A Cortical Bridge Too Far: Commentary on an article by William D. Lack, MD, et al.: "Any Cortical Bridging Predicts Healing of Tibial Shaft Fractures".

Abstract

Orthopaedic surgeons are faced every day with the question: “Will this fracture heal?” As clinicians, what criteria do we use to determine fracture-healing? Often this is a clinical gestalt involving symptoms such as pain at the fracture site, physical examination findings such as absence of tenderness to palpation at the fracture site, and a careful analysis of radiographs. Clinicians often use the presence of bridging callus as a radiographic sign of fracture-healing. However, there is ongoing controversy about how much callus and how many cortices with bridging callus, as well as the visibility of the fracture line, there should be to be interpreted as signs of fracture-healing. Currently, there is no one “gold standard” or commonly agreed to criterion to determine or even measure fracture-healing1-3. A variety of scoring systems have been developed over the years, but none have become common parts of the daily life of clinicians treating fractures4,5. Devices to …