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Li Y, Yang Z, Tong L, Yang J, Wang J, Wen Y. Wall thickness analysis method for judging the degree of lower extremity long bone healing. Sci Rep 2023; 13:20650. [PMID: 38001361 PMCID: PMC10673992 DOI: 10.1038/s41598-023-48212-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 11/23/2023] [Indexed: 11/26/2023] Open
Abstract
To evaluate the possibility of judging the degree of bone healing by wall thickness analysis provide reference for quantitative analysis of bone healing. Patients with lower limb fracture from April 2014 to October 2019 were recruited and divided into bone healing (group A), poor bone healing (group B), and nonunion (group C). Models were built in Mimics 20.0 with DICOM 3.0 data obtained from patient's CT. Three-dimensional geometric models of unaffected limb and affected limb after simulated removal of internal fixation were established, corresponding to basic phase and simulated phase, respectively. Wall thickness analysis was performed to obtain median wall thickness after meshing. R2 (median wall thickness ratio), R4 (CT value ratio), and R5 (healing index ratio) were obtained by calculating the ratio of each value in simulated phase to that in basic phase. Receiver operating characteristic curve analysis was used to evaluate the ability of Wall Thickness Analysis to indicate fracture healing. 112 CT scans of 79 patients were included in the study. The frequency of categorization in groups A, B, and C was 49, 37 and 26, respectively. The median R2 in groups A, B, and C was 0.91, 0.80, and 0.67, respectively (group A > group B > group C, all P < 0.05). The best cutoff point for R2 in predicting bone healing was 0.84, and predicting bone nonunion was 0.74. The Wall Thickness Analysis can be used to quantitatively evaluate fracture healing state, with median wall thickness ratio as a more intuitive and reliable judgment index.
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Affiliation(s)
- Ying Li
- Department of Orthopedics, Air Force Hospital of Eastern Theater Command, Nanjing, Jiangsu, China
- Department of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Zhiwei Yang
- Department of Orthopedics, Air Force Hospital of Eastern Theater Command, Nanjing, Jiangsu, China
| | - Liangcheng Tong
- Department of Orthopedics, Air Force Hospital of Eastern Theater Command, Nanjing, Jiangsu, China
| | - Junsheng Yang
- Department of Orthopedics, Air Force Hospital of Eastern Theater Command, Nanjing, Jiangsu, China
| | - Jianling Wang
- Department of Orthopedics, Air Force Hospital of Eastern Theater Command, Nanjing, Jiangsu, China
| | - Yaoke Wen
- School of Mechanical Engineering, Nanjing University of Science and Technology, No. 200 Xiaolingwei, Nanjing, 210094, Jiangsu, China.
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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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Sparks DS, Wiper J, Lloyd T, Wille ML, Sehu M, Savi FM, Ward N, Hutmacher DW, Wagels M. Protocol for the BONE-RECON trial: a single-arm feasibility trial for critical sized lower limb BONE defect RECONstruction using the mPCL-TCP scaffold system with autologous vascularised corticoperiosteal tissue transfer. BMJ Open 2023; 13:e056440. [PMID: 37137563 PMCID: PMC10163528 DOI: 10.1136/bmjopen-2021-056440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Reconstruction of critical bone defects is challenging. In a substantial subgroup of patients, conventional reconstructive techniques are insufficient. Biodegradable scaffolds have emerged as a novel tissue engineering strategy for critical-sized bone defect reconstruction. A corticoperiosteal flap integrates the hosts' ability to regenerate bone and permits the creation of a vascular axis for scaffold neo-vascularisation (regenerative matching axial vascularisation-RMAV). This phase IIa study evaluates the application of the RMAV approach alongside a custom medical-grade polycaprolactone-tricalcium phosphate (mPCL-TCP) scaffold (Osteopore) to regenerate bone sufficient to heal critical size defects in lower limb defects. METHODS AND ANALYSIS This open-label, single-arm feasibility trial will be jointly coordinated by the Complex Lower Limb Clinic (CLLC) at the Princess Alexandra Hospital in Woolloongabba (Queensland, Australia), the Australian Centre for Complex Integrated Surgical Solutions (Queensland, Australia) and the Faculty of Engineering, Queensland University of Technology in Kelvin Grove (Queensland, Australia). Aiming for limb salvage, the study population (n=10) includes any patient referred to the CLLC with a critical-sized bone defect not amenable to conventional reconstructive approaches, after discussion by the interdisciplinary team. All patients will receive treatment using the RMAV approach using a custom mPCL-TCP implant. The primary study endpoint will be safety and tolerability of the reconstruction. Secondary end points include time to bone union and weight-bearing status on the treated limb. Results of this trial will help shape the role of scaffold-guided bone regenerative approaches in complex lower limb reconstruction where current options remain limited. ETHICS AND DISSEMINATION Approval was obtained from the Human Research Ethics Committee at the participating centre. Results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ACTRN12620001007921.
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Affiliation(s)
- David S Sparks
- Queensland University of Technology, Faculty of Engineering, Brisbane, Queensland, Australia
- The University of Queensland PA Southside Clinical School, Woolloongabba, Queensland, Australia
| | - Jay Wiper
- Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Thomas Lloyd
- Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Department of Radiology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Marie-Luise Wille
- Queensland University of Technology, Faculty of Engineering, Brisbane, Queensland, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Mechanical, Medical, and Process Engineering | Faculty of Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Marjoree Sehu
- Department of Infectious Diseases, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Flavia M Savi
- Queensland University of Technology, Faculty of Engineering, Brisbane, Queensland, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Mechanical, Medical, and Process Engineering | Faculty of Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicola Ward
- Department of Orthopaedics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Dietmar W Hutmacher
- ARC Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Mechanical, Medical, and Process Engineering | Faculty of Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Health, School of Biomedical Siences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael Wagels
- Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Australian Centre for Complex Integrated Surgical Solutions (ACCISS), Translational Research Institute Australia Ghrelin Research Group, South Brisbane, Queensland, Australia
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Kwee TC, Kwee RM. Workload of diagnostic radiologists in the foreseeable future based on recent scientific advances: growth expectations and role of artificial intelligence. Insights Imaging 2021; 12:88. [PMID: 34185175 PMCID: PMC8241957 DOI: 10.1186/s13244-021-01031-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/08/2021] [Indexed: 12/13/2022] Open
Abstract
Objective To determine the anticipated contribution of recently published medical imaging literature, including artificial intelligence (AI), on the workload of diagnostic radiologists. Methods This study included a random sample of 440 medical imaging studies published in 2019. The direct contribution of each study to patient care and its effect on the workload of diagnostic radiologists (i.e., number of examinations performed per time unit) was assessed. Separate analyses were done for an academic tertiary care center and a non-academic general teaching hospital. Results In the academic tertiary care center setting, 65.0% (286/440) of studies could directly contribute to patient care, of which 48.3% (138/286) would increase workload, 46.2% (132/286) would not change workload, 4.5% (13/286) would decrease workload, and 1.0% (3/286) had an unclear effect on workload. In the non-academic general teaching hospital setting, 63.0% (277/240) of studies could directly contribute to patient care, of which 48.7% (135/277) would increase workload, 46.2% (128/277) would not change workload, 4.3% (12/277) would decrease workload, and 0.7% (2/277) had an unclear effect on workload. Studies with AI as primary research area were significantly associated with an increased workload (p < 0.001), with an odds ratio (OR) of 10.64 (95% confidence interval (CI) 3.25–34.80) in the academic tertiary care center setting and an OR of 10.45 (95% CI 3.19–34.21) in the non-academic general teaching hospital setting. Conclusions Recently published medical imaging studies often add value to radiological patient care. However, they likely increase the overall workload of diagnostic radiologists, and this particularly applies to AI studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01031-4.
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Affiliation(s)
- Thomas C Kwee
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Robert M Kwee
- Department of Radiology, Zuyderland Medical Center, Heerlen, Sittard-Geleen, The Netherlands
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Jayankura M, Schulz AP, Delahaut O, Witvrouw R, Seefried L, Berg BV, Heynen G, Sonnet W. Percutaneous administration of allogeneic bone-forming cells for the treatment of delayed unions of fractures: a pilot study. Stem Cell Res Ther 2021; 12:363. [PMID: 34174963 PMCID: PMC8235864 DOI: 10.1186/s13287-021-02432-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/06/2021] [Indexed: 01/15/2023] Open
Abstract
Background Overall, 5–10% of fractures result in delayed unions or non-unions, causing major disabilities and a huge socioeconomic burden. Since rescue surgery with autologous bone grafts can cause additional challenges, alternative treatment options have been developed to stimulate a deficient healing process. This study assessed the technical feasibility, safety and preliminary efficacy of local percutaneous implantation of allogeneic bone-forming cells in delayed unions of long bone fractures. Methods In this phase I/IIA open-label pilot trial, 22 adult patients with non-infected delayed unions of long bone fractures, which failed to consolidate after 3 to 7 months, received a percutaneous implantation of allogeneic bone-forming cells derived from bone marrow mesenchymal stem cells (ALLOB; Bone Therapeutics) into the fracture site (50 × 106 to 100 × 106 cells). Patients were monitored for adverse events and need for rescue surgery for 30 months. Fracture healing was monitored by Tomographic Union Score (TUS) and modified Radiographic Union Score. The health status was evaluated using the Global Disease Evaluation (GDE) score and pain at palpation using a visual analogue scale. The presence of reactive anti-human leukocyte antigen (HLA) antibodies was evaluated. Results During the 6-month follow-up, three serious treatment-emergent adverse events were reported in two patients, of which two were considered as possibly treatment-related. None of the 21 patients in the per-protocol efficacy population needed rescue surgery within 6 months, but 2/21 (9.5%) patients had rescue surgery within 30 months post-treatment. At 6 months post-treatment, an improvement of at least 2 points in TUS was reached in 76.2% of patients, the GDE score improved by a mean of 48%, and pain at palpation at the fracture site was reduced by an average of 61% compared to baseline. The proportion of blood samples containing donor-specific anti-HLA antibodies increased from 8/22 (36.4%) before treatment to 13/22 (59.1%) at 6 months post-treatment, but no treatment-mediated allogeneic immune reactions were observed. Conclusion This pilot study showed that the percutaneous implantation of allogeneic bone-forming cells was technically feasible and well tolerated in patients with delayed unions of long bone fractures. Preliminary efficacy evidence is supporting the further development of this treatment. Trial registration NCT02020590. Registered on 25 December 2013. ALLOB-DU1, A pilot Phase I/IIa, multicentre, open proof-of-concept study on the efficacy and safetyof allogeneic osteoblastic cells (ALLOB®) implantation in non-infected delayed-union fractures. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-021-02432-4.
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Affiliation(s)
- Marc Jayankura
- Service d'Orthopédie - Traumatologie, Cliniques Universitaires de Bruxelles - Université Libre de Bruxelles, Hôpital Erasme, Route de Lennik 808, 1070, Brussels, Belgium.
| | - Arndt Peter Schulz
- Klinik für Orthopädie und Unfallchirurgie, Universität zu Lübeck, Ratzeburger Allee 160, 23568, Lübeck, Germany.,Labor für Biomechanik, BG Klinikum Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Germany.,Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering, Mönkhofer Weg 239 a, 23562, Lübeck, Germany
| | - Olivier Delahaut
- Service d'Orthopédie, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Richard Witvrouw
- Department of Traumatology and Orthopaedics, Oost-Limburg Hospital, Schiepse Bos 2, Genk, Belgium
| | - Lothar Seefried
- Orthopedic Department, University of Wuerzburg, Wuerzburg, Germany
| | - Bruno Vande Berg
- Service de Radiologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Guy Heynen
- Bone Therapeutics S.A., Gosselies, Belgium
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Perlepe V, Michoux N, Kirchgesner T, Lecouvet F, Vande Berg B. Semi-quantitative CT scoring of nailed shaft fractures during normal healing and in non-unions: comparison with radiographic scoring. Eur J Radiol 2021; 138:109618. [PMID: 33684696 DOI: 10.1016/j.ejrad.2021.109618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 01/25/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare tomographic (TUS) with radiographic (RUS) union scores in nailed shaft fractures during normal healing and in non-unions. METHODS Two radiologists blinded to fracture age separately determined RUS and TUS in nailed femoral or tibial shaft fractures by analyzing the radiographic and CT examinations obtained in 47 patients during normal healing (early fracture group; 24 study participants, 17 men,19 tibias, mean fracture-CT delay 109 ± 57 days [42-204 days]) and in surgically proven non-united fractures (late fracture group, 23 patients, 14 men, 12 tibias, mean fracture-CT delay 565 ± 519 days[180-1983 days]). In both study groups, we determined the inter- and intra-observer agreement of RUS and TUS and compared TUS with RUS. RESULTS Intra- and inter-observer agreement of RUS and TUS was very good in the early fracture group and good in the late fracture group for both readers. TUS correlated with RUS substantially in the early fracture group and only weakly in the late fracture group. TUS was statistically significantly lower than RUS in study participants with RUS ≥ 8 or 9 for R2 only and ≥ 10 for both readers in the early fracture group and in patients with RUS ≥ 8, 9 or 10 in the late fracture group for both readers. CONCLUSION RUS and TUS of nailed shaft fractures during normal healing or in non-unions are both feasible and reproducible. They yield similar values in fractures with no or limited callus. TUS yields lower values than RUS in fractures with callus.
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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
| | - Thomas Kirchgesner
- Cliniques Universitaires Saint-Luc, IREC (Institut de Recherche Clinique et Experimentale), Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Frederic Lecouvet
- 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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Hiraoka N, Nakagawa S, Otakara E, Inoue H, Takahashi K, Arai Y. Radiologic results of additional single screw fixation with lateral locking plate after hybrid closed-wedge high tibial osteotomy. Knee Surg Relat Res 2020; 32:65. [PMID: 33317642 PMCID: PMC7734755 DOI: 10.1186/s43019-020-00085-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Hybrid closed-wedge high tibial osteotomy (hybrid CWHTO) is an effective surgical treatment for medial compartment osteoarthritis of the knee. Our study investigated whether the combination of a lateral locking plate and a single medial screw promoted bone union after hybrid CWHTO. Methods The study cohort consisted of 30 patients (15 men and 15 women) who underwent hybrid CWHTO for medial compartment osteoarthritis or spontaneous osteonecrosis of the knee. Sixteen knees were fixed with a lateral locking plate (LP group), and 17 were fixed with both a lateral locking plate and a cannulated cancellous screw on the medial side of the tibia (LPS group). The times to bone union, radiolucency, and callus formation at the osteotomy site were evaluated radiographically. Results The mean postoperative time to radiographic confirmation of bone union was 5.5 ± 2.6 months in the LP group and 3.4 ± 1.5 months in the LPS group. Radiolucency at the osteotomy site and excess callus formation on the posterior side of the tibia were lower in the LPS group than in the LP group. Conclusions This modified hybrid CWHTO combining a lateral locking plate and a cannulated cancellous screw on the medial side of the tibia improves the stability of the osteotomy site and shortens the period of bone union.
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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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