Abstract Background: Fracture healing is a complex, multi-stage biological and mechanical process that cannot be fully captured by conventional radiography alone. Early inflammatory changes, marrow edema, angiogenesis, and soft-callus formation occur well before mineralization becomes radiographically apparent. With increasing clinical demand for early diagnosis, timely intervention, and accurate prediction of healing outcomes, modern radiological modalities—including MRI, CT, ultrasound, nuclear medicine, and radiomics-driven artificial intelligence—have become central to orthopedic follow-up. These modalities provide complementary insights into biological activity, structural integrity, metabolic turnover, and quantitative microarchitecture, forming a comprehensive framework for evaluating fracture repair. Objective: This study aims to evaluate the comparative performance of contemporary radiological modalities in detecting, characterizing, and predicting fracture healing across sequential stages. A multimodal assessment involving MRI, CT, ultrasound, nuclear medicine, and radiomics was performed to determine their diagnostic strengths, temporal sensitivity, and overall clinical utility in orthopedic follow-up. Methods: A prospective multimodal analysis was conducted at MGM Medical College, involving 22 eligible patients who underwent scheduled imaging at baseline, 2 weeks, 6 weeks, and 12 weeks. Modalities included radiography, high-frequency ultrasound, 1.5T MRI (T1, T2, STIR, DWI, UTE/ZTE), multidetector CT with 3D reconstruction, Tc-99m MDP bone scintigraphy, and radiomics-based feature extraction. A standardized 0–3 healing score was applied across modalities, and a Modality Performance Score (MPS) was constructed to quantitatively compare early biological sensitivity, structural accuracy, metabolic insight, predictive capability, and 55clinical usability. Results: Ultrasound demonstrated the earliest indicators of healing, detecting periosteal reaction and Doppler vascularity in over 80% of patients by week two. MRI revealed marrow edema resolution and fibrocartilaginous callus earlier than any structural modality, reaching a mean healing score of 2.4 ± 0.3 by week six. CT provided the most reliable structural assessment, confirming partial cortical bridging in 68.1% of cases at week six and complete bridging in 90.9% at week twelve. Nuclear medicine illustrated metabolic activity consistent with osteoblastic turnover, with uptake ratios peaking during the reparative phase. Radiomics achieved the highest predictive accuracy (86– 88%), distinguishing early healing from delayed patterns through quantitative microtexture analysis. Overall, radiomics achieved the highest Modality Performance Score (76/100), followed by MRI (73/100) and CT (62/100). Conclusion: A multimodal radiological approach offers the most accurate assessment of fracture healing, with each modality contributing distinct and essential information. Ultrasound and MRI provide superior early-phase sensitivity, CT remains indispensable for structural consolidation, nuclear imaging identifies metabolic viability, and radiomics supplies predictive biomarkers capable of early risk stratification. Integrating these modalities enables earlier detection of impaired healing, more confident clinical decision-making, and improved personalization of orthopedic care.
International Journal of Medical Science and Advanced Clinical Research (IJMACR) (Tue,) studied this question.