Ultrasound detects fracture healing earlier than conventional radiographic methods; however, its clinical applicability is limited by subjective nature of interpretation. An ultrasonographic scoring system was developed to quantify fracture healing objectively.

Fifty closed traumatic diaphyseal fractures of less than three weeks, treated by IM Nails, were subjected to serial radiographic and USG examinations (2–24 weeks) by LOGIQ 500 USG machine using 7.5MHz linear transducer. USG parameters included were Echogenecity (EC), Visibility of IM Nail (VIMN), Bridging Callus (BC), and Continuity of Cortex (CC). Marks were allotted from 0–3 for each parameter in the three fracture zones. Three portals were used and mean was obtained. Disorganized echopattern was also defined by us. The results were statistically analyzed and compared with radiological findings using Bone Formation (BF) score.

At 2 weeks, 94% had EC score of < 3, increasing significantly at each follow-up. Defective unions had EC less than 3 at all the times. BC score of 9 was obtained by 94% at 2 weeks increasing to 100% at 8 wks. In non-union score remained 0. VIMN did not provide any statistically significant information. CC were significant only 12 weeks onwards.

USG Score parallels the appearance and progressive mineralization of callus in the fracture gap. Healing pattern can be predicted more definitely in the earlier stages where EC score has more positive predictive value and statistical significance than radiological BF score. EC> 3, BC> 3 and absence of DE was considered an essential USG criteria to conclude fracture union. The advantage over radiological assessment is lost after 12 weeks. We also conclude that a fracture will probably end up in delayed union nonunion if, at 6–8 weeks, the fracture has EC score < 1 or does not show bridging callus in any of the sonographic portals (BC score < 3) or has a disorganized echopattern in any of the sonographic portals.