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Tong L, Yang Z, Dai W, Sun Z, Yang J, Xue Q, Li Y. Experimental study on determining the degree of bone healing by wall thickness ratio analysis. J Orthop Surg Res 2024; 19:79. [PMID: 38243260 PMCID: PMC10799492 DOI: 10.1186/s13018-024-04565-7] [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: 11/24/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024] Open
Abstract
To verify the reliability and accuracy of wall thickness ratio analysis to determine the degree of bone healing, fracture models were established with 6 beagles. X-ray, micro-CT, and CT scans were performed at 24 weeks. The healthy side and the affected side were used to simulate the three-dimensional geometric model after internal fixation, and the mesh was divided. The mean and median CT wall thickness values were obtained through the wall thickness analysis. X-ray, CT, micro-CT, and gross appearance were used to determine the degree of bone healing, which was compared with wall thickness analysis. There was a positive correlation between the average CT value and the median wall thickness. The correlation coefficient analysis of the median wall thickness ratio (R2) and healing index ratio (R3) showed a positive correlation. The results of the wall thickness ratio (R2) and the healing index ratio (R3) were used to determine bone healing, and the results were consistent with the results of the actual mechanical test and image analysis. The results of wall thickness ratio analysis were significantly correlated with the degree of bone healing. This method is simple, rapid, and practical to analyze and judge the degree of bone healing.
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Affiliation(s)
- Liangcheng Tong
- Department of Orthopedics, Air Force Hospital of Eastern Theater Command, Anhui Medical University, No. 1 Malu Road, Nanjing, 210002, Jiangsu, China
| | - Zhiwei Yang
- Department of Orthopedics, Air Force Hospital of Eastern Theater Command, Anhui Medical University, No. 1 Malu Road, Nanjing, 210002, Jiangsu, China
| | - Wei Dai
- Department of Orthopedics, Air Force Hospital of Eastern Theater Command, Anhui Medical University, No. 1 Malu Road, Nanjing, 210002, Jiangsu, China
| | - Zhongyang Sun
- Department of Orthopedics, Air Force Hospital of Eastern Theater Command, Anhui Medical University, No. 1 Malu Road, Nanjing, 210002, Jiangsu, China
| | - Junsheng Yang
- Department of Orthopedics, Air Force Hospital of Eastern Theater Command, Anhui Medical University, No. 1 Malu Road, Nanjing, 210002, Jiangsu, China
| | - Qing Xue
- Department of Orthopedics, Air Force Hospital of Eastern Theater Command, Anhui Medical University, No. 1 Malu Road, Nanjing, 210002, Jiangsu, China
| | - Ying Li
- Department of Orthopedics, Air Force Hospital of Eastern Theater Command, Anhui Medical University, No. 1 Malu Road, Nanjing, 210002, Jiangsu, China.
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Radiographic Evaluation of Distal Radius Fracture Healing by Time: Orthopedist versus Qualitative Assessment of Image Processing. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2030040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Distal radius fractures are among the most prevalent long-bone fractures in the body. Fracture healing assessment is based on clinical evaluation and radiological examinations. A lack of consensus exists regarding the radiographic criteria for fracture union. Our work examined the commonly used criteria for the assessment of fracture healing. Thirty-two patients, conservatively treated for distal radius fracture, participated in a prospective study. Enrolled patients followed protocol for 26 weeks. Four orthopedic surgeons with similar ranks were asked to evaluate three parameters of radiographic measurements for each set of radiographs, including callus formation, the presence of a fracture line, and bridging of fracture sites or sites of fracture edges in 70 radiographs. Ten patients were eligible for the study. The degree of agreement among surgeons was “good” (Cronbach’s alpha): callus formation—0.8, bridging of fracture sites—0.775, blurring of fracture line gap—0.795. A timeline based on the specific week and grading system was made. Radiographic detection of callus formation was seen after the second film, between 6 and 9 weeks, and an agreement among surgeons was achieved for more than half of the patients for the blurring of the fracture gap. The radiographic healing progression of the distal radius can be detected after 6 and 9 weeks in all three parameters with good agreement between different surgeons. A timeline graph such as the one that was made in this model can be used for the follow-up of patients’ fracture healing or early detection of non-union.
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Glinkowski W, Chelnokov AN. The orthopaedic surgeon's clinical and experimental experience affect methods used for the fracture healing assessment (FHA) - An International Survey. Injury 2021; 52:2205-2214. [PMID: 33836844 DOI: 10.1016/j.injury.2021.03.039] [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: 11/16/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 02/02/2023]
Abstract
Detection of fracture healing (FH), which depends on assessment methods, is a crucial factor affecting treatment. The study aimed to examine orthopedic surgeons in terms of practical methods of fracture healing (FHA) assessment (physical, imaging, measurement, and laboratory) and to check whether surgeons participating in clinical and laboratory experiments or only clinical practitioners prefer different FHA methods. An International Survey on Fracture Healing Assessment Methods was developed and distributed through the Web-based survey portal. Ninety-three orthopedic surgeons, on average age 41.46 years, from 24 countries participated in the study. Thirty-one respondents (33.3%) reported dealing with fractures both in the clinic and in experimental studies, six (6.5%) reported dealing with fractures only in laboratory research work, and fifty-six (60.2%) indicated that they dealt with fractures only clinically. The survey's internal consistency was significantly high (Cronbach's alpha coefficients ranged from 0.84 to 0.96). The majority of respondents (80.83%) use specific clinical criteria to define a fracture union. The FHA was mainly based on the physical examination and plain radiograms. Laboratory findings, patient-oriented outcomes scores, and quantitative methods are rarely used. Orthopaedic surgeons dealing with fractures both in the clinic and in laboratory fracture research studies are more likely to use more quantitative FHA methods. Future research is needed to improve the international standard of the FHA methods for use in research, clinical trials, and clinical practice. Using a quantitative, reliable, and standardized approach, including online support, can be valuable for increasing compliance in the orthopedic surgeon population, effectively improving the adherence of fracture healing assessment in clinical conditions, and improving early detection of fracture healing disorders, improving fracture efficiency treatment.
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Affiliation(s)
- Wojciech Glinkowski
- Centre of Excellence "TeleOrto" for Telediagnostics and Treatment of Disorders and Injuries of the Locomotor System, Medical University of Warsaw, 00581 Warsaw, Poland; Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 00581 Warsaw, Poland; Polish Telemedicine and eHealth Society, 03728 Warsaw, Poland; Gabinet Lekarski, 03728 Warsaw, Poland.
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Godoy-Santos AL, Bernasconi A, Bordalo-Rodrigues M, Lintz F, Lôbo CFT, de Cesar Netto C. Weight-bearing cone-beam computed tomography in the foot and ankle specialty: where we are and where we are going - an update. Radiol Bras 2021; 54:177-184. [PMID: 34108765 PMCID: PMC8177673 DOI: 10.1590/0100-3984.2020.0048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/17/2020] [Indexed: 12/24/2022] Open
Abstract
Cone-beam computed tomography (CBCT) has been applied in dentistry and medicine for nearly two decades. Its application in the foot and ankle specialty has grown exponentially in recent years. Weight-bearing CBCT allows clinicians to obtain weight-bearing images that can be viewed in all three planes and to construct three-dimensional models, similar to those constructed from traditional CT scans, as well as exposing patients to less radiation than do traditional CT scans. This technology has revolutionized diagnoses, improving the understanding of various lesions and surgical planning in the foot and ankle specialty. Ongoing studies of the use of weight-bearing CBCT in foot and ankle surgery are focused on fully automated and semi-automated three-dimensional measurements, as well as bone segmentation, mapping of the distances/orientation of the joints, and the production of customized implants. The aims of this review article are to show the evolution of this emerging tool in the foot and ankle specialty, to update those in related specialties on its use in current clinical practice, and to indicate where the research community is heading.
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Affiliation(s)
- Alexandre Leme Godoy-Santos
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil., Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Correspondence: Dr. Alexandre Leme Godoy-Santos. Laboratório Professor Manlio Mario Marco Napoli - HC-FMUSP. Rua Doutor Ovídio Pires de Campos, 333, Cerqueira César. São Paulo, SP, Brazil, 05403-010.
| | | | - Marcelo Bordalo-Rodrigues
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | | | - Carlos Felipe Teixeira Lôbo
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
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Abstract
PURPOSE OF REVIEW This review discusses imaging modalities for fracture repair assessment, with an emphasis on pragmatic clinical and translational use, best practices for implementation, and challenges and opportunities for continuing research. RECENT FINDINGS Semiquantitative radiographic union scoring remains the clinical gold standard, but has questionable reliability as a surrogate indicator of structural bone healing, particularly in early-stage, complex, or compromised healing scenarios. Alternatively, computed tomography (CT) scanning enables quantitative assessment of callus morphometry and mechanics through the use of patient-specific finite-element models. Dual-energy X-ray absorptiometry (DXA) scanning and radiostereometric analysis (RSA) are also quantitative, but technically challenging. Nonionizing magnetic resonance (MR) and ultrasound imaging are of high interest, but require development to enable quantification of 3D mineralized structures. Emerging image-based methods for quantitative assessment of bone healing may transform clinical research design by displacing binary outcomes classification (union/nonunion) and ultimately enhance clinical care by enabling early nonunion detection.
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Affiliation(s)
- Peter Schwarzenberg
- Department of Mechanical Engineering & Mechanics, Lehigh University, Bethlehem, PA, USA
| | - Salim Darwiche
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zürich, Zürich, Switzerland
| | - Richard S Yoon
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Hannah L Dailey
- Department of Mechanical Engineering & Mechanics, Lehigh University, Bethlehem, PA, USA.
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Perlepe V, Michoux N, Heynen G, Vande Berg B. Semi-quantitative CT assessment of fracture healing: How many and which CT reformats should be analyzed? Eur J Radiol 2019; 118:181-186. [PMID: 31439239 DOI: 10.1016/j.ejrad.2019.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/19/2019] [Accepted: 07/18/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess how many and which CT reformats of long bone non-unions should be analyzed to best approximate the analysis of a larger number of CT reformats obtained in the three orthogonal planes. METHOD We used 29 CT examinations of tibial or femoral non-unions to obtain 87 stacks of 7 CT reformats each in the coronal (n = 29), sagittal (n = 29) or transverse (n = 29) planes. Two independent radiologists scored two fracture sites on each CT reformat by using a Tomographic Union Score (TUS) (1: no callus, 2: non-bridging callus; 3: bridging immature callus; 4: bridging remodeled callus). The reference standard was the mean of the three TUS calculated from the cortical scores obtained on all the sagittal, coronal and transverse CT reformats. We determined the agreement (intra-class correlation coefficient (ICC) between the reference standard and 33 models combining one to seven CT reformats from one to three planes. The three best models were compared following a resampling procedure by a Wilcoxon's signed rank test. RESULTS Three models combining two (mid-coronal and mid-sagittal), three (mid-coronal, mid-sagittal and mid-transverse) or four (two paramedian coronal and sagittal) CT reformats had the highest ICC (ICC ≥ 0.89) for both observers. After resampling, the model combining the two paramedian sagittal and coronal CT reformats statistically outperformed the two other models. CONCLUSION Semi-quantitative analysis of the two paramedian sagittal and coronal CT reformats is an acceptable alternative to the analysis of more numerous reformats.
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Affiliation(s)
- Vasiliki Perlepe
- Cliniques Universitaires Saint-Luc, IREC (Institut de Recherche Clinique et Experimentale), Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Nicolas Michoux
- Cliniques Universitaires Saint-Luc, IREC (Institut de Recherche Clinique et Experimentale), Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Guy Heynen
- Cliniques Universitaires Saint-Luc, IREC (Institut de Recherche Clinique et Experimentale), Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Bruno Vande Berg
- Cliniques Universitaires Saint-Luc, IREC (Institut de Recherche Clinique et Experimentale), Avenue Hippocrate 10, 1200, Brussels, Belgium.
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Gallaher HM, Butler JR, Wills RW, Priddy LB, Elder SH, Heller SM, Brinkman E, Baumgartner W. Effects of short- and long-term administration of nonsteroidal anti-inflammatory drugs on osteotomy healing in dogs. Vet Surg 2019; 48:1318-1329. [PMID: 31291009 DOI: 10.1111/vsu.13282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/17/2019] [Accepted: 06/18/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the influence of short-term administration of carprofen on bone healing in dogs. STUDY DESIGN Randomized controlled experimental study. ANIMALS Eighteen purpose-bred sexually mature hound dogs. METHODS Tibial osteotomies were performed, and dogs were divided into three groups: no carprofen (n = 6), 2-week administration of carprofen at 2.2 mg/kg twice daily (n = 6), and 8-week administration of carprofen at 2.2 mg/kg twice daily (n = 5). Bone healing was evaluated radiographically at 4 and 8 weeks postoperatively. Postmortem, fracture healing was assessed via biomechanical testing (three-point bending), histological cartilage:callus ratio, and bone mineral density (BMD) with quantitative computed tomography. RESULTS No biomechanical difference was detected between dogs that received no carprofen and those that received 2 weeks of carprofen or between those that received 2 weeks vs 8 weeks of carprofen. Stiffness (P = .035) and maximum stress (P = .042) were higher in dogs that received no carprofen than in those that received 8 weeks of carprofen. Radiographic healing did not differ between dogs without carprofen and those with 2-week administration of carprofen (P = .9923). However, tibias of dogs without carprofen and those with 2-week administration of carprofen were more healed compared with those in the 8-week-carprofen group at 4 and 8 weeks after surgery (P = .0011). No treatment effect was detected by cartilage:callus ratio or BMD. CONCLUSION Long-term administration of carprofen had a negative effect on bone healing compared with short-term or no administration of carprofen. CLINICAL SIGNIFICANCE Nonsteroidal anti-inflammatory drugs should be used cautiously in dogs at risk for delayed bone healing, and administration should be discontinued beyond the perioperative period in dogs with fractures or osteotomies.
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Affiliation(s)
- Hayley M Gallaher
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - James R Butler
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - Robert W Wills
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - Lauren B Priddy
- Department of Agricultural and Biological Engineering, Bagley College of Engineering, Mississippi State University, Mississippi State, Mississippi
| | - Steven H Elder
- Department of Agricultural and Biological Engineering, Bagley College of Engineering, Mississippi State University, Mississippi State, Mississippi
| | - Sarah M Heller
- Department of Agricultural and Biological Engineering, Bagley College of Engineering, Mississippi State University, Mississippi State, Mississippi
| | - Erin Brinkman
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
| | - Wes Baumgartner
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi
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