Proposal of an Ultrasonographic Classification of Tibial Bone Healing Image Patterns
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Purpose : To describe the image patterns related to POCUS evaluation of tibial fracture healing and delayed healing. Methods : Between August 2020 and December 2023, patients with tibial fractures treated with intramedullary nails were evaluated monthly using ultrasonographic and radiographic evaluations and documentation. Ultrasonographic image patterns are described. Results : Six different frequent patterns were found: (1) disorganized cotton-like image at the fracture line, (2) small bump with bridging callus in lower-energy trauma, (3) bridging callus with displaced cortical fragment, (4) larger callus with mountain formation, either continuous or with a lip-like image, (5) mushroom-like bridging callus with height greater than length, and (6) V-shaped image with irregular borders and corkscrew signal, indicating nonunion. Conclusion : Imaging patterns can help to understand the healing process and guide future research on bone healing. Knowledge of the early stage of bone healing can influence decision making in delayed union and nonunion treatment.
