Author: Jung Gyu Chi, Sungwook Choi, Don-Soo Kim 👨🔬
Affiliation: IAM ORTHOPAEDIC CLINIC, Boston Children's Hospital/Harvard Medical School, Massachusetts College of Pharmacy and Health Science 🌍
Purpose: To explore quantifiable parameters of the fracture healing process to aid physicians in determining the treatment plan for intramedullary nailing removal.
Methods: In contrast to conventional subjective radiographic assessment, several potential parameters of fracture healing were explored and plotted to identify patterns. A single case of a displaced tibial midshaft fracture treated with intramedullary nailing was selected. A series of post-operative follow-up radiographic images were collected and processed using ImageJ software to generate gray value plots over time.To assess changes in fracture gap distance, the Full Width at Half Maximum (FWHM) of the gray value plots was measured. To assess changes in gray value within the fracture gap, peak fracture gap gray value to normal bone gray value ratios (F/B) were collected over time. Several methods were explored to determine the best approach for obtaining FWHM and F/B and collecting useful parameters. Both parameters were plotted on scatter plots, and linear regression analysis was conducted.
Results: While FWHM plotting did not produce any significant trends over follow-up time (r = 0.41151 p-value = 0.10077), which might be caused by the unique process of healing of bones, F/B plotting resulted in moderate to strong correlation with significance (r = -0.66137 / p-value = 0.0015).
Conclusion: Evaluating contrast, such as through F/B or similar methods, may reveal a parameter for assessing fracture healing stages in follow-up radiographs. Notably, the FWHM plot also exhibited a trend with a relatively low standard deviation, suggesting potential for significance with increased sample size. Both approaches could be further applied to various bone fracture cases for quantitative evaluation of healing.