title: Computed tomography reformation in evaluation of fracture healing with metallic fixation: correlation with clinical outcome.
abstract: BACKGROUND
  The amount of callous needed for fracture stability is typically estimated by a combination of radiographic and physical examinations. Computed tomography (CT) with sagittal and coronal reformations was performed to determine the amount of callous needed for fracture stability based on a quartile analysis of bony bridging of the circumference of the fracture site.
  
  
  METHODS
  All patients who received CT with sagittal and coronal reformations of a fractured tubular bone for the purpose of analyzing bony bridging over a 22-month period were retrospectively reviewed. The final analysis included 34 patients and a total of 47 examinations. Fractures were placed into one of four groups depending on the amount of cortical bridging of the circumference of the bone: group I, 0-24%, group II, 25-49%, group III, 50-74%, group IV, 75-100%. Clinical outcome was determined on the basis of fracture stability, with mean follow-up of approximately 62 weeks.
  
  
  RESULTS
  A statistically significant increase in clinical failure was found in patients with <25% bridging. A cut-point analysis revealed that 37.5% (6 of 16) of failures occurred among patients with <25% bony bridging, and only 9.7% (3 of 31) of failures occurred among patients with >25% bridging, corresponding to a Fisher's exact test p value of 0.045.
  
  
  CONCLUSIONS
  Patients with less than 25% bridging of the circumference of a tubular bone should be considered high risk for failure, indicating the need for continued protection of the site.
authors.affiliation: Division of Diagnostic Imaging, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1273, Houston, TX 77030, USA. ccostelloe@di.mdacc.tmc.edu
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Costelloe
authors.forename: Kyle
authors.initials: K
authors.lastname: Dickson
authors.forename: Dianna D
authors.initials: DD
authors.lastname: Cody
authors.forename: Mike
authors.initials: M
authors.lastname: Hernandez
authors.forename: Edward H
authors.initials: EH
authors.lastname: DeMouy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002146:Bony Callus / Q000000981:diagnostic imaging*; D005260:Female; D005593:Fracture Fixation, Internal; D017102:Fracture Healing / Q000502:physiology*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging; D006801:Humans; D018889:Ilizarov Technique; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult