New Approach Monitors Bone Fracture Healing Without X-Ray Radiation

Until now, monitoring bone fractures has primarily relied on X-ray imaging or computed tomography (CT) scans. These techniques, however, involve exposure to high-energy radiation, limiting how often they can safely be used. Another challenge is that X-rays and CT scans are not very effective at detecting early stages of bone healing. As the bone starts to mend, soft bone tissue begins to form across the fracture site, but its low density prevents it from being picked up on X-rays. The mineralization stage—when calcium salts are deposited and bone density increases—is what finally becomes visible on imaging, but this occurs later in the healing process. Until then, the healing activity remains largely undetectable, making it difficult to determine whether a fracture is progressing as it should.

These imaging methods also provide only intermittent snapshots, leaving the changes occurring between scans unobserved. A new method now offers a way to overcome these limitations by monitoring blood flow and oxygen levels at the fracture site using near-infrared light, avoiding the risks of harmful radiation. Recent findings published in Biosensors and Bioelectronics and Journal of Functional Biomaterials reveal that this technique allows for fast and straightforward monitoring of bone regeneration.

This innovative method was developed by a medical research group at Saarland University (Saarbrücken, Germany), which demonstrated that blood circulation and oxygen saturation in the fracture tissue could be measured accurately without relying on short-wavelength radiation. Using standard medical devices already in use to assess blood flow and oxygen levels in skin and muscle—devices that employ safe LED and laser light capable of penetrating to bone depth—they showed that these could also track how fractures heal.

The new method permits ongoing, non-invasive observation of the healing process directly through the skin. This helps patients gain clearer insights into their recovery and allows care providers to detect complications earlier. The researchers successfully applied this method to monitor the healing of patients with tibial (shin bone) fractures. Now, they are aiming to expand its use to other kinds of bone fractures and defects.

The research team achieved this breakthrough by analyzing how blood flow and oxygen levels fluctuate during the healing process. Two distinct studies were carried out, monitoring 55 patients with tibial fractures over several months and comparing them with a control group of 51 individuals without fractures. The data revealed a consistent trend in bone regeneration: blood flow at the fracture site surges sharply at first and peaks, then gradually declines after two to three weeks. Oxygen saturation in the tissue near the fracture drops initially, but begins to rise again after the same two-to-three-week window, signaling the formation of new blood vessels. These are the first such detailed, longitudinal observations of the fracture healing process in human subjects.

The technology used in this work combines laser Doppler flowmetry for assessing blood flow with white light spectroscopy for measuring tissue oxygen saturation. If blood flow and oxygen levels do not return to baseline within a few weeks, it may suggest that healing is not proceeding correctly. The researchers also observed that the blood flow and oxygen trends differ depending on why healing may be delayed.

One current limitation of this light-based method is its depth of penetration—it cannot measure fractures located more than five centimeters beneath the skin. To address this, the team is also exploring other novel techniques to track bone healing, including the use of self-sensing shape memory materials. These materials can monitor changes in the stiffness and flexibility of the fracture site, offering another layer of insight into healing progress.

This research is part of the broader ‘Smart Implants’ initiative, which has already produced several prototype designs and patent filings for intelligent fracture plates. These next-generation implants are intended not only to monitor healing from the time of surgery but also to actively promote it—such as through micromechanical stimulation or by adapting the stiffness of the implant over time. Data from the laser Doppler and white light spectroscopy studies are now being incorporated into these smart implants. Currently, efforts are underway to miniaturize this monitoring technology so it can be embedded inside intramedullary nails, which are just a few millimeters in diameter.

“Our method is not intended to replace X-ray imaging. We regard it as a useful adjunct – a rapid control method that provides supplementary information in areas where existing techniques leave gaps,” said Professor Bergita Ganse, who is leading the medical research team at Saarland University. “Small, affordable monitoring devices could improve fracture care in settings without access to large, expensive equipment like X-ray machines – particularly in low-resource countries or remote areas.”

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Saarland University