Contrast-Enhanced Ultrasound (CEUS) Identifies Perfusion Differences Between Tibial Fracture Unions and Non-Unions

Abstract

Purpose To assess the value of CEUS in the evaluation of tibial fracture perfusion and its ability to differentiate between physiologic and abnormal fracture healing.

Materials and Methods From 2014 to 2017, 107 patients with tibial fractures or tibial non-unions underwent CEUS examination. CEUS was performed at the regular follow-up examination 26 weeks after osteosynthesis or before non-union surgery. Time-intensity curves (TICs) of the contrast enhancement in the fracture gap were generated, and volume parameters such as wash-in rate (WiR), peak enhancement (PE) and wash-in perfusion index (WiPI) were quantified.

Results A total of 34 patients met the inclusion criteria of this study, including 14 consolidated fractures, 12 aseptic non-unions and 8 infected non-unions. WiR, PE and WiPI showed significantly lower values in aseptic non-unions compared to unions (p = 0.009, 0.009, 0.012, resp.). In contrast, infected non-unions showed higher values of WiR, PE and WiPI when compared to unions (p = 0.034, 0.056, 0.029, resp.).

Conclusion CEUS represents a feasible method in the assessment of tibial fracture perfusion. Perfusion differences between aseptic and infected tibial non-unions as well as healing tibial fractures could be detected. The deviation of physiologic fracture perfusion seems to be associated with disturbed osseous regeneration leading to non-union.

Zusammenfassung

Ziel Diese Studie untersuchte den Nutzen des CEUS für die Beurteilung verschiedener Perfusionsmuster nach Tibiafrakturen, die zur Ausheilung oder Pseudarthrosenbildung führen können.

Material und Methode Von 2014 bis 2017 wurde bei 107 Patienten mit Tibiafraktur oder Tibia-Pseudarthrose eine CEUS-Untersuchung durchgeführt. Die CEUS-Untersuchung fand zum regulären 26-Wochen Nachuntersuchungstermin statt, bei Patienten mit Pseudarthrose unmittelbar vor der Revisionsoperation. Es wurden Zeit-Intensitäts-Kurven der Kontrastmittelanflutung im Frakturspalt erstellt und quantitative Parameter wie „Wash-in Rate“ (WiR), „Peak Enhancement“ (PE) sowie „Wash-in Perfusion Index“ (WiPI) berechnet.

Ergebnisse 34 Patienten wurden eingeschlossen, davon 14 verheilte Frakturen, 12 aseptische Pseudarthrosen und 8 Infektpseudarthrosen. Die Perfusionsparameter WiR, PE and WiPI zeigten bei aseptischen Pseudarthrosen signifikant niedrigere Werte als bei verheilten Frakturen (p = 0,009; 0,009; 0,012). Im Gegensatz dazu waren WiR, PE and WiPI bei Infektpseudarthrosen höher als bei physiologisch verheilten Frakturen (p = 0,034; 0,056; 0,029).

Schlussfolgerung CEUS ist eine geeignete Methode zur Beurteilung der ossären Perfusion nach Fraktur. Im CEUS zeigen sich Perfusionsunterschiede von Tibiafrakturen mit regulärem Heilungsverlauf und solchen, die eine Pseudarthrose ausgebildet haben. Abweichungen von der physiologischen ossären Perfusion nach Tibiafraktur scheinen mit der Ausbildung einer Pseudarthrose zusammenzuhängen.

Key words

CEUS - fracture - non-union - tibia - osseus perfusion

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