Assessing Cortical Thickness in Human Tibiae With Sonography vs Computed Tomography: A Pilot Study

Abstract

Approximately 200 million people worldwide have osteoporosis, a disease that contributes to about 9 million fragility fractures every year. 1 This accounts for $20 billion in health care costs in the United States alone. 2 Most bones are composed of two main compartments: the trabecular bone, known as spongy bone, and the cortical bone, which is a compact bone that forms the outer shell around the trabecular bone. With age, skeletal fragility becomes more prevalent as some individuals experience bone loss and microstructural deterioration in both the trabecular and cortical compartments. This increase in fragility, with an increased risk of falling, causes persons of advanced age to be more susceptible to bone fractures. 2 Fracture risk grows exponentially with the presence of bone disease, such as osteoporosis. Osteoporosis is characterized by low bone mineral density (BMD) and by changes in the microstructure of the bones, thus resulting in a decrease in bone strength and an increased risk for fractures. 2 This issue will continue to escalate as life expectancy increases and the aging population grows, resulting in an even greater economic burden in health care costs. 3 Clinically, areal BMD obtained by dual-energy x-ray absorptiometry has been the gold standard in determining bone strength for the diagnosis of osteoporosis. 2 Yet, <50% of the changes that affect whole-bone strength are directly caused by variations in BMD. 4,5 According to criteria of the World Health Organization, osteoporosis is determined if the areal BMD value obtained is ≥2.5 SD below the young adult reference mean (T score ≤ −2.5 SD). 6 However, multiple studies revealed that fragility fractures occur in patients with T scores > −2.5. 4,5,7 A prospective study consisting of 7806 participants aged >55 years found that 56% and 79% of fractures that occurred in women and men, respectively, had T scores between −1.0 and −2.5. 5 Nonetheless, merely lowering the T-score threshold is not a solution. Bringing the T-score threshold closer to zero will also decrease the threshold value for 754045J DMXXX10.

Effect of coronal fracture angle on the stability of screw fixation in medial malleolar fractures: A finite element analysis

“…The cartilage contact surface area between tibia and talus was measured as 1120.59 mm 2 . These thickness values for cortical bone and cartilage are compatible within an acceptable range with the scientific literature reported for cortical bone 19–23 and articular cartilage. 24–30 Two standard M4 X 35 size malleolar screws were used for the fixation of the fracture fragments modelling.…”