinical determinations made in orthopaedics. However, there are currently no standardized methods of assessing fracture union, which in turn has created significant disagreement among orthopaedic surgeons in both clinical and research settings. An extensive amount of research has been dedicated to finding novel and reliable ways of determining healing with some promising results. Recent advancements in imaging techniques and introduction of new radiographic scores have helped decrease the amount of disagreement on this topic among physicians. The knowledge gained from biomechanical studies of bone healing has helped us refine our tools and create more efficient and practical research instruments. Additionally, a deeper understanding of the molecular pathways involved in the bone healing process has led to emergence of serologic markers as possible candidates in assessment of fracture union. In addition to our current physician centered methods, patient-centered approaches assessing quality of life and function are gaining popularity in assessment of fracture union. Despite these advances, assessment of union remains an imperfect practice in the clinical setting. Therefore, clinicians need to draw on multiple modalities that directly and indirectly measure or correlate with bone healing when counseling patients.

Retrograde nailing of femoral fractures: a retrospective study

“…We defined bony union as healing of three out of four cortices in an anteroposterior and lateral radiograph of the femur [20]. All the patients were followed up initially 2 weeks after surgery and then every 3 weeks until bony union was confirmed on radiograph.…”

Clinical Aspects of Fracture Healing: An Overview

“…Nearly 5-10 % of all fractures in the USA result in fracture nonunion [19,20]. In the USA, of the 600,000 fractures that result in delayed healing, nearly 100,000 progress to nonunion [21].…”

“…FE is a tool that mathematically simulates static or dynamic problems, such as weightbearing capacity of implants or fall analysis [20]. FE analyzes CT images to quantitatively assess for bone strength.…”

“…Furthermore, depending on the patient's body habitus and fracture location, thick layers soft tissue superficial to the fracture site will obscure the imaging. Further studies are required to validate the use of ultrasound to identify nonunions or delayed healing [20,21].…”

Bone healing in 2016

“…Of the estimated 7.9 million fractures that occur annually in the United States, approximately 5-10% have either delayed or impaired healing (1,2). Furthermore, of these 600,000 fractures with delayed healing, nearly 100,000 progress to nonunion (3).…”