A new article published in Current Osteoporosis Reports discussed imaging modalities for fracture repair assessment, with an emphasis on pragmatic clinical and translational use, best practices for implementation and challenges, and opportunities for continuing research.

The authors stated that semiquantitative radiographic union scoring remains the clinical gold standard, but has questionable reliability as a surrogate indicator of structural bone healing, particularly in early-stage, complex or compromised healing scenarios. On the other hand, computed tomography (CT) scanning enables quantitative assessment of callus morphometry and mechanics through the use of patient-specific finite-element models. Meanwhile dual-energy X-ray absorptiometry (DXA) scanning and radiostereometric analysis (RSA) are also quantitative, but technically challenging. Nonionizing magnetic resonance (MR) and ultrasound imaging are of high interest—it requires development to enable quantification of 3D mineralized structures.

The article concluded that emerging image-based methods for quantitative assessment of bone healing may transform clinical research design by displacing binary outcomes classification (union/nonunion), and ultimately enhance clinical care by enabling an early nonunion detection.

Source: Current Osteoporosis Reports. 2020 Mar 25. doi: 10.1007/s11914-020-00584-5.