Artikel
Contrast-Enhanced Ultrasound (CEUS): A viable diagnostic tool in predicting treatment failure after non-union revision surgery for upper- and lower-limb non-unions
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Autoren
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Stefan Waizenegger
- Univeristätsklinikum Heidelberg, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Heidelberg, Germany
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Julian Doll
- Univeristätsklinikum Heidelberg, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Heidelberg, Germany
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Paul Mick
- Univeristätsklinikum Heidelberg, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Heidelberg, Germany
| Veröffentlicht: | 23. Oktober 2023 |
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Gliederung
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Objectives: Non-unions remain a major complication in the treatment of long-bone fractures and impact quality of life considerably. Early detection and treatment of non-unions, especially after non-union surgery, are essential to secure subsequent fracture union. Sufficient vascularisation plays a key role in the healing process. The aim of this prospective cohort study was, to quantify the microperfusion within non-unions by means of contrast-enhanced ultrasound (CEUS) as early as twelve weeks after non-union surgery and examine the prognostic capability of CEUS in predicting treatment failure.
Methods: Between 2014 and 2020 a total of 157 patients with long bone non-unions were initially included in this study. Twelve weeks (± four weeks) after surgical intervention patients received a CEUS examination, aiming to assess the microperfusion of the soft callus formation in the non-union gap. Follow-up X-ray and CT examinations were performed at regular intervals up to 36 months after revision surgery. Non-unions were classified as consolidated and therefore “responders” if at least three of four cortices were bridged. Means and standard deviation (SD), medians and quartiles (Q25, Q75) were calculated, as well as Wilcoxon U-Test to illustrate potential differences between consolidated unions and persistent non-unions. The diagnostic ability of continuous binary data was illustrated using receiver operating (ROC) analysis and ideal cut-off points were determined by calculating the Youden Index.
Results and conclusion: Of 109 patients with non-union surgery, consolidation within 36 months was achieved in 86 patients (“responders”), whereas 23 patients showed persistent non-unions (“non-responders”) and required further surgery. CEUS quantification parameters such as Peak Enhancement (PE), Wash-in Area Under the Curve (WiAUC) and Wash-in Perfusion Index (WiPI) revealed significantly higher perfusion levels in “responders” compared to “non-responders” (p < 0.05). ROC analysis revealed that persistent fracture non-unions could be predicted with a sensitivity/specificity of 88.1%/72.2% in lower-limb non-unions and a sensitivity/specificity of 66.7%/100.0% in upper-limb non-unions.
Figure 1 [Fig. 1]
Therefore CEUS is a viable diagnostic tool in predicting treatment failure as early as twelve weeks after non-union surgery and should be integrated into the clinical routine when deciding on revision surgery at an early stage.
