The management of upper-limb non-unions can be challenging, especially when infection is existent. Thus, pre-operative detection of infection plays a relevant role in non-union treatment. This study investigated in a large cohort the diagnostic potential of contrast-enhanced ultrasound (CEUS) as stand-alone method for differentiating between aseptic and infected upper-limb non-unions. Osseous perfusion of 50 upper-extremity non-unions (radius/ulna, n = 20; humerus, n = 22; clavicle, n = 8) was prospectively assessed with CEUS before revision surgery. The perfusion was quantified via time-intensity curves and peak enhancement (in arbitrary units). Significant perfusion differences between aseptic and infected non-unions could be detected (peak enhancement, p < 0.001). The sensitivity and specificity for the detection of infected upper-limb non-unions were 80% and 94.3% (cutoff peak enhancement: 130.8 arbitrary units). CEUS reliably differentiates between aseptic and infected upper-limb non-unions. Consequently, CEUS should be integrated into the daily diagnostic routine algorithm to plan non-union revision surgery more precisely as a single- or multi-step procedure.

上肢骨不连的管理可能具有挑战性，尤其是当存在感染时。因此，术前检测感染在不愈合治疗中起着重要作用。本研究在一个大型队列中调查了对比增强超声 (CEUS) 作为区分无菌性和感染性上肢骨不连的独立方法的诊断潜力。 在翻修手术前用 CEUS 前瞻性评估了50 个上肢骨不连（桡骨/尺骨，n  = 20；肱骨，n  = 22；锁骨，n = 8）的骨灌注。灌注量通过时间强度曲线和峰值增强（以任意单位）。可以检测到无菌和感染的不愈合之间的显着灌注差异（峰值增强，p < 0.001）。检测感染上肢不愈合的灵敏度和特异性分别为 80% 和 94.3%（截止峰值增强：130.8 个任意单位）。CEUS 能够可靠地区分无菌性和感染性上肢骨不连。因此，应将 CEUS 整合到日常诊断常规算法中，以作为单步或多步程序更精确地计划不愈合修复手术。