Fracture Gap and Callus Area Delineation on Digital Radiogram Utilizing Modified Segmentation Algorithm

The regenerating bone during fracture healing is usually assessed by observing standard plain radiographs but radiographic definition of union is still not well established. Almost all clinical studies utilize radiographic expertise. The end-point of fracture healing has to be defined properly to make accurate clinical decision. The aim of the study was to support fracture healing evaluation by use of supplemental tool for proper segmentation of fracture callus region for further analysis. We have modified the one of the bacterial colony growth like segmentation algorithm for proper delineation of fracture gap and callus area on digital or digitalized X-ray of long bone fracture cases. The algorithm has been tested on different X-ray images including DICOM digital images (up to 1000 intensity levels) and standard graphical formats (jpeg, gif, tiff) (255 gray scale levels). We have found that results of using developed algorithm in user-dependent time of segmentation method may discover correctly expected region of gap or callus in almost all so called not ambiguous cases. The new, described approach that considers callus formation and its contribution in bone healing may enhance quantitative assessment in daily orthopedic practice and improve prediction of bone union. The clinical usefulness of the algorithm in process of numerical evaluation of long bone fracture healing requires further evaluation.