How much earlier can ultrasound show healing of a fracture as compared to X-ray? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you get a fracture of one of the metatarsal bones in your foot, you’re not going to be able to run until it heals and as soon as it’s healed, you want to start running again. Now, you may have recently seen the episode that I did where I was talking about how ultrasound can oftentimes show healing sooner than X-rays. And it’s really simple how that happens.
Basically, X-rays only show something’s wrong because you have an area of decreased density, radio density, where the X-ray particles get absorbed more as they go through the tissue. Obviously, X-rays pass easier and with less impediments through soft tissue than bone.
When you take an X-ray of your foot, we get white bones on a black background and where there’s a fracture line because the X-rays are going right through, it’s black. So, what does this mean? Well, on ultrasound, it’s something different. Ultrasound does not use X-rays. It uses sound waves that go through the tissue and bounce back. Those sound waves do not penetrate at all through bone, so you see a hard white line and everything beneath that is black when you’re looking at an ultrasound image.
However, when you have a fracture, you start to get some filling in of that fracture with material that gets more and more dense that actually does change on the ultrasound. How do I say that I believe that I can see fracture healing and start runners about two weeks earlier is what I generally say than what would have been allowed if I was only using X-ray and I was not using ultrasound to assess the changes in the fracture healing that what we call the bone callus or the healing site in the fractured bone. And that is not just my opinion.
I was just giving a talk at the International Foot and Ankle foundation to a bunch of physicians as a medical conference and one of the things I cited was I showed that there was an article published in 2015 in the journal orthopedic trauma and in that article in 2015, it actually showed that fracture consolidation happens about three weeks earlier on diagnostic ultrasound than it does on X-rays.
In the chapter on fracture sonography which is a textbook teaching doctors how to use ultrasound image bone fracture, Christian Tesch, the author of that chapter stated that fracture healing can reliably be seen two weeks earlier using ultrasound than X-rays.
So, what does this mean for you? Well think about if you are off of your foot because you have a fracture. What would be the difference in your fitness if you are off of your feet and not running or training at all for eight weeks instead of six weeks or if you’re off your feet for six weeks instead of four weeks.
The thing is, is that it’s the loss of fitness is kind of exponential. So it’s super important that as soon as it looks like it’s starting to consolidate, we have some real evidence that it’s getting more stable and you should be able to work out, you need to start working out and so that’s why you should ask your doctor about looking at it with an ultrasound
If you liked this episode, please like it, please subscribe, but also if you haven’t seen the stress fracture masterclass and you’re a runner with a stress fracture, you might want to check it out. It’s free. It’s a deep plot dive I go into lots of stuff about stress fractures that runners don’t really need to think about. Then you can get it for free at www.docontherun.com/stressfracturemasterclass. So go check it out, and I’ll see you in the training.
Chachan S, Tudu B, Sahu B. Ultrasound monitoring of fracture healing: is this the end of radiography in fracture follow-ups? J Orthop Trauma. 2015 Mar;29(3):e133-8.