Correlations of radiographic analysis of healing fractures with strength: A statistical analysis of experimental osteotomies

The assessment of fracture healing strength using routine roentgenograms is difficult and controversial. There are few experimental data that correlate radiographic appearance with the actual quantitative strength of healing fractures. However, this method is widely used in clinical practice. A study is presented in which transversely osteotomized rabbit tibiae were allowed to heal for 3 to 8 weeks. A pair of orthogonal roentgenograms was taken of each bone and the bones were tested for strength in a dynamic torsion testing machine. Statistical analyses were done to study the correlations between the roentgenographic and strength parameters. Cortical continuity was found to be the best single predictor of strength of a healing fracture (correlation coefficient r = 0.80). The least important predictor was the callus area (r = 0.17). Fracture displacement, callus thickness, and callus diameter had negative correlations. From these experimental findings in an animal model, we conclude that even under laboratory conditions the information gained from plain radiographs is not sufficient to accurately predict the strength of a healing fracture.