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Ren T, Inglis B, Darwiche S, Dailey HL. Torsion constants and virtual mechanical tests are valid image-based surrogate measures of ovine fracture healing. J Orthop Res 2024; 42:1810-1819. [PMID: 38491964 DOI: 10.1002/jor.25836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 08/30/2023] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Abstract
In large animal studies, the mechanical reintegration of the bone fragments is measured using postmortem physical testing, but these assessments can only be performed once, after sacrifice. Image-based virtual mechanical testing is an attractive alternative because it could be used to monitor healing longitudinally. However, the procedures and software required to perform finite element analysis (FEA) on subject-specific models for virtual mechanical testing can be time consuming and costly. Accordingly, the goal of this study was to determine whether a simpler image-based geometric measure-the torsion constant, sometimes known as polar moment of inertia-can be reliably used as a surrogate measure of bone healing in large animals. To achieve this, postmortem biomechanical testing and microCT scans were analyzed for a total of 33 operated and 20 intact ovine tibiae. An image-processing procedure to compute the attenuation-weighted torsion constant from the microCT scans was developed in MATLAB and this code has been made freely available. Linear regression analysis was performed between the postmortem biomechanical data, the results of virtual mechanical testing using FEA, and the torsion constants measured from the scans. The results showed that virtual mechanical testing is the most reliable surrogate measure of postmortem torsional rigidity, having strong correlations and high absolute agreement. However, when FEA is not practical, the torsion constant is a viable alternative surrogate measure that is moderately correlated with postmortem torsional rigidity and can be readily calculated.
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Affiliation(s)
- Tianyi Ren
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Brendan Inglis
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Salim Darwiche
- Musculoskeltal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Hannah L Dailey
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, Pennsylvania, USA
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Hetreau C, Mischler D, Schlatter J, Valenti A, Ernst M, Varga P, Schwarzenberg P. Longitudinal CT-based finite element analyses provide objective fracture healing measures in an ovine tibia model. J Orthop Res 2024; 42:1762-1770. [PMID: 38483000 DOI: 10.1002/jor.25838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 07/04/2024]
Abstract
Measuring the healing status of a bone fracture is important to determine the clinical care a patient receives. Implantable devices can directly and continuously assess the healing status of fracture fixation constructs, while subject-specific virtual biomechanical tests can noninvasively determine callus structural integrity at single time points. Despite their potential for objectification, both methods are not yet integrated into clinical practice with further evidence of their benefits required. This study correlated continuous data from an implantable sensor assessing healing status through implant load monitoring with computer tomography (CT) based longitudinal finite element (FE) simulations in a large animal model. Eight sheep were part of a previous preclinical study utilizing a tibial osteotomy model and equipped with such a sensor. Sensor signal was collected over several months, and CT scans were acquired at six interim time points. For each scan, two FE analyses were performed: a virtual torsional rigidity test of the bone and a model of the bone-implant construct with the sensor. The longitudinal simulation results were compared to the sensor data at corresponding time points and a cohort-specific empirical healing rule was employed. Healing status predicted by both in silico simulations correlated significantly with the sensor data at corresponding time points and correctly identified a delayed and a nonunion in the cohort. The methodology is readily translatable with the potential to be applied to further preclinical or clinical cohorts to find generalizable healing criteria. Virtual mechanical tests can objectively measure fracture healing progressing using longitudinal CT scans.
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Affiliation(s)
| | | | | | | | | | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
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Cen C, Cao Y, Zhang Y, Hu C, Wang Y, Xia K, Liu C, Qiu B. Synergistic effects of autologous platelet-rich plasma combined with an extracorporeal shock wave in treatment of long diaphysis aseptic nonunion. Orthop Traumatol Surg Res 2024; 110:103417. [PMID: 37010140 DOI: 10.1016/j.otsr.2022.103417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 07/27/2022] [Accepted: 08/25/2022] [Indexed: 04/04/2023]
Abstract
INTRODUCTION Union of long bone fractures is a complicated biological mechanism affected by numerous systemic and local variables. Disruption of any of these components may result in fracture nonunion. There are various types of clinically available treatment strategies for aseptic nonunion. Both activated platelet plasma and extracorporeal shock waves play important roles in fracture healing. This study aimed to investigate the interaction of platelet-rich plasma (PRP) and extracorporeal shock wave (ESW) in bone healing of nonunion. HYPOTHESIS PRP and ESW have synergistic effects in treating long bone nonunion. METHODS Between January 2016 and December 2021, a total of 60 patients with established nonunion of a long bone (18 tibias, 15 femurs, 9 humerus, 6 radii, and 12 ulnae) were included in this study, comprising 31 males and 29 females, ranging from 18 to 60 years old. Patients with bone nonunion were separated into two groups: PRP alone (Monotherapy group) and those treated with PRP combined with ESW (Combined treatment group). The two groups were compared to assess the therapeutic benefits, callus development, local problems, bone healing time, and Johner Wruhs functional classification of operated limbs. RESULTS Fifty-five patients were followed up, 5 patients were lost to follow-up, two in the PRP group and three in the PRP+ESW group, the follow-up time varied from 6 to 18 months, with an average of 12.7±5.2 months. At 8, 12, 16, 20, and 24 weeks following intervention, the callus score in the monotherapy group was significantly lower than in the combined treatment group (p<0.05). Both groups had no swelling and infection in the soft tissue of the nonunion operation site. In the PRP+ESW group, the fracture union rate was 92.59% and the healing time was 16.3±5.2 weeks. In the PRP group, the fracture union rate was 71.43% and the healing time was 21.5±3.7 weeks. The clinical healing time of the monotherapy group was significantly longer than the combined treatment group (p<0.05). All the nonunion patients with no signs of healing were treated with revision surgery. The excellent and good rate of Johner-Wruhs functional classification of affected limbs in the monotherapy group was significantly lower than in the combined treatment group (p<0.05). CONCLUSION PRP combined with ESW has a certain synergistic effect in treating aseptic nonunion after fracture surgery. It can significantly improve the formation of new bone, it is a minimally invasive and effective strategy to treat aseptic nonunion in a clinical setting. LEVEL OF EVIDENCE III, retrospective, single-centre, case-control study.
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Affiliation(s)
- Chaode Cen
- Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China
| | - Yongfei Cao
- Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China
| | - Yong Zhang
- Department of Gynaecology and Obstetrics, Guiyang First People's Hospital, Guiyang 550000, China
| | - Chaoran Hu
- Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China
| | - Yusong Wang
- Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China
| | - Keming Xia
- Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China
| | - Chengwei Liu
- Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China
| | - Bing Qiu
- Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China.
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Requist MR, Mills MK, Carroll KL, Lenz AL. Quantitative Skeletal Imaging and Image-Based Modeling in Pediatric Orthopaedics. Curr Osteoporos Rep 2024; 22:44-55. [PMID: 38243151 DOI: 10.1007/s11914-023-00845-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE OF REVIEW Musculoskeletal imaging serves a critical role in clinical care and orthopaedic research. Image-based modeling is also gaining traction as a useful tool in understanding skeletal morphology and mechanics. However, there are fewer studies on advanced imaging and modeling in pediatric populations. The purpose of this review is to provide an overview of recent literature on skeletal imaging modalities and modeling techniques with a special emphasis on current and future uses in pediatric research and clinical care. RECENT FINDINGS While many principles of imaging and 3D modeling are relevant across the lifespan, there are special considerations for pediatric musculoskeletal imaging and fewer studies of 3D skeletal modeling in pediatric populations. Improved understanding of bone morphology and growth during childhood in healthy and pathologic patients may provide new insight into the pathophysiology of pediatric-onset skeletal diseases and the biomechanics of bone development. Clinical translation of 3D modeling tools developed in orthopaedic research is limited by the requirement for manual image segmentation and the resources needed for segmentation, modeling, and analysis. This paper highlights the current and future uses of common musculoskeletal imaging modalities and 3D modeling techniques in pediatric orthopaedic clinical care and research.
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Affiliation(s)
- Melissa R Requist
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Dr., Salt Lake City, UT, 84112, USA
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, 30 N Mario Capecchi Dr. 2 South, Salt Lake City, UT, 84112, USA
| | - Kristen L Carroll
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
- Shriners Hospital for Children, 1275 E Fairfax Rd, Salt Lake City, UT, 84103, USA
| | - Amy L Lenz
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
- Department of Biomedical Engineering, University of Utah, 36 S Wasatch Dr., Salt Lake City, UT, 84112, USA.
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Heyland M, Deppe D, Reisener MJ, Damm P, Taylor WR, Reinke S, Duda GN, Trepczynski A. Lower-limb internal loading and potential consequences for fracture healing. Front Bioeng Biotechnol 2023; 11:1284091. [PMID: 37901836 PMCID: PMC10602681 DOI: 10.3389/fbioe.2023.1284091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction: Mechanical loading is known to determine the course of bone fracture healing. We hypothesise that lower limb long bone loading differs with knee flexion angle during walking and frontal knee alignment, which affects fracture healing success. Materials and methods: Using our musculoskeletal in silico modelling constrained against in vivo data from patients with instrumented knee implants allowed us to assess internal loads in femur and tibia. These internal forces were associated with the clinical outcome of fracture healing in a relevant cohort of 178 extra-articular femur and tibia fractures in patients using a retrospective approach. Results: Mean peak forces differed with femoral compression (1,330-1,936 N at mid-shaft) amounting to about half of tibial compression (2,299-5,224 N). Mean peak bending moments in the frontal plane were greater in the femur (71-130 Nm) than in the tibia (from 26 to 43 Nm), each increasing proximally. Bending in the sagittal plane showed smaller mean peak bending moments in the femur (-38 to 43 Nm) reaching substantially higher values in the tibia (-63 to -175 Nm) with a peak proximally. Peak torsional moments had opposite directions for the femur (-13 to -40 Nm) versus tibia (15-48 Nm) with an increase towards the proximal end in both. Femoral fractures showed significantly lower scores in the modified Radiological Union Scale for Tibia (mRUST) at last follow-up (p < 0.001) compared to tibial fractures. Specifically, compression (r = 0.304), sagittal bending (r = 0.259), and frontal bending (r = -0.318) showed strong associations (p < 0.001) to mRUST at last follow-up. This was not the case for age, body weight, or localisation alone. Discussion: This study showed that moments in femur and tibia tend to decrease towards their distal ends. Tibial load components were influenced by knee flexion angle, especially at push-off, while static frontal alignment played a smaller role. Our results indicate that femur and tibia are loaded differently and thus require adapted fracture fixation considering load components rather than just overall load level.
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Affiliation(s)
- Mark Heyland
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Deppe
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
- Department of Radiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Marie Jacqueline Reisener
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
- Centre for Muskuloskeletal Surgery (CMSC), Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Damm
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - William R. Taylor
- Laboratory for Movement Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Simon Reinke
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Georg N. Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Adam Trepczynski
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
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6
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Theunissen L, Deleu PA, Birch I, Reymond N, Devos Bevernage B, Maldague P, Gombault V, Malherbe C, Leemrijse T. Subtalar Arthrodesis in Patients With Prior Tibiotalar Arthrodesis for Posttraumatic Osteoarthritis. Foot Ankle Int 2023; 44:862-871. [PMID: 37434387 DOI: 10.1177/10711007231181568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND The tibiotalar arthrodesis for end-stage ankle osteoarthritis is a surgical procedure that leads to a modification of the kinematics of the adjacent joints and may result in the development of secondary osteoarthritic degeneration of the subtalar joint. It has previously been observed that subtalar arthrodesis in this context shows a lower fusion rate than isolated subtalar arthrodesis. This retrospective study reports the results of subtalar joint arthrodesis with previous ipsilateral tibiotalar arthrodesis and suggests some factors that may compromise the fusion of the joint. METHODS Between September 2010 and October 2021, 15 arthrodeses of the subtalar joint with screw fixation were performed in 14 patients, with a fusion of the ipsilateral tibiotalar joint. Fourteen of 15 cases used an open sinus tarsi approach, 13 were augmented with iliac crest bone graft, and 11 had supplemental demineralized bone matrix (DBM). The outcome variables were fusion rate, time to fusion, and revision rate. Fusion was assessed by radiographs and computed tomography scan. RESULTS Twelve of the 15 subtalar arthrodeses (80%) fused at the first attempt with an average fusion time of 4.7 months. CONCLUSION In this limited retrospective case series, compared to the fusion rate of isolated subtalar arthrodesis reported in the literature, the rate of subtalar fusion in the presence of an ipsilateral tibiotalar arthrodesis was found to be lower. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | | | - Ivan Birch
- Sheffield Teaching Hospitals NHS Foundation Trust, Woodhouse Clinic, Sheffield, United Kingdom
| | | | | | - Pierre Maldague
- Foot and Ankle Institute, Bruxelles, Belgium
- CHIREC Delta Hospital, Brussels, Belgium
| | - Vincent Gombault
- Foot and Ankle Institute, Bruxelles, Belgium
- CHIREC Delta Hospital, Brussels, Belgium
| | - Corentin Malherbe
- Foot and Ankle Institute, Bruxelles, Belgium
- CHIREC Delta Hospital, Brussels, Belgium
| | - Thibaut Leemrijse
- Foot and Ankle Institute, Bruxelles, Belgium
- CHIREC Delta Hospital, Brussels, Belgium
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Shariyate MJ, Kheir N, Caro D, Abbasian M, Rodriguez EK, Snyder BD, Nazarian A. Assessment of Bone Healing: Opportunities to Improve the Standard of Care. J Bone Joint Surg Am 2023; 105:1193-1202. [PMID: 37339171 DOI: 10.2106/jbjs.22.01224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
➤ Bone healing is commonly evaluated by clinical examination and serial radiographic evaluation. Physicians should be mindful that personal and cultural differences in pain perception may affect the clinical examination. Radiographic assessment, even with the Radiographic Union Score, is qualitative, with limited interobserver agreement.➤ Physicians may use serial clinical and radiographical examinations to assess bone healing in most patients, but in ambiguous and complicated cases, they may require other methods to provide assistance in decision-making.➤ In complicated instances, clinically available biomarkers, ultrasound, and magnetic resonance imaging may determine initial callus development. Quantitative computed tomography and finite element analysis can estimate bone strength in later callus consolidation phases.➤ As a future direction, quantitative rigidity assessments for bone healing may help patients to return to function earlier by increasing a clinician's confidence in successful progressive healing.
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Affiliation(s)
- Mohammad Javad Shariyate
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniela Caro
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Edward K Rodriguez
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Brian D Snyder
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Yerevan State Medical University Yerevan, Armenia
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Banerjee A, Tai Y, Myung NV, Nam J. Non-destructive characterization of bone mineral content by machine learning-assisted electrochemical impedance spectroscopy. Front Bioeng Biotechnol 2022; 10:961108. [PMID: 36131724 PMCID: PMC9484274 DOI: 10.3389/fbioe.2022.961108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
Continuous quantitative monitoring of the change in mineral content during the bone healing process is crucial for efficient clinical treatment. Current radiography-based modalities, however, pose various technological, medical, and economical challenges such as low sensitivity, radiation exposure risk, and high cost/instrument accessibility. In this regard, an analytical approach utilizing electrochemical impedance spectroscopy (EIS) assisted by machine learning algorithms is developed to quantitatively characterize the physico-electrochemical properties of the bone, in response to the changes in the bone mineral contents. The system is designed and validated following the process of impedance data measurement, equivalent circuit model designing, machine learning algorithm optimization, and data training and testing. Overall, the systematic machine learning-based classification utilizing the combination of EIS measurements and electrical circuit modeling offers a means to accurately monitor the status of the bone healing process.
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Affiliation(s)
- Aihik Banerjee
- Department of Bioengineering, University of California, Riverside, University Ave, Riverside, CA, United States
| | - Youyi Tai
- Department of Bioengineering, University of California, Riverside, University Ave, Riverside, CA, United States
| | - Nosang V. Myung
- Department of Chemical and Biomolecular Engineering, University of Notre Dame, Notre Dame, IN, United States
| | - Jin Nam
- Department of Bioengineering, University of California, Riverside, University Ave, Riverside, CA, United States
- UC-KIMS Center for Innovative Materials, University of California, Riverside, University Ave, Riverside, CA, United States
- *Correspondence: Jin Nam,
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Fukase N, Duke VR, Lin MC, Stake IK, Huard M, Huard J, Marmor MT, Maharbiz MM, Ehrhart NP, Bahney CS, Herfat ST. Wireless Measurements Using Electrical Impedance Spectroscopy to Monitor Fracture Healing. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22166233. [PMID: 36016004 PMCID: PMC9412277 DOI: 10.3390/s22166233] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 05/05/2023]
Abstract
There is an unmet need for improved, clinically relevant methods to longitudinally quantify bone healing during fracture care. Here we develop a smart bone plate to wirelessly monitor healing utilizing electrical impedance spectroscopy (EIS) to provide real-time data on tissue composition within the fracture callus. To validate our technology, we created a 1-mm rabbit tibial defect and fixed the bone with a standard veterinary plate modified with a custom-designed housing that included two impedance sensors capable of wireless transmission. Impedance magnitude and phase measurements were transmitted every 48 h for up to 10 weeks. Bone healing was assessed by X-ray, µCT, and histology. Our results indicated the sensors successfully incorporated into the fracture callus and did not impede repair. Electrical impedance, resistance, and reactance increased steadily from weeks 3 to 7-corresponding to the transition from hematoma to cartilage to bone within the fracture gap-then plateaued as the bone began to consolidate. These three electrical readings significantly correlated with traditional measurements of bone healing and successfully distinguished between union and not-healed fractures, with the strongest relationship found with impedance magnitude. These results suggest that our EIS smart bone plate can provide continuous and highly sensitive quantitative tissue measurements throughout the course of fracture healing to better guide personalized clinical care.
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Affiliation(s)
- Naomasa Fukase
- Linda and Mitch Hart Center for Regenerative & Personalized Medicine at the Steadman Philippon Research Institute, Vail, CO 81657, USA
| | - Victoria R. Duke
- Linda and Mitch Hart Center for Regenerative & Personalized Medicine at the Steadman Philippon Research Institute, Vail, CO 81657, USA
| | - Monica C. Lin
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Department of Bioengineering, University of California, Berkeley, CA 94720, USA
| | - Ingrid K. Stake
- Linda and Mitch Hart Center for Regenerative & Personalized Medicine at the Steadman Philippon Research Institute, Vail, CO 81657, USA
- Department of Orthopaedic Surgery, Ostfold Hospital Trust, 1714 Graalum, Norway
| | - Matthieu Huard
- Linda and Mitch Hart Center for Regenerative & Personalized Medicine at the Steadman Philippon Research Institute, Vail, CO 81657, USA
| | - Johnny Huard
- Linda and Mitch Hart Center for Regenerative & Personalized Medicine at the Steadman Philippon Research Institute, Vail, CO 81657, USA
| | - Meir T. Marmor
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Michel M. Maharbiz
- Department of Bioengineering, University of California, Berkeley, CA 94720, USA
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94720, USA
- Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
| | - Nicole P. Ehrhart
- Department of Clinical Sciences, Flint Animal Cancer Center, College of Veterinary Medicine, Colorado State University, Fort Collins, CO 80523, USA
| | - Chelsea S. Bahney
- Linda and Mitch Hart Center for Regenerative & Personalized Medicine at the Steadman Philippon Research Institute, Vail, CO 81657, USA
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Correspondence: (C.S.B.); (S.T.H.)
| | - Safa T. Herfat
- UCSF Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Correspondence: (C.S.B.); (S.T.H.)
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10
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Sommer F, Kirnaz S, Goldberg JL, McGrath LB, Schmidt F, Gadjradj P, Medary B, Härtl R. Safety and Feasibility of DTRAX Cervical Cages in the Atlantoaxial Joint for C1/2 Stabilization. Oper Neurosurg (Hagerstown) 2022; 22:322-327. [PMID: 35315806 DOI: 10.1227/ons.0000000000000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pathological changes in the atlantoaxial joint often lead to instability, pain, and neurological deterioration. One treatment option is the surgical stabilization of the atlantoaxial joint. In other areas of the spine, fusion rates have been improved by the introduction of an interbody cage. Our aim was to use cervical interbody spacers, originally designed to augment fusion across subaxial posterior cervical facets, to optimize the conditions for atlantoaxial fusion. OBJECTIVE To evaluate the safety and efficacy of implanting cervical cages in the atlantoaxial joint for C1/2 stabilization. METHODS Our retrospective study evaluated patients who had undergone C1/2 cervical fusions by the Harms/Goel technique. This technique was modified by implanting a titanium cervical interbody spacer into the joint space. Mean overall pain, as measured by a 0 to 10 visual analog scale (VAS) and neurological outcomes were measured preoperatively and postoperatively. In addition, radiological outcomes were collected using follow-up imaging. RESULTS Nine patients were included in this case series. The mean preoperative VAS for overall pain was 5.0 ± 4.0, which changed to a mean VAS of 2.0 ± 3.0 after an average follow-up period of 41.4 ± 20.4 (P = .043). All patients showed a bony fusion in our case series. None of the radiological imaging during follow-up showed screw loosening, hardware breakage, implant migration, or nonunion. CONCLUSION The implantation of cervical titanium cages into the atlantoaxial joint in combination with posterior fixation appears to be a safe and effective method for achieving C1/2 fusion.
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Affiliation(s)
- Fabian Sommer
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
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11
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Inglis B, Schwarzenberg P, Klein K, von Rechenberg B, Darwiche S, Dailey HL. Biomechanical duality of fracture healing captured using virtual mechanical testing and validated in ovine bones. Sci Rep 2022; 12:2492. [PMID: 35169187 PMCID: PMC8847550 DOI: 10.1038/s41598-022-06267-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/17/2022] [Indexed: 01/08/2023] Open
Abstract
Bone fractures commonly repair by forming a bridging structure called callus, which begins as soft tissue and gradually ossifies to restore rigidity to the bone. Virtual mechanical testing is a promising technique for image-based assessment of structural bone healing in both preclinical and clinical settings, but its accuracy depends on the validity of the material model used to assign tissue mechanical properties. The goal of this study was to develop a constitutive model for callus that captures the heterogeneity and biomechanical duality of the callus, which contains both soft tissue and woven bone. To achieve this, a large-scale optimization analysis was performed on 2363 variations of 3D finite element models derived from computed tomography (CT) scans of 33 osteotomized sheep under normal and delayed healing conditions. A piecewise material model was identified that produced high absolute agreement between virtual and physical tests by differentiating between soft and hard callus based on radiodensity. The results showed that the structural integrity of a healing long bone is conferred by an internal architecture of mineralized hard callus that is supported by interstitial soft tissue. These findings suggest that with appropriate material modeling, virtual mechanical testing is a reliable surrogate for physical biomechanical testing.
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Affiliation(s)
- Brendan Inglis
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA, 18015, USA.
| | - Peter Schwarzenberg
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA, 18015, USA
| | - Karina Klein
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland.,Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, 8057, Zurich, Switzerland
| | - Salim Darwiche
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland.,Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, 8057, Zurich, Switzerland
| | - Hannah L Dailey
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA, 18015, USA.
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12
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Willems A, Iҫli C, Waarsing JH, Bierma-Zeinstra SMA, Meuffels DE. Bone Union Assessment with Computed Tomography (CT) and Statistical Associations with Mechanical or Histological Testing: A Systematic Review of Animal Studies. Calcif Tissue Int 2022; 110:147-161. [PMID: 34417861 PMCID: PMC8784489 DOI: 10.1007/s00223-021-00904-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/09/2021] [Indexed: 11/02/2022]
Abstract
Objective and accurate assessment of bone union after a fracture, arthrodesis, or osteotomy is relevant for scientific and clinical purposes. Bone union is most accurately imaged with computed tomography (CT), but no consensus exists about objective assessment of bone union from CT images. It is unclear which CT-generated parameters are most suitable for bone union assessment. The aim of this review of animal studies is to find which CT-generated parameters are associated most strongly with actual bone union. Scientific databases were systematically searched. Eligible studies were studies that (1) were animal studies, (2) created a fracture, (3) assessed bone union with CT, (4) performed mechanical or histological testing as measure of actual bone union, and (5) associated CT-generated outcomes to mechanical or histological testing results. Two authors selected eligible studies and performed risk of bias assessment with QUADAS-2 tool. From 2567 studies that were screened, thirteen studies were included. Most common CT parameters that were investigated were bone mineral density, bone volume, and total callus volume. Studies showed conflicting results concerning the associations of these parameters with actual bone union. CT-assessed torsional rigidity (assessed by three studies) and callus density (assessed by two studies) showed best results. The studies investigating these two parameters reported moderate to strong associations with actual bone union. CT-assessed torsional rigidity and callus density seem the most promising parameters to represent actual bone union after a fracture, arthrodesis, or osteotomy.Prospero trial registration number: CRD42020164733.
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Affiliation(s)
- A Willems
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, 3015GD, Rotterdam, The Netherlands.
| | - C Iҫli
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - J H Waarsing
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
- Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - D E Meuffels
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
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13
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Kumabe Y, Oe K, Morimoto M, Yagi N, Fukui T, Kuroda R, Hata Y, Niikura T. Ultrasound Frequency-Based Monitoring for Bone Healing. Tissue Eng Part C Methods 2021; 27:349-356. [PMID: 33906381 DOI: 10.1089/ten.tec.2021.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Correct assessment of the bone healing process is required for the management of limb immobilization during the treatment of bone injuries, including fractures and defects. Although the monitoring of bone healing using ultrasound poses several advantages regarding cost and ionizing radiation exposure compared with other dominant imaging methods, such as radiography and computed tomography (CT), traditional ultrasound B-mode imaging lacks reliability and objectivity. However, the body structures can be quantitatively observed by ultrasound frequency-based methods, and therefore, the disadvantages of B-mode imaging can be overcome. In this study, we created a femoral bone hole model of a rat and observed the bone healing process using the quantitative ultrasound method and micro-CT, which provides a reliable assessment of the tissue microstructure of the bone. This study analyzed the correlation between these two assessments. The results revealed that the quantitative ultrasound measurements correlated with the CT measurements for rat bone healing. This ultrasound frequency-based method could have the potential to serve as a novel modality for quantitative monitoring of bone healing with the advantages of being less invasive and easily accessible. Impact statement Bone healing monitoring with ultrasound is advantageous as it is less invasive and easily accessible; however, the traditional B-mode method lacks reliability and objectivity. This study demonstrated that the proposed ultrasound frequency-based monitoring method can quantitatively observe bone healing and strongly correlates with the computed tomography measurements for rat bone healing. This method has the potential to become a reliable modality for monitoring bone healing.
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Affiliation(s)
- Yohei Kumabe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keisuke Oe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Naomi Yagi
- Faculty of Health Care Science, Department of Medical Engineering, Himeji Dokkyo University, Himeji, Japan
| | - Tomoaki Fukui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Hata
- Graduate School of Simulation Studies, University of Hyogo, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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14
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Schwarzenberg P, Klein K, Ferguson SJ, von Rechenberg B, Darwiche S, Dailey HL. Virtual mechanical tests out-perform morphometric measures for assessment of mechanical stability of fracture healing in vivo. J Orthop Res 2021; 39:727-738. [PMID: 32970350 DOI: 10.1002/jor.24866] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 02/04/2023]
Abstract
Finite element analysis with models derived from computed tomography (CT) scans is potentially powerful as a translational research tool because it can achieve what animal studies and cadaver biomechanics cannot-low-risk, noninvasive, objective assessment of outcomes in living humans who have actually experienced the injury, or treatment being studied. The purpose of this study was to assess the validity of CT-based virtual mechanical testing with respect to physical biomechanical tests in a large animal model. Three different tibial osteotomy models were performed on 44 sheep. Data from 33 operated limbs and 20 intact limbs was retrospectively analyzed. Radiographic union scoring was performed on the operated limbs and physical torsional tests were performed on all limbs. Morphometric measures and finite element models were developed from CT scans and virtual torsional tests were performed to assess healing with four material assignment techniques. In correlation analysis, morphometric measures and radiographic scores were unreliable predictors of biomechanical rigidity, while the virtual torsion test results were strongly and significantly correlated with measured biomechanical test data, with high absolute agreement. Overall, the results validated the use of virtual mechanical testing as a reliable in vivo assessment of structural bone healing. This method is readily translatable to clinical evaluation for noninvasive assessment of the healing progress of fractures with minimal risk. Clinical significance: virtual mechanical testing can be used to reliably and noninvasively assess the rigidity of a healing fracture using clinical-resolution CT scans and that this measure is superior to morphometric and radiographic measures.
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Affiliation(s)
- Peter Schwarzenberg
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Karina Klein
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Stephen J Ferguson
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.,Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Salim Darwiche
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Hannah L Dailey
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, Pennsylvania, USA
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15
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Lewis JR, Voortman T, Ioannidis JP. Evaluating and Strengthening the Evidence for Nutritional Bone Research: Ready to Break New Ground? J Bone Miner Res 2021; 36:219-226. [PMID: 33503301 DOI: 10.1002/jbmr.4236] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/01/2020] [Accepted: 12/18/2020] [Indexed: 01/19/2023]
Abstract
A healthy diet is essential to attain genetically determined peak bone mass and maintain optimal skeletal health across the adult lifespan. Despite the importance of nutrition for bone health, many of the nutritional requirements of the skeleton across the lifespan remain underexplored, poorly understood, or controversial. With increasingly aging populations, combined with rapidly changing diets and lifestyles globally, one anticipates large increases in the prevalence of osteoporosis and incidence of osteoporotic fractures. Robust, transparent, and reproducible nutrition research is a cornerstone for developing reliable public health recommendations to prevent osteoporosis and osteoporotic fractures. However, nutrition research is often criticized or ignored by healthcare professionals due to the overemphasis of weak science, conflicting, confusing or implausible findings, industry interests, common misconceptions, and strong opinions. Conversely, spurious research findings are often overemphasized or misconstrued by the media or prominent figures especially via social media, potentially leading to confusion and a lack of trust by the general public. Recently, reforms of the broader discipline of nutrition science have been suggested and promoted, leading to new tools and recommendations to attempt to address these issues. In this perspective, we provide a brief overview of what has been achieved in the field on nutrition and bone health, focusing on osteoporosis and osteoporotic fractures. We discuss what we view as some of the challenges, including inherent difficulties in assessing diet and its change, disentangling complex interactions between dietary components and between diet and other factors, selection of bone-related outcomes for nutrition studies, obtaining evidence with more unbiased designs, and perhaps most importantly, ensuring the trust of the public and healthcare professionals. This perspective also provides specific recommendations and highlights new developments and future opportunities for scientists studying nutrition and bone health. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Joshua R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Medical School, The University of Western Australia, Perth, WA, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - John Pa Ioannidis
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA, USA.,Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA.,Department of Biomedical Data Science, Stanford University, Stanford, CA, USA.,Department of Statistics, Stanford University, Stanford, CA, USA.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
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16
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Bizzoca D, Vicenti G, Caiaffa V, Abate A, De Carolis O, Carrozzo M, Solarino G, Moretti B. Assessment of fracture healing in orthopaedic trauma. Injury 2020; 54 Suppl 1:S46-S52. [PMID: 33234266 DOI: 10.1016/j.injury.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
Fracture healing is a complex physiologic process, relying on the crucial interplay between biological and mechanical factors. It is generally assessed using imaging modalities, including conventional radiology, CT, MRI and ultrasound (US), based on the fracture and patient features. Although these techniques are routinely used in orthopaedic clinical practice, unfortunately, they do not provide any information about the biomechanical status of the fracture site. Therefore, in recent years, several non-invasive techniques have been proposed to assess bone healing using ultrasonic wave propagation, changes in electrical properties of bones and callus stiffness measurement. Moreover, different research groups are currently developing smart orthopaedic implants (plates, intramedullary nails and external fixators), able to provide information about the fracture healing process. These devices could significantly improve orthopaedic and trauma clinical practice in the future and, at the same time, reduce patients' exposure to X-rays. This study aims to define the role of traditional imaging techniques and emerging technologies in the assessment of the fracture healing process.
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Affiliation(s)
- Davide Bizzoca
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giovanni Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy.
| | - Vincenzo Caiaffa
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Antonella Abate
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Oronzo De Carolis
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
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