Abstract
Aim: To determine the time at which callus is visible on plain radiographs of tibial fractures and hence the appropriate time to order x-rays to assess union.
Method: The radiographs of patients with tibial diaphyseal fractures were graded for amount of callus on a scale of 1 (no callus) to 5 (no visible fracture line) and the time from injury recorded.
Results: 68 patients were identified, with 45 managed non-operatively by cast, 16 with intramedullary nails and 7 with other methods of fixation. Mean time to grade 3 callus (at least 2 cortices) in adults with non-operatively treated fractures was 8.4 weeks and 4.6 weeks for children. Mean time to union (four cortex bridging callus) was 17.6 weeks for adults and 8.1 weeks for children. In the nailed fractures, mean time to radiographic union was 20 weeks.
Conclusions: To assess union in adult tibial diaphyseal fractures, we recommend an x-ray at eight weeks and 16 weeks after injury, providing there are no clinical concerns. For children, the times should be reduced to 4 and 8 weeks after injury, respectively. Nailed tibial shaft fractures should have radiographs at 12 weeks and 18 weeks to assess union.
Correspondence should be addressed to David Bracey, Honorary Secretary c/o Royal Cornwall Hospitals Trust, Truro, Cornwall TR1 3LJ
