Saturday February 24, 1996

Ultrasound detects healing progress earlier than X-rays

A new study proves that ultrasound shows fracture healing progress and the possible need for secondary surgery to correct a problem weeks earlier than X-rays can provide this information.

Each year, an estimated 185,000 tibial fractures occur in the United States, accounting for 2.4 million days lost from work or school.

Ultrasound identifies tibial shaft fracture patients who are candidates for secondary surgery to avoid problems such as delayed union, nonunion and subsequent fatigue of the nail and/or interlocking screws, said Berton R. Moed, MD, chief, division of orthopaedic traumatology, department of orthopaedic surgery, Henry Ford Hospital, Detroit.

"Complications of tibial shaft fractures are difficult to predict, and can influence individual disability," said Dr. Moed, who presented these findings Friday in scientific paper 189.

"Selecting patients who actually require additional surgery (to attain fracture healing) is much more desirable than to routinely re-operate on all patients."

To evaluate the efficacy of ultrasound, 50 tibial shaft fractures, initially treated with unreamed intramedullary nailing with static interlocking, were followed until the fracture healed or at least one year after surgery. Dr. Moed said that the procedure involves inserting a rod inside the bone to serve as an internal splint for the fracture. "This keeps the broken bones in place while the fracture heals, and allows early mobilization of the patient," he said.

The mechanism of injury to these patients was motor vehicle accident, a fall, misstep, or gunshot wound.

"Ultrasound showed that 38 fractures were healed and 12 fractures were not healed," said Dr. Moed. "Ultrasound provides important prognostic information upon which subsequent treatment can be based."

While X-rays took 19 weeks (on average) to indicate fracture healing, ultrasound showed healing of 32 fractures at six weeks; 6 fractures at nine weeks.

Patients whose ultrasound showed callus formation-an early indicator of fracture healing-could begin rehabilitation and progress to full weight-bearing by six to nine weeks after surgery, without the risk of implant failure.

"Implant failure occurred in two patients identified at risk, but only after both had refused recommended secondary surgical intervention," said Dr. Moed.

Co-authors of the study with Dr. Moed are Marnix van Holsbeeck, MD, musculoskeletal radiology division, Henry Ford Hospital; and Sendhil Subramanian, MD, J. Tracy Watson, MD, Kathryn E. Cramer, MD, and David E. Karges, DO, division of orthopaedic traumatology, department of orthopaedic surgery, Henry Ford Hospital.

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