## Investigation of Choice for Assessing Fracture Healing Stages **Key Point:** Plain radiography remains the gold standard and first-line investigation for assessing fracture healing progression, particularly for evaluating callus formation and bridging across the fracture site. ### Why Plain Radiograph is Optimal at 3 Weeks At 3 weeks post-fracture, the healing process enters the **early callus (soft callus) stage**, where: - Soft callus begins to form (cartilaginous and fibrous tissue) - Early mineralization may be visible on plain X-rays - Bridging callus starts to appear at the fracture margins - Plain radiographs clearly demonstrate these changes with adequate sensitivity ### Radiographic Signs of Healing at 3 Weeks | Stage | Timeline | Radiographic Finding | Investigation | |-------|----------|----------------------|----------------| | Inflammatory | 0–2 weeks | Fracture line, soft tissue swelling | Plain X-ray | | **Soft callus** | **2–6 weeks** | **Callus bridging, early mineralization** | **Plain X-ray (BEST)** | | Hard callus | 6–12 weeks | Dense callus, bridging complete | Plain X-ray | | Remodeling | 12 weeks–2 years | Callus resorption, restoration of anatomy | Plain X-ray | **High-Yield:** At 3 weeks, plain radiographs will show the transition from inflammatory phase to early callus phase — the most clinically relevant information for this timepoint. ### Clinical Pearl Repeat radiographs at 2–3 week intervals are standard practice to monitor fracture healing progression without unnecessary radiation exposure or cost. **Tip:** Always obtain AP and lateral views to assess callus formation in three dimensions and detect any angulation or displacement. 
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