Sonographic callus may enable assessment of fracture healing. The aim of this study was to establish a reliable method for three-dimensional reconstruction of sonographic callus. Patients that underwent non-operative management of displaced midshaft clavicle fractures and intramedullary nailing of tibia fractures were prospectively recruited and followed to union. Ultrasound scanning was performed at periodical time points following injury. Infra-red tracking technology was used to map each image to a three-dimensional lattice. Criteria was fist established for two-dimensional bridging callus detection in a pilot study. Using echo intensity of the ultrasound image, semi-automated mapping was used to create an anatomic three-dimensional representation of fracture healing. Agreement on the presence of sonographic bridging callus was assessed using the kappa coefficient and intra-class-correlation (ICC) between observers. 112 clavicle fractures and 10 tibia fractures completed follow-up at six months. Sonographic bridging callus was detected in 62.5% (n=70/112) of the clavicles at six weeks post-injury. If present, union occurred in 98.6% of the fractures (n=69/70). If absent, nonunion developed in 40.5% of cases (n=17/42)(73.4%-sensitive and 100%-specific to predict union). Out of 10 tibia fractures, 7 had bridging callus of at least one cortex at 6 weeks and when present all united. Of the three patients lacking sonographic bridging callus, one went onto a nonunion (77.8%-sensitive and 100%-specific to predict union). The ICC for sonographic callus between four reviewers was 0.82 (95% CI 0.68–0.91) Three-dimensional ultrasound reconstruction of bridging callus has the potential to identify impaired fracture healing at an early stage in fracture management.
The aim of this study was to review the current evidence and future application for the role of diagnostic and therapeutic ultrasound in fracture management. A review of relevant literature was undertaken, including articles indexed in PubMed with keywords “ultrasound” or “sonography” combined with “diagnosis”, “fracture healing”, “impaired fracture healing”, “nonunion”, “microbiology”, and “fracture-related infection”.Objectives
Methods
Distension arthrography of the glenohumeral joint was adopted as a mainstream treatment for adhesive capsulitis before any randomised controlled trials were performed. Interpretation of the effectiveness of this procedure rests on data from cohort studies of which there are few of high quality. Papers reporting on the long-term results have either excluded diabetic patients or failed to report on patient orientated outcomes. We present a prospective cohort study of 51 patients with adhesive capsulitis of the shoulder who had a distension arthrogram performed by a single radiologist as a primary intervention. We included diabetic patients. Range of movement (ROM), Oxford shoulder score (OSS) and a visual analogue pain score (VAS) were recorded pre-procedure, at 2 days and 1 month. OSS and VAS were recorded again at a mean of 14 months post procedure (range 8–26 months). OSS improved from pre-procedure mean of 22.3 by 16.9 points at final follow up in September 2011 (p < 0.001) whilst VAS improved from a mean pre-procedure of 7.1 by −3.5 by September 2011 (p< 0.001). ROM improved with a mean increase of 39.3 degrees in flexion, 55.2 degrees in abduction and 19.5 degrees in external rotation by 1 month (p < 0.001 for all). The outcome in diabetic patients was the same as in non-diabetic patients. We conclude that distension arthrography is a safe and effective treatment for adhesive capsulitis.
