Clinical outcomes of the fracture fixation treatment were significantly associated with bone density, as per research of Archives of Orthopaedic and Trauma Surgery journal. Osteoporosis and reduced bone density is a severe condition that enhances the risk of fractures. The association between the low bone density and fracture risk is well known, but the effects of fracture risk on fracture fixation and related clinical outcomes are unknown.

Therefore to determine a relationship between clinical outcomes after fracture fixation and bone quality, Stephen J. Warner and colleagues conducted a study with 64 patients who got the ankle fracture fixation by the one surgeon from 2003 to 2013. A preoperative and postoperative computed tomography (CT) imaging was done to assess injured and contralateral ankle respectively.  An elliptical region of interest that was limited to the cancellous metaphyseal region of the distal fibula and tibia was used to determine Hounsfield unit (HU) values. The Foot and Ankle Outcome Scores (FAOS) and ankle range of motion (ROM) were used as primary and secondary study outcomes. All the patients had the record of clinical outcome data at least one year.

An almost perfect agreement (ICC(2,1) = 0.938) was noticed from the comparison of injured and contralateral HU values. As per the agreement, the HU values can be correctly determined in the setting of a fracture. The improved outcomes in the four FAOS domains; quality of life, pain, sports and activities of daily living showed a significant association with the enhanced HU values of the fibula and distal tibia (P ≤ 0.05). However, no significant relationship was noticed between HU values and range of motion. According to results, the quality of bones plays a very crucial role in the fracture fixation.