From the Research
To assess clavicle fracture union, a non-contrast CT scan with thin-slice reconstruction is recommended. When ordering, specify "CT clavicle without contrast" with a clinical indication of "assessment of fracture healing/union status post clavicle fracture." Request thin slices (1mm or less) with multiplanar reconstructions in coronal and sagittal planes. The radiologist should be asked to specifically evaluate for cortical bridging across the fracture site and the percentage of union.
Key Considerations
- CT is superior to plain radiographs for this purpose because it provides three-dimensional visualization of the fracture site, allowing for accurate assessment of callus formation and cortical bridging in multiple planes, as supported by a study published in 2021 1.
- This is particularly important for clavicle fractures where overlapping structures on plain radiographs can obscure the fracture site.
- CT can detect union earlier than radiographs and can quantify the percentage of healing, which is valuable for clinical decision-making regarding return to activities or need for surgical intervention in delayed or non-union cases.
Ordering the Scan
- The scan typically takes 5-10 minutes to complete, and patients should be positioned supine with arms at their sides.
- It is essential to follow the patient's progress and adjust the treatment plan accordingly, considering the potential risks and benefits of operative treatment, as discussed in a review published in 2020 2.
Clinical Decision-Making
- The use of CT scans in assessing clavicle fracture union can help identify patients at risk of non-union, allowing for early intervention and potentially improving outcomes, as suggested by a study published in 2020 3.
- A treatment algorithm should be proposed based on the location and type of fracture, as well as patient characteristics, to ensure optimal care and minimize the risk of complications.