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Scientific Articles   |    
Variability in the Assessment of Fracture-Healing in Orthopaedic Trauma Studies
Luis A. Corrales, MD1; Saam Morshed, MD, MPH3; Mohit Bhandari, MD, MSc, FRCSC2; Theodore MiclauIII, MD3
1 Department of Orthopaedic Surgery, University of California at San Francisco School of Medicine, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143
3 Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, Room 3A-36, San Francisco, CA 94110. E-mail address for T. Miclau III: miclaut@orthosurg.ucsf.edu
2 Hamilton General Hospital, 7 North, Suite 727, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from a Doris Duke Clinical Research Fellowship, an Orthopaedic Research and Education Foundation (OREF) Clinical Research Training Fellowship, and the National Institutes of Health. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California; San Francisco General Hospital, San Francisco, California; and the Department of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Sep 01;90(9):1862-1868. doi: 10.2106/JBJS.G.01580
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Abstract

Background: There is a lack of consensus among orthopaedic surgeons in the assessment of fracture-healing. We conducted a systematic review of recent clinical studies of long-bone fracture care that were published in three major orthopaedic journals to identify current definitions of fracture-healing.

Methods: MEDLINE and the computerized databases for The Journal of Bone and Joint Surgery (American Volume), The Journal of Bone and Joint Surgery (British Volume), and the Journal of Orthopaedic Trauma were searched from January 1996 through December 2006 with use of title, abstract, keyword, and medical subject headings. Therapeutic clinical studies of long-bone fractures of the appendicular skeleton in adults in which fracture-healing was assessed were selected. Two reviewers independently identified articles and extracted data. Any disagreement was resolved by consensus. We qualitatively and quantitatively summarized the definition of fracture union and the reliability of the assessment of radiographic fracture-healing.

Results: One hundred and twenty-three studies proved to be eligible. Union was defined on the basis of a combination of clinical and radiographic criteria in 62% of the studies, on the basis of radiographic criteria only in 37%, and on the basis of clinical criteria only in 1%. Twelve different criteria were used to define fracture union clinically, and the most common criterion was the absence of pain or tenderness at the fracture site during weight-bearing. In studies involving the use of plain radiographs, eleven different criteria were used to define fracture union, and the most common criterion was bridging of the fracture site. A quantitative measure of the reliability of the radiographic assessment of fracture union was reported in two studies.

Conclusions: We found a lack of consensus with regard to the definition of fracture-healing in the current orthopaedic literature. Without valid and reliable clinical or radiographic measures of union, the interpretation of fracture care studies remains difficult.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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