Can measuring blood flow in broken bones help surgeons choose the best treatment?

People are suffering more broken bones than ever before in the UK. Many are left permanently disabled. Researchers are investigating whether a new MRI scanning technique can measure damage to the blood supply in fractures. This information has not been routinely available before, but it could help surgeons choose the most appropriate treatment, so more people make a full recovery.

What's the problem and who does it affect?

Surgeons lack vital information on blood flow in broken bones

Professor Roger Atkins, the Project Leader on this study, estimates that we suffer about 7 million significant fractures per year in the UK. People of all ages are affected. For example, many young people develop lifelong disabilities after breaking bones in accidents on the roads or when playing sports, and older people with osteoporosis have such fragile bones they’re susceptible to fractures during everyday activities.

Complex fractures are very difficult to treat, and patients often need extensive surgery. The best method of treatment varies depending on the nature of the break and any disruption to the bone’s blood supply. Re-establishing this blood supply is vital if fractures are to heal properly.

The problem is that blood flow within bones is very poorly understood. Surgeons have no routine way of assessing it in their fracture clinics. They are often forced to make critical decisions about how to treat fractures without knowing how the bone’s blood supply has been affected.

What is the project trying to achieve?

Measuring blood flow through bones

Researchers aim to find out whether a new way of taking MRI scans, called ultra short echo time (UTE) imaging, can measure blood flow in broken bones. Breakthrough studies have already shown that the new technique can provide images of the blood vessels within bones if patients have an injection of a substance called gadolinium before their scan. Gadolinium acts like a dye and it’s seen moving into, and out of, patients’ bones. It’s widely used and rarely causes side effects.

In this project, researchers will first scan the shins of 10 normal volunteers to see if they can measure how blood flows through healthy bones. Next, they will scan 20 patients who have broken their leg and monitor their recovery, taking at least one more scan as the fracture heals. Researchers hope the results will show how fractures, and the healing process, affect blood flow through bones.

What are the researchers' credentials?

Professor Roger Atkins is a leader in research into the reconstruction of limbs, and is interested in fracture healing and bone regeneration. He leads the Limb Reconstruction research team at the United Bristol Healthcare Trust and lectures regularly at national and international meetings. Matthew Robson has been heavily involved in the development of the groundbreaking new MRI scanning technique known as UTE. Together with their colleagues, they form an excellent multi-disciplinary team.

The Bristol Royal Infirmary houses Europe’s busiest limb reconstruction unit. Its specialist doctors treat patients with difficult fractures and reconstruct patients’ limbs after they’ve been damaged by fracture, infection, cancer or congenital defects. The unit has a very strong track record, with many of its staff having international reputations.

Who stands to benefit from this research and how?

Improving recovery from fracture

Researchers hope their work will reveal whether surgeons could use the new way of taking MRI scans on a routine basis to measure blood flow in broken bones. This is a pilot study, but a larger investigation is planned if the technique shows promise.

The ability to measure the blood flow to fractures before surgery would have a major impact. Surgeons would have much better information on the nature of each patient’s injuries, which would help them to select the most appropriate treatment. They would also be able to monitor patients’ recovery more accurately.

Researchers estimate that, if the technique was used to assess all major fractures, it could benefit hundreds of thousands of patients each year in the UK. Improved treatment should mean patients’ fractures heal more effectively, so getting people back to normal life more swiftly. It might also help stop so many patients from developing permanent disabilities.

Fractures are very common, affecting many otherwise fit people and preventing them from working. And the number of fractures is on the increase. Even a very minor success in improving patients’ recoveries would have a massive effect on spending on healthcare.