Preoperative measures of bone mineral density from digital wrist radiographs
Aims: Assessment of bone mineral density (BMD) with dual-energy X-ray absorptiometry (DXA) is a well-established clinical technique, but it is not available in the acute trauma setting. Thus, it cannot provide a preoperative estimation of BMD to help guide the technique of fracture fixation. Alterna...
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2021-12-01
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| Series: | Bone & Joint Research |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.1012.BJR-2021-0098.R1 |
| _version_ | 1818871519273549824 |
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| author | Greg Robertson Robert Wallace A. Hamish R. W. Simpson Sarah P. Dawson |
| author_facet | Greg Robertson Robert Wallace A. Hamish R. W. Simpson Sarah P. Dawson |
| author_sort | Greg Robertson |
| collection | DOAJ |
| description | Aims: Assessment of bone mineral density (BMD) with dual-energy X-ray absorptiometry (DXA) is a well-established clinical technique, but it is not available in the acute trauma setting. Thus, it cannot provide a preoperative estimation of BMD to help guide the technique of fracture fixation. Alternative methods that have been suggested for assessing BMD include: 1) cortical measures, such as cortical ratios and combined cortical scores; and 2) aluminium grading systems from preoperative digital radiographs. However, limited research has been performed in this area to validate the different methods. The aim of this study was to investigate the evaluation of BMD from digital radiographs by comparing various methods against DXA scanning. Methods: A total of 54 patients with distal radial fractures were included in the study. Each underwent posteroanterior (PA) and lateral radiographs of the injured wrist with an aluminium step wedge. Overall 27 patients underwent routine DXA scanning of the hip and lumbar spine, with 13 undergoing additional DXA scanning of the uninjured forearm. Analysis of radiographs was performed on ImageJ and Matlab with calculations of cortical measures, cortical indices, combined cortical scores, and aluminium equivalent grading. Results: Cortical measures showed varying correlations with the forearm DXA results (range: Pearson correlation coefficient (r) = 0.343 (p = 0.251) to r = 0.521 (p = 0.068)), with none showing statistically significant correlations. Aluminium equivalent grading showed statistically significant correlations with the forearm DXA of the corresponding region of interest (p < 0.017). Conclusion: Cortical measures, cortical indices, and combined cortical scores did not show a statistically significant correlation to forearm DXA measures. Aluminium-equivalent is an easily applicable method for estimation of BMD from digital radiographs in the preoperative setting. Cite this article: Bone Joint Res 2021;10(12):830–839. |
| first_indexed | 2024-12-19T12:24:12Z |
| format | Article |
| id | doaj.art-16b47759f511481e81382875f94be1cb |
| institution | Directory Open Access Journal |
| issn | 2046-3758 |
| language | English |
| last_indexed | 2024-12-19T12:24:12Z |
| publishDate | 2021-12-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Research |
| spelling | doaj.art-16b47759f511481e81382875f94be1cb2022-12-21T20:21:38ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Research2046-37582021-12-01101283083910.1302/2046-3758.1012.BJR-2021-0098.R1Preoperative measures of bone mineral density from digital wrist radiographsGreg Robertson0Robert Wallace1A. Hamish R. W. Simpson2Sarah P. Dawson3Department of Orthopaedics and Trauma, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UKDepartment of Orthopaedics and Trauma, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UKDepartment of Orthopaedics and Trauma, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UKPark Doctor Pty Ltd, St Lucia, South AfricaAims: Assessment of bone mineral density (BMD) with dual-energy X-ray absorptiometry (DXA) is a well-established clinical technique, but it is not available in the acute trauma setting. Thus, it cannot provide a preoperative estimation of BMD to help guide the technique of fracture fixation. Alternative methods that have been suggested for assessing BMD include: 1) cortical measures, such as cortical ratios and combined cortical scores; and 2) aluminium grading systems from preoperative digital radiographs. However, limited research has been performed in this area to validate the different methods. The aim of this study was to investigate the evaluation of BMD from digital radiographs by comparing various methods against DXA scanning. Methods: A total of 54 patients with distal radial fractures were included in the study. Each underwent posteroanterior (PA) and lateral radiographs of the injured wrist with an aluminium step wedge. Overall 27 patients underwent routine DXA scanning of the hip and lumbar spine, with 13 undergoing additional DXA scanning of the uninjured forearm. Analysis of radiographs was performed on ImageJ and Matlab with calculations of cortical measures, cortical indices, combined cortical scores, and aluminium equivalent grading. Results: Cortical measures showed varying correlations with the forearm DXA results (range: Pearson correlation coefficient (r) = 0.343 (p = 0.251) to r = 0.521 (p = 0.068)), with none showing statistically significant correlations. Aluminium equivalent grading showed statistically significant correlations with the forearm DXA of the corresponding region of interest (p < 0.017). Conclusion: Cortical measures, cortical indices, and combined cortical scores did not show a statistically significant correlation to forearm DXA measures. Aluminium-equivalent is an easily applicable method for estimation of BMD from digital radiographs in the preoperative setting. Cite this article: Bone Joint Res 2021;10(12):830–839.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.1012.BJR-2021-0098.R1bone densitytraumafracture fixationradiographywristbone mineral density (bmd)forearmhipdual-energy x-ray absorptiometrypearson correlation coefficientdigital radiographsfracture fixationfractures of the distal radius |
| spellingShingle | Greg Robertson Robert Wallace A. Hamish R. W. Simpson Sarah P. Dawson Preoperative measures of bone mineral density from digital wrist radiographs Bone & Joint Research bone density trauma fracture fixation radiography wrist bone mineral density (bmd) forearm hip dual-energy x-ray absorptiometry pearson correlation coefficient digital radiographs fracture fixation fractures of the distal radius |
| title | Preoperative measures of bone mineral density from digital wrist radiographs |
| title_full | Preoperative measures of bone mineral density from digital wrist radiographs |
| title_fullStr | Preoperative measures of bone mineral density from digital wrist radiographs |
| title_full_unstemmed | Preoperative measures of bone mineral density from digital wrist radiographs |
| title_short | Preoperative measures of bone mineral density from digital wrist radiographs |
| title_sort | preoperative measures of bone mineral density from digital wrist radiographs |
| topic | bone density trauma fracture fixation radiography wrist bone mineral density (bmd) forearm hip dual-energy x-ray absorptiometry pearson correlation coefficient digital radiographs fracture fixation fractures of the distal radius |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.1012.BJR-2021-0098.R1 |
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