Abstract
We report a radiological sign which predicts progression to hypertrophic non-union for fractures of the tibial diaphysis. Radiographs of 46 tibial fractures were reviewed independently by four orthopaedic trauma surgeons and two musculoskeletal radiologists. Patients were identified from a database of tibial fractures managed with Ilizarov frame fixation. There were 23 fractures that progressed to non-union requiring further surgery. The controls were 23 fractures that had united without need for further surgery at 1-year follow-up. Radiographs selected were the first images taken following frame removal. All radiographs were anonymised and randomized prior to review. Presence of the callus fracture sign was identified in 16 radiographs of the fractures that progressed to non-union, and 7 of the united fracture group. Sensitivity is 69.6 %. Specificity is 91.4 %. Positive and negative predictive values are 88.9 and 75.0 %, respectively. These results compare favourably with computerised tomography for predicting non-union. Intra- and inter-observer reliability was good (κ = 0.68), and moderate (κ = 0.57), respectively. The callus fracture sign is a useful radiological predictor of progression to non-union and may represent insufficient mechanical stability at the fracture site.
Highlights
Fracture union is dependent on the biological environment and the mechanical properties of the fracture site [1]
We report a radiological sign which predicts progression to hypertrophic non-union for fractures of the tibial diaphysis
Presence of the callus fracture sign was identified in 16 radiographs of the fractures that progressed to nonunion, and 7 of the united fracture group
Summary
Fracture union is dependent on the biological environment and the mechanical properties of the fracture site [1]. The senior author has identified a radiological sign in a series of fractures thought to have united but which progressed to established nonunion after removal of fixation. In these cases, bridging callus, as defined above, was seen to join the bone ends across the fracture site in more than one view but, on closer examination, the fracture cleavage can be seen to extend beyond the original cortical boundary of the bone but not to the boundary of the bridging callus (Fig. 2). The senior author was asked to review the radiographs on two separate occasions, after a 6-month interval, to allow for analysis of intra-observer reliability
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