Adequately assessing injury severity is critical in treating articular fractures. Severity assessment is used to inform clinical and surgical decision making through anticipation of patient outcomes. The assessments generally involve interpreting radiographs or CT image data. In recognition of the poor reliability of existing clinical severity assessments, objective severity metrics have been developed that are firmly rooted in mechanics and provide capable alternatives for use in research, where reliable data is paramount. Their broader clinical utility remains to be established. An existing CT-based method for determining the energy expended in a bone fracture was extended to facilitate its use in more fracture types. Its utility in different articular joints was evaluated. Specifically, the severities of articular fractures of the proximal tibia (plateau), of the distal tibia (plafond), and of the calcaneus were compared with present clinical severity metrics, patient outcomes, and/or surgeon rankings of severity. Differences in the fracture energies in the different joints were also compared. The objective fracture energy metric compared favorably with present clinical severity metrics. The fracture energies for fractures of the tibial plateau had between 71% and 78% concordance with surgeon rankings of severity. The calcaneal fracture energies had a 75% concordance with the present clinical standard. Fracture energy was also predictive of later radiographic indicators of post-traumatic osteoarthritis. The fracture energy metric is a capable tool for analyzing fracture severity in various joints. Fracture energy correlated well with outcomes and present clinical gold standards for severity assessment. The methods for assessing fracture energy described are highly useful for orthopaedic research and have potential as an important clinical tool.
