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Quantification of Fracture Healing from Radiographs Using the Maximum Callus Index

  • Symposium: Biomechanics of Bone Healing
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Callus formation and growth are an essential part of secondary fracture healing. Callus growth can be observed radiographically and measured using the “Callus Index,” which is defined as the maximum diameter of the callus divided by the diameter of the bone. We compared three groups of patients with tibial fractures treated by external fixation, intramedullary nailing, and casting to assess the validity of using serial measurements of callus index as a measure of fracture healing. When callus index was plotted against time for each patient, the point at which the fracture began to remodel, indicated by the highest point of the curve, was observed as a consistent feature regardless of fixation method. This occurred on average at 2½ weeks after plaster cast removal (14 weeks post injury), 5 weeks after external fixator removal (22 weeks post injury), and 27 weeks post injury for the intramedullary nailed fractures. Because remodeling only occurs once the fracture is stable, a peak in callus index is a reliable sign that the fracture has united. Serial measurements of callus index would therefore appear to offer a simple method of quantifying secondary fracture healing regardless of the treatment method used.

Level of Evidence: Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Winford Unit, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK

    S. J. Eastaugh-Waring MB, ChB, FRCS & C. C. Joslin MB, ChB, FRCS

  2. Department of Orthopaedic Surgery, University of Bristol, Bristol Royal Infirmary, Bristol, UK

    J. R. W. Hardy MD, FRCS

  3. Department of Mechanical Engineering, Centre for Orthopaedic Biomechanics, University of Bath, Bath, BA2 7AY, UK

    J. L. Cunningham PhD

Authors
  1. S. J. Eastaugh-Waring MB, ChB, FRCS
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  2. C. C. Joslin MB, ChB, FRCS
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  3. J. R. W. Hardy MD, FRCS
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  4. J. L. Cunningham PhD
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Corresponding author

Correspondence to J. L. Cunningham PhD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained.

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Eastaugh-Waring, S.J., Joslin, C.C., Hardy, J.R.W. et al. Quantification of Fracture Healing from Radiographs Using the Maximum Callus Index. Clin Orthop Relat Res 467, 1986–1991 (2009). https://doi.org/10.1007/s11999-009-0775-0

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  • DOI: https://doi.org/10.1007/s11999-009-0775-0

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