Analysis of fracture healing process by HR-pQCT in patients with distal radius fracture

Nishino, Yuichiro; Chiba, Ko; Era, Makoto; Okazaki, Narihiro; Miyamoto, Takashi; Yonekura, Akihiko; Tomita, Masato; Osaki, Makoto

doi:10.1007/s00774-020-01109-x

Cited by 7 publications

(5 citation statements)

References 18 publications

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“…Its clinical value is remaining still marginal due to several reasons, including technical issues, a lack of standardization in scan acquisition and evaluation, and it's cost-related limited availability (10). However, in recent years HR-pQCT has made significant progress in many scientific fields, e.g., in the assessment of the influence of rheumatologic diseases on joint surfaces (11,12), of bone microarchitecture and bone strength in secondary osteoporosis and metabolic bone disorders (10), the effect of several anti-osteoporotic drugs on bone quality (13) as well as in the evaluation of fracture healing (14)(15)(16) and research on fracture mechanisms of the distal radius (17,18).…”

Section: Introductionmentioning

confidence: 99%

The impact of motion induced artifacts in the evaluation of HR-pQCT scans of the scaphoid bone: an assessment of inter- and intraobserver variability and quantitative parameters

Benedikt¹,

Horling²,

Stock³

et al. 2023

Quant Imaging Med Surg

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Background: In-vivo high-resolution peripheral quantitative computed tomography (HR-pQCT) has high potential in scaphoid bone pathologies' scientific and clinical fields. The manufacturer's visual grading scale (VGS) classifies motion artifacts and divides scans into five quality grades ranging from grade 1 (good quality) to grade 5 (poor quality). This prospective study aimed to investigate the feasibility of the VGS and the influence of image quality on bone density and microarchitecture parameters for the scaphoid bone.Methods: Within one year, twenty-two patients with scaphoid fractures received up to six scans of their fractured and contralateral wrist (each consisting of three stacks) using second-generation HR-pQCT (total 256 scans). Three experienced observers graded each stack following the visual grading system, and interand intraobserver variability were assessed. The contralateral uninjured scaphoids were then compared pairwise within each patient to high-quality grade 1 scans to determine the influence of image quality on density and microarchitecture parameters.Results: Inter-and intraobserver variability among the three observers significantly revealed fair to moderate agreement, P<0.001 and P<0.05, respectively. Bone volume (BV) fraction tended to increase with poorer image quality but did not exceed four percent. Trabecular bone mineral density (Tb.BMD) decreased with poorer image quality but did not exceed five percent. Trabecular number and trabecular thickness significantly increased by 15.5% and 6.8% at grade five (P<0.001), respectively, and trabecular separation significantly decreased by 13.7% at grade five (P<0.001).Conclusions: This study revealed a considerable influence of motion on bone morphometry parameters of the scaphoid. Therefore, high image quality must be a central point in studies focusing on the histomorphometry of small objects. The high inter-and intraobserver variability limit the VGS. Future research may focus on other grading systems or automated techniques leading to more consistent and reproducible results. Currently, the use of microarchitectural analysis should be limited to cases without motion artefacts or, at most low graded motion artefacts.

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Section: Introductionmentioning

confidence: 99%

The impact of motion induced artifacts in the evaluation of HR-pQCT scans of the scaphoid bone: an assessment of inter- and intraobserver variability and quantitative parameters

Benedikt¹,

Horling²,

Stock³

et al. 2023

Quant Imaging Med Surg

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“…Interestingly, Nishino and colleagues investigated BMD directly at the fracture site and observed increases in BMD within the cortical gap and internal callus of the fracture throughout the 6‐month study, whereas increases in BMD of the external callus were slight. ( 15 ) These findings indicate that although increases in density may occur within the fracture region, the long‐term balance between cortical and trabecular density may be altered postfracture. In agreement with these previous findings, higher density cortical bone formation increased between 3‐months and 1‐year postfracture, which was the latest measurement included herein.…”

Section: Discussionmentioning

confidence: 87%

“…However, concurrent research has also shown that 3D image registration can be applied to fractured radii and even help to monitor changes in bone mineral density (BMD) in localized regions of the fracture. (14,15) Importantly though, these studies have been limited to proof of concept due to their evaluation of only small regions of interest and three or four patients, respectively. Thus, by applying the combined techniques of 3D image registration and quantification of bone formation and resorption to images of healing fractured radii, we may be able to specifically and locally quantify microstructural changes in BMD and structure throughout the duration of fracture healing.…”

Section: Introductionmentioning

confidence: 99%

Formation Dominates Resorption With Increasing Mineralized Density and Time Postfracture in Cortical but Not Trabecular Bone: A Longitudinal HRpQCT Imaging Study in the Distal Radius

et al. 2021

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“…The rats used in this study were divided into four groups, each of them containing 12 subjects, which was determined following sample size estimation. The groups were named A, B, C, and D according to their time of euthanasia (6,8,10, and 12 weeks postoperatively respectively). Littermates were randomized into each of the four groups.…”

Section: Animalsmentioning

confidence: 99%

“…To date, usual methods of evaluation of bone healing are mainly radiography, CT scans, and, optionally, magnetic resonance imaging [3,4]. Additionally, more refined but not commonly used methods in clinical practice are peripheral quantitative computed tomography (pQCT) and high-resolution peripheral quantitative computed tomography (HRpQCT) [5,6]. For experimental purposes only, micro-CT, Raman Spectroscopy, and the three-point-bending ex vivo test are also used [3,7].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Femoral Bone Fracture Healing in Rats by the Modal Damping Factor and Its Correlation With Peripheral Quantitative Computed Tomography

Chalikias

Παπαϊωάννου

Koundis

et al. 2021

Cureus

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Introduction Monitoring the progress of fracture healing is essential in order to establish the appropriate timing that ensures adequate bone strength for weight-bearing. In the present experimental study on a rat model of femoral fracture healing, the measurement of bone density and strength by peripheral quantitative computerized tomography (pQCT) was correlated with the modal damping factor (MDF) method. Methods Four groups of 12 male six-month-old Wistar rats each were anesthetized and submitted to baseline femoral pQCT and MDF scanning, followed by aseptic midshaft osteotomy of the right femur which was fixed by a locking intramedullary nail technique. The animals were left to recover and re-scanned following euthanasia of each group after six, eight, 10, and 12 weeks, respectively. The parameters measured by the pQCT method were total bone mineral density (BMD) and polar strength strain index (SSIp). Results Fracture healing progressed over time and at 12 weeks post-osteotomy there was no statistically significant difference between the osteotomized right and the control left femurs regarding MDF, BMD, and SSIp measurements. The highest correlations for the osteotomized femurs were observed between MDF and BMD (r =-0.647, P = 0.043), and between MDF and SSIp (r =-0.350, P = 0.321), at 10 weeks postoperatively. The high to moderate correlations between MDF and BMD, and between MDF and SSIp respectively, support the validity of MDF in assessing fracture healing. Conclusions Based on our findings in this fracture healing animal model, the results from the MDF method are reliable and correlate highly with the total BMD and moderately with the SSI polar values obtained by the pQCT method of bone quality measurement. Further studies are needed which may additionally support that the MDF method can be an attractive portable alternative to monitor fracture healing in the community.

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Analysis of fracture healing process by HR-pQCT in patients with distal radius fracture

Cited by 7 publications

References 18 publications

The impact of motion induced artifacts in the evaluation of HR-pQCT scans of the scaphoid bone: an assessment of inter- and intraobserver variability and quantitative parameters

The impact of motion induced artifacts in the evaluation of HR-pQCT scans of the scaphoid bone: an assessment of inter- and intraobserver variability and quantitative parameters

Formation Dominates Resorption With Increasing Mineralized Density and Time Postfracture in Cortical but Not Trabecular Bone: A Longitudinal HRpQCT Imaging Study in the Distal Radius

Evaluation of Femoral Bone Fracture Healing in Rats by the Modal Damping Factor and Its Correlation With Peripheral Quantitative Computed Tomography

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