Improvements in radiographic and clinical assessment of distal radius fracture healing by FE-estimated bone stiffness
Bone strength determined from finite element (FE) modelling provides an estimate of fracture healing progression following a distal radius fracture (DRF), but how these measures relate to patient-reported outcomes and functional outcomes remains unknown. We hypothesized that changes in bone stiffnes...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-06-01
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| Series: | Bone Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352187221000036 |
| _version_ | 1818650926003519488 |
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| author | Phillip J.C. Spanswick Danielle E. Whittier Cory Kwong Robert Korley Steven K. Boyd Prism S. Schneider |
| author_facet | Phillip J.C. Spanswick Danielle E. Whittier Cory Kwong Robert Korley Steven K. Boyd Prism S. Schneider |
| author_sort | Phillip J.C. Spanswick |
| collection | DOAJ |
| description | Bone strength determined from finite element (FE) modelling provides an estimate of fracture healing progression following a distal radius fracture (DRF), but how these measures relate to patient-reported outcomes and functional outcomes remains unknown. We hypothesized that changes in bone stiffness and bone mineral density measured using high-resolution peripheral quantitative computed tomography (HR-pQCT) are associated with clinically available measures of functional and patient-reported outcomes. We also aimed to identify which clinical outcome measures best predict fracture stiffness and could therefore be used to inform cast removal.Participants (n = 30) with stable distal radius fractures were followed for two week intervals from the time of fracture until two months post-fracture, then at three months and six months post-fracture. At each follow-up, participants underwent clinical, radiographic, and functional assessments, as well as had their fractured wrist scanned using HR-pQCT. Recovery of bone stiffness during fracture healing was determined from micro-FE (μFE) models generated from HR-pQCT image data.During the DRF healing process, significant longitudinal changes were found in μFE-estimated stiffness, patient-reported outcomes, grip strength, range of motion (ROM), tenderness, number of cortices healed based on radiographs, and fracture line visibility (p < 0.05); however, no significant change was detected in HR-pQCT based total bone mineral density. Patient-reported outcomes, such as the Patient-Rated Wrist Evaluation (PRWE) and the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) questionnaire, correlated strongly with μFE-estimated stiffness (0.61 ≥ rm ≥ 0.66). Based on μFE-estimated stiffness, PRWE and QuickDASH are the best predictors of stiffness recovery (p < 0.05) and may be used to guide duration of cast immobilization in the clinical setting. |
| first_indexed | 2024-12-17T01:57:58Z |
| format | Article |
| id | doaj.art-d28ed8b6704c423bad9891ddf2950f98 |
| institution | Directory Open Access Journal |
| issn | 2352-1872 |
| language | English |
| last_indexed | 2024-12-17T01:57:58Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Bone Reports |
| spelling | doaj.art-d28ed8b6704c423bad9891ddf2950f982022-12-21T22:07:55ZengElsevierBone Reports2352-18722021-06-0114100748Improvements in radiographic and clinical assessment of distal radius fracture healing by FE-estimated bone stiffnessPhillip J.C. Spanswick0Danielle E. Whittier1Cory Kwong2Robert Korley3Steven K. Boyd4Prism S. Schneider5Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, CanadaDepartment of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, CanadaDepartment of Surgery, Division of Orthopaedic Trauma, Cumming School of Medicine, University of Calgary, Calgary, AB, CanadaDepartment of Surgery, Division of Orthopaedic Trauma, Cumming School of Medicine, University of Calgary, Calgary, AB, CanadaDepartment of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, CanadaDepartment of Surgery, Division of Orthopaedic Trauma, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada; Corresponding author at: McCaig Institute for Bone and Joint Health, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta T2N 5A1, Canada.Bone strength determined from finite element (FE) modelling provides an estimate of fracture healing progression following a distal radius fracture (DRF), but how these measures relate to patient-reported outcomes and functional outcomes remains unknown. We hypothesized that changes in bone stiffness and bone mineral density measured using high-resolution peripheral quantitative computed tomography (HR-pQCT) are associated with clinically available measures of functional and patient-reported outcomes. We also aimed to identify which clinical outcome measures best predict fracture stiffness and could therefore be used to inform cast removal.Participants (n = 30) with stable distal radius fractures were followed for two week intervals from the time of fracture until two months post-fracture, then at three months and six months post-fracture. At each follow-up, participants underwent clinical, radiographic, and functional assessments, as well as had their fractured wrist scanned using HR-pQCT. Recovery of bone stiffness during fracture healing was determined from micro-FE (μFE) models generated from HR-pQCT image data.During the DRF healing process, significant longitudinal changes were found in μFE-estimated stiffness, patient-reported outcomes, grip strength, range of motion (ROM), tenderness, number of cortices healed based on radiographs, and fracture line visibility (p < 0.05); however, no significant change was detected in HR-pQCT based total bone mineral density. Patient-reported outcomes, such as the Patient-Rated Wrist Evaluation (PRWE) and the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) questionnaire, correlated strongly with μFE-estimated stiffness (0.61 ≥ rm ≥ 0.66). Based on μFE-estimated stiffness, PRWE and QuickDASH are the best predictors of stiffness recovery (p < 0.05) and may be used to guide duration of cast immobilization in the clinical setting.http://www.sciencedirect.com/science/article/pii/S2352187221000036Fracture healingDistal radiusHr-pQCTFinite element analysisClinical evaluation |
| spellingShingle | Phillip J.C. Spanswick Danielle E. Whittier Cory Kwong Robert Korley Steven K. Boyd Prism S. Schneider Improvements in radiographic and clinical assessment of distal radius fracture healing by FE-estimated bone stiffness Bone Reports Fracture healing Distal radius Hr-pQCT Finite element analysis Clinical evaluation |
| title | Improvements in radiographic and clinical assessment of distal radius fracture healing by FE-estimated bone stiffness |
| title_full | Improvements in radiographic and clinical assessment of distal radius fracture healing by FE-estimated bone stiffness |
| title_fullStr | Improvements in radiographic and clinical assessment of distal radius fracture healing by FE-estimated bone stiffness |
| title_full_unstemmed | Improvements in radiographic and clinical assessment of distal radius fracture healing by FE-estimated bone stiffness |
| title_short | Improvements in radiographic and clinical assessment of distal radius fracture healing by FE-estimated bone stiffness |
| title_sort | improvements in radiographic and clinical assessment of distal radius fracture healing by fe estimated bone stiffness |
| topic | Fracture healing Distal radius Hr-pQCT Finite element analysis Clinical evaluation |
| url | http://www.sciencedirect.com/science/article/pii/S2352187221000036 |
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