How to Determine Blood Flow in Poorly Healed Fractures?

Poor fracture healing

"How can we determine if blood circulation is present after a fracture has been surgically repaired?" I fell while hiking on October 3, 2014, resulting in a fracture of my left radius with displacement.
I underwent surgery to fixate the fracture with a metal plate, and the plate was removed on January 7, 2016.
On February 9, 2016, I visited the clinic due to pain in my hand, and it was confirmed that the fracture had healed poorly, with compromised blood flow and the newly formed bone being hollow, leading to a re-fracture.
I underwent another surgery on February 10, 2016, where bone marrow from my pelvis was used to cover the fractured bone to promote blood circulation.
Is it possible to assess whether blood circulation is present at the fracture site through testing? Thank you!

lan, 50~59 year old female. Ask Date: 2016/05/29

Dr. Shi Guozheng reply Orthopedics

The healing of a fracture needs to be confirmed through X-rays rather than by checking whether blood flow is present.
Even if blood flow is restored, it does not guarantee that the fracture will heal.
For non-union fractures, reoperation and bone grafting is the appropriate course of action, followed by close monitoring until the bone heals.

Reply Date: 2016/05/29

More Info

To determine blood flow in poorly healed fractures, particularly after surgical intervention, a combination of clinical evaluation and imaging techniques is typically employed. The healing process of a fracture is complex and involves not only the formation of new bone but also the restoration of adequate blood supply to the affected area. In your case, where there was a history of a poorly healed fracture of the radius, it is essential to assess both the mechanical stability of the fracture site and the vascular supply.

Clinical Evaluation
1. Physical Examination: A thorough physical examination is crucial. The physician will assess for signs of compromised blood flow, such as changes in skin color (pallor or cyanosis), temperature differences between the affected limb and the rest of the body, and the presence of swelling or tenderness. Additionally, the doctor will check for capillary refill time, which can indicate blood flow adequacy.

2. Symptoms: Patients often report symptoms such as persistent pain, swelling, or a feeling of heaviness in the affected limb. In your case, the pain and the hollow appearance of the newly formed bone suggest that there may be inadequate blood supply, which can hinder proper healing.

Imaging Techniques
1. X-rays: Standard X-rays are the first-line imaging modality to evaluate bone healing. They can show the alignment of the fracture, the presence of callus formation, and any signs of non-union or malunion. However, X-rays alone do not provide information about blood flow.

2. CT Scans: A computed tomography (CT) scan can provide a more detailed view of the fracture and surrounding soft tissues. It can help identify any complications such as bone necrosis or the presence of a hematoma that might be affecting blood flow.

3. MRI: Magnetic resonance imaging (MRI) is particularly useful in assessing soft tissue and bone marrow. It can help visualize the vascularity of the bone and surrounding tissues, which is crucial in determining whether blood flow is adequate for healing. MRI can also identify any associated soft tissue injuries that may impact recovery.

4. Doppler Ultrasound: This non-invasive test can assess blood flow in the arteries and veins of the affected limb. It can help determine if there are any vascular obstructions or abnormalities that could be contributing to poor blood supply.

5. Bone Scintigraphy: A bone scan can be used to evaluate the metabolic activity of the bone. Increased uptake in the area of the fracture may indicate healing, while decreased uptake could suggest avascular necrosis or non-union.

Conclusion
In summary, determining blood flow in poorly healed fractures involves a combination of clinical assessment and advanced imaging techniques. If there are concerns about blood flow, it is essential to consult with an orthopedic specialist who can recommend the appropriate diagnostic tests and treatment options. In your case, the surgical intervention to cover the fracture site with bone marrow from the pelvis was a sound approach to enhance healing and restore blood supply. Continuous follow-up with imaging and clinical evaluations will be necessary to monitor the healing process and ensure that adequate blood flow is restored to the affected area.

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