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The callus fracture sign: a radiological predictor of progression to hypertrophic non-union in diaphyseal tibial fractures.

Salih S, Blakey C, Chan D, McGregor-Riley JC, Royston SL, Gowlett S, Moore D, Dennison MG - Strategies Trauma Limb Reconstr (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Orthopaedics, Northern General Hospital, Herres Rd, Sheffield, S5 7AU, UK. saifsalih@hotmail.com.

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.

No MeSH data available.


Related in: MedlinePlus

A hypertrophic non-union in a diaphyseal tibial fracture. The line drawing depicts the extension of the fracture line to the periphery of the callus
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Fig1: A hypertrophic non-union in a diaphyseal tibial fracture. The line drawing depicts the extension of the fracture line to the periphery of the callus

Mentions: Fracture union is dependent on the biological environment and the mechanical properties of the fracture site [1]. Hypertrophic non-union can occur in the presence of an appropriate biological response but inadequate mechanical stability. In the context of the Ilizarov method, fractures heal by secondary or indirect bone healing, i.e. in the presence of relative stability provided by the circular fine-wire fixator, the fracture heals by periosteal bony callus (intramembranous ossification) at the periphery of the fracture and fibrocartilaginous bridging callus (endochondral ossification) between bone ends [1, 2]. Here the term ‘bridging callus’ is used to describe the appearance of calcified tissue between the ends of a fracture. Several authors define union as the radiological presence of bridging callus at 3 out of 4 cortices on AP and lateral views [3, 4]. The classic elephant’s foot appearance of a hypertrophic non-union (Fig. 1) results from instability preventing ossification with further cartilaginous material continued to be laid down [1].Fig. 1


The callus fracture sign: a radiological predictor of progression to hypertrophic non-union in diaphyseal tibial fractures.

Salih S, Blakey C, Chan D, McGregor-Riley JC, Royston SL, Gowlett S, Moore D, Dennison MG - Strategies Trauma Limb Reconstr (2015)

A hypertrophic non-union in a diaphyseal tibial fracture. The line drawing depicts the extension of the fracture line to the periphery of the callus
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4666228&req=5

Fig1: A hypertrophic non-union in a diaphyseal tibial fracture. The line drawing depicts the extension of the fracture line to the periphery of the callus
Mentions: Fracture union is dependent on the biological environment and the mechanical properties of the fracture site [1]. Hypertrophic non-union can occur in the presence of an appropriate biological response but inadequate mechanical stability. In the context of the Ilizarov method, fractures heal by secondary or indirect bone healing, i.e. in the presence of relative stability provided by the circular fine-wire fixator, the fracture heals by periosteal bony callus (intramembranous ossification) at the periphery of the fracture and fibrocartilaginous bridging callus (endochondral ossification) between bone ends [1, 2]. Here the term ‘bridging callus’ is used to describe the appearance of calcified tissue between the ends of a fracture. Several authors define union as the radiological presence of bridging callus at 3 out of 4 cortices on AP and lateral views [3, 4]. The classic elephant’s foot appearance of a hypertrophic non-union (Fig. 1) results from instability preventing ossification with further cartilaginous material continued to be laid down [1].Fig. 1

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Orthopaedics, Northern General Hospital, Herres Rd, Sheffield, S5 7AU, UK. saifsalih@hotmail.com.

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.

No MeSH data available.


Related in: MedlinePlus