{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T18:55:31Z","timestamp":1784919331179,"version":"3.55.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T00:00:00Z","timestamp":1695945600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T00:00:00Z","timestamp":1695945600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100009363","name":"Osteosynthesis and Trauma Care Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009363","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Orthop Surg Traumatol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>To determine the feasibility and reliability of ultrasound in the assessment of humeral shaft fracture healing and estimate the accuracy of 6wk ultrasound in predicting nonunion.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Twelve adults with a non-operatively managed humeral shaft fracture were prospectively recruited and underwent ultrasound scanning at 6wks and 12wks post-injury. Seven blinded observers evaluated sonographic callus appearance to determine intra- and inter-observer reliability. Nonunion prediction accuracy was estimated by comparing images for patients that united (<jats:italic>n<\/jats:italic>\u2009=\u200910\/12) with those that developed a nonunion (<jats:italic>n<\/jats:italic>\u2009=\u20092\/12).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The mean scan duration was 8\u00a0min (5\u201312) and all patients tolerated the procedure. At 6wks and 12wks, sonographic callus (SC) was present in 11 patients (10 united, one nonunion) and sonographic bridging callus (SBC) in seven (all united). Ultrasound had substantial intra- (weighted <jats:italic>kappa<\/jats:italic>: 6wk 0.75; 12wk 0.75) and inter-observer reliability (intraclass correlation coefficient: 6wk 0.60; 12wk 0.76). At 6wks, the absence of SC demonstrated sensitivity 50%, specificity 100%, positive predictive value (PPV) 100% and negative predictive value (NPV) 91% in nonunion prediction (overall accuracy 92%). The absence of SBC demonstrated sensitivity 100%, specificity 70%, PPV 40% and NPV 100% in nonunion prediction (overall accuracy 75%). Of three patients at risk of nonunion (Radiographic Union Score for HUmeral fractures\u2009&lt;\u20098), one had SBC on 6wk ultrasound (that subsequently united) and the others had non-bridging\/absent SC (both developed nonunion).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Ultrasound assessment of humeral shaft fracture healing was feasible, reliable and may predict nonunion. Ultrasound could be useful in defining nonunion risk among patients with reduced radiographic callus formation.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00590-023-03725-5","type":"journal-article","created":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T11:02:13Z","timestamp":1695985333000},"page":"909-918","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ultrasound assessment of humeral shaft nonunion risk: a feasibility and proof of concept study"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8976-2260","authenticated-orcid":false,"given":"William M.","family":"Oliver","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3640-8254","authenticated-orcid":false,"given":"Jamie A.","family":"Nicholson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4145-4909","authenticated-orcid":false,"given":"Katrina R.","family":"Bell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2883-371X","authenticated-orcid":false,"given":"Thomas H.","family":"Carter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6125-7112","authenticated-orcid":false,"given":"Timothy O.","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8792-0659","authenticated-orcid":false,"given":"Nicholas D.","family":"Clement","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5317-1300","authenticated-orcid":false,"given":"Andrew D.","family":"Duckworth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7793-642X","authenticated-orcid":false,"given":"A. 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TOW reports institutional research grants from Acumed and Smith & Nephew and royalties from Elsevier, all unrelated to this study. NDC is an editorial board member of The Bone & Joint Journal and Bone & Joint Research. ADD reports research grants from NIHR, OTA, and SORT-iT, institutional research grants from Stryker, Smith & Nephew and Acumed, royalties from Taylor & Francis and Elsevier, and a speaker payment from AgNovos Healthcare, all unrelated to this study. ADD is also an editorial board member of The Bone & Joint Journal, Bone & Joint Research, and Bone & Joint 360, an Associate Editor for Trials, OTAI, and JBJS Case Connector, and a member of the OTA and OTS Research Committees. AHRWS is the Editor-in-Chief of Bone & Joint Research and a member of the Research Committee of the Orthopaedic Trauma Care Foundation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethical approval was prospectively obtained for this study from South-East Scotland Research Ethics Committee (reference number 06\/S1103\/51).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed written consent was obtained from all study participants. No patient-identifiable details were included in this manuscript and therefore explicit consent for publication was not required.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}