Computed Tomography Reformation in Evaluation of Fracture Healing With Metallic Fixation: Correlation With Clinical Outcome

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Abstract

Background:

The amount of callous needed for fracture stability is typically estimated by a combination of radiographic and physical examinations. Computed tomography (CT) with sagittal and coronal reformations was performed to determine the amount of callous needed for fracture stability based on a quartile analysis of bony bridging of the circumference of the fracture site.

Methods:

All patients who received CT with sagittal and coronal reformations of a fractured tubular bone for the purpose of analyzing bony bridging over a 22-month period were retrospectively reviewed. The final analysis included 34 patients and a total of 47 examinations. Fractures were placed into one of four groups depending on the amount of cortical bridging of the circumference of the bone: group I, 0–24%, group II, 25–49%, group III, 50–74%, group IV, 75–100%. Clinical outcome was determined on the basis of fracture stability, with mean follow-up of approximately 62 weeks.

Results:

A statistically significant increase in clinical failure was found in patients with <25% bridging. A cut-point analysis revealed that 37.5% (6 of 16) of failures occurred among patients with <25% bony bridging, and only 9.7% (3 of 31) of failures occurred among patients with >25% bridging, corresponding to a Fisher's exact test p value of 0.045.

Conclusions:

Patients with less than 25% bridging of the circumference of a tubular bone should be considered high risk for failure, indicating the need for continued protection of the site.

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