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The Journal of Bone and Joint Surgery 80:1711-2 (1998)
© 1998 The Journal of Bone and Joint Surgery, Inc.

Correspondence

Correspondence

Roger Wade, F.R.C.S (Ed), Benjamin Littenberg, M.D., Loryn P. Weinstein, M.D., Madeline McCarren, Ph.D., Thomas Mead, M.L.S., Marc F. Swiontkowski, M.D., Sally A. Rudicel, M.D. and David Heck, M.D.

TO THE EDITOR:

I read with interest "Closed Fractures of the Tibial Shaft. A Meta-Analysis of Three Methods of Treatment" (80-A: 174–183, Feb. 1998), by Littenberg et al. I have several comments regarding the outcome measures that are used to assess fracture-healing.

The strength of a study relies on its initial design and the outcome measure that it uses. With regard to fracture-healing and time to union, the measures used to assess the end point of healing (when independent weight-bearing is possible) are clinical and radiographic assessment. The accuracy of a physician's ability to assess fracture stability is low; only a deflection on the order of 3 degrees can be reliably assessed1, and as healing progresses the deflection required for assessment approaches 1 degree. . . . [Full Text of this Article]


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