A comparative study of ultrasound and x-ray in detection, of fracture callus in tibial shaft fractures, treated by unreamed interlocking nailing


  • Veera Kumaran R. Department of Orthopedics, Central Leprosy Teaching &Research Institute, Chengalpattu, Chennai, Tamil Nadu
  • Krishna Kumar S. Department of Orthopedics, Krishanakumar Orthopedic Hospital, Nagercoil, Tamil Nadu




Ultra sound, X-ray, Tibial shaft fractures, Unreamed interlocking nailing


Background: Trauma is a major health problem in young adults and adolescents. It is a major cause of disability with fracture being a leading contributor to hospital cost and lost productivity in the workplace. Comparative study of ultrasonography and radiography in the early detection of fracture callus in tibial shaft fracture treated by unreamed static interlocking nailing.

Methods: All skeletally mature patients admitted to Krishna Kumar Orthopedic Hospital, Nagercoil were included in our study from 2007 to 2008. 21 patients totally, who had sustained an acute fracture of the tibial shaft and who were treated by statically locked unreamed interlocking nailing were candidates for the study.

Results: The mean±standard deviation for ultrasound and X-ray method of detection fracture callus in fractures shaft of tibia treated with static interlocking nailing are 4.82±1.01 and 7.05±1.02 respectively which is statistically highly significant. This analysis reveals that ultrasound detects fracture callus much earlier than X-ray.

Conclusions: Ultrasound was able to detect fracture callus in tibial shaft fracture treated by a static unreamed interlocking nail. There was a statistically high significance difference of 2.23 weeks between the two techniques Ultrasound was done using a 7.5 MHz linear transducer probe. Ultrasound could detect fracture callus at a mean period of 4.82 weeks. Whereas X-rays could d detect fracture callus only at a mean period of 7.05 weeks.

Author Biography

Veera Kumaran R., Department of Orthopedics, Central Leprosy Teaching &Research Institute, Chengalpattu, Chennai, Tamil Nadu

assistant professor , annamalaiuniversity, chidambaram


Ashworth MJ, Patel N. Compartment syndrome following ankle fracture-dislocation: a case report. J Orthop Trauma. 1998;12:67–8.

Attal R, Hansen M, Kirjavainen M, Bail H, Hammer TO, Rosenberger R, et al. A multicentre case series of tibia fractures treated with the Expert Tibia Nail (ETN). Arch Orthop Trauma Surg. 2012;132(7):975–84.

Adamson GJ, Wiss DA, Lowery GL, Peters CL. Type II floating knee: ipsilateral femoral and tibial fractures with intraarticular extension into the knee joint. J Orthop Trauma. 1992;6(3):333–9.

Agel J, Coetzee JC, Sangeorzan BJ, Roberts MM, Hansen ST Jr. Functional limitations of patients with end-stage ankle arthrosis. Foot Ankle Int. 2005;26(7):537–9.

Ahmad MA, Sivaraman A, Zia A, Rai A, Patel AD. Percutaneous locking plates for fractures of the distal tibia: our experience and a review of the literature. J Trauma Acute Care Surg. 2012;72(2):81–7.

Alberts KA, Lohan G, Einarsdottir H. Open tibial fractures: faster union after unreamed nailing than an external fixation. Injury. 1999;30(8):519–23.

Alho A, Benterud JG, Hogevold HE, Ekeland A, Strømsøe K. Comparison of functional bracing and locked intramedullary nailing in the treatment of displaced tibial shaft fractures. Clin Orthop Relat Res. 1992;277:243–50.

Anderson LD, Hutchins WC, Wright PE, Disney JM. Fractures of the tibia and fibula treating bt casts and transfixing pins. Clin Orthop Relat Res. 1975;105:179–91.

Anglen JO. Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. A prospective, randomized study. J Bone Joint Surg Am. 2005;87(7):1415–22.

Antich-Adrover P, Marti-Garin D, Murias-Alvarez J, Puente-Alonso C. External fixation and secondary intramedullary nailing of open tibial fractures. A randomized, prospective trial. J Bone Joint Surg Br. 1997;79(3):433–7.

Ares O, Conesa X, Seijas R, Carrera L. Proximal tibiofibular dislocation associated with fracture of the tibia: a case report. Cases J. 2009;18(2):196.

Aydın A, Atmaca H, Müezzinog˘lu US. Anterior knee dislocation with ipsilateral open tibia diaphyseal fracture: a 5-year clinical follow-up of a professional athlete. Musculoskelet Surg. 2013;97(2):165–8.

Bach AW, Hansen ST Jr. Plates versus external fixation in severe open tibial diaphyseal fractures. A randomized trial. Clin Orthop Relat Res. 1989;241:89–94.

Bansal VP, Singhal V, Mam MK, Gill SS. The floating knee. 40 cases of ipsilateral fractures of the femur and the tibia. Int Orthop. 1984;8(3):183–7.

Baumgart F, Kohler G, Ochsner PE. The physics of heat generation during reaming of the medullary cavity. Injury. 1998;29(2):11–25.

Berkes M, Obremskey WT, Scannell B, Ellington JK, Hymes RA, Bosse M, Southeast Fracture. Maintenance of hardware after a yearly postoperative infection following fracture internal fixation Consortium. J Bone Joint Surg Am. 2010;92(4):823–8.

Bhandari M, Zlowodzki M, Tornetta P III, Schmidt A, Templeman DC. Intramedullary nailing following external fixation in femoral and tibial shaft fractures. J Orthop Trauma. 2005;19(2):140–4.

Bhattacharyya T, Seng K, Nassif NA, Freedman I. Knee pain after tibial nailing: the role of nail prominence. Clin Orthop Relat Res. 2006;449:303–7.

Blick SS, Brumback RJ, Poka A, Burgess AR, Ebraheim NA. Compartment syndrome in open tibial fractures. J Bone Joint Surg Am. 1986;68(9):1348–53.

Blum ML, Esser M, Richardson M, Paul E, Rosenfeldt FL. Negative pressure wound therapy reduces deep infection rate in open tibial fractures. J Orthop Trauma. 2012;26(9):499–505.

Moed BR, Subramanian S, van Holsbeeck M, Watson JT, Cramer KE, Karges DE, et al. Ultrasound for the Early diagnosis of Tibial Fracture Healing after static interlocked Nailing without Reaming - clinical results. J Orthop Trauma. 1998;12(3);206-13.

Young JWR, kostrubiak IS, Resnik CS, Paley D. Sonographic evaluation of bone production at the distraction site in Ilizarov limb – lengthening procedures. Am J Radiol. 1990;134:125-8.






Original Research Articles