Development and duration of radiographic signs of bone healing in children

OBJECTIVE. Few articles report the evaluation of pediatric fracture healing and dating based on radiographic: appearance. We established a timetable f or expected radiographic changes visible during bone healing in otherwise h ealthy children. MATERIALS AND METHODS. We examined 707 radiographs of fractured forearms in 141 patients. Each fracture was assessed by a pediatric radiologist who wa s unaware of the timing of the initial injury. Assessment included the foll owing features. fracture margins, fracture gal,, periosteal reaction, callu s, bridging, and remodeling. The time interval between injury and the appea rance of the radiographic features and the duration of radiographic signs w ere determined and correlated with age, sex, angulation, displacement, and location. RESULTS, Sclerosis at the fracture margins was evident in 85% of fractures 5 weeks after injury. Widening of the fracture gap was observed in 62% of f ractures at 6 weeks. Periosteal reaction was evident on ail images by 4 wee ks, and after 7 weeks, periosteal reaction was separable from cortex in onl y 10% of fractures. Fracture callus had a density equal to or greater than that of adjacent cortex 10 weeks after injury in 90% of fractures CONCLUSION. A wide variation exists in the appearance and duration of the r adiographic signs of bone healing. Marginal sclerosis should be an expected radiographic sign of normal bone healing. Applying maximum and minimum tim e spans to objective radiographic signs may aid in fracture dating.