Bone density measurements from CT scans may predict the healing capacity of scaphoid waist fractures

Abstract

Aims We quantitatively compared the 3D bone density distributions on CT scans performed on scaphoid waist fractures subacutely that went on to union or nonunion, and assessed whether 2D CT evaluations correlate with 3D bone density evaluations. Methods We constructed 3D models from 17 scaphoid waist fracture CTs performed between four to 18 weeks after fracture that did not unite (nonunion group), 17 age-matched scaphoid waist fracture CTs that healed (union group), and 17 age-matched control CTs without injury (control group). We measured the 3D bone density for the distal and proximal fragments relative to the triquetrum bone density and compared findings among the three groups. We then performed bone density measurements using 2D CT and evaluated the correlation with 3D bone densities. We identified the optimal cutoff with diagnostic values of the 2D method to predict nonunion with receiver operating characteristic (ROC) curves. Results In the nonunion group, both the distal (100.2%) and proximal (126.6%) fragments had a significantly higher bone density compared to the union (distal: 85.7%; proximal: 108.3%) or control groups (distal: 91.6%; proximal: 109.1%) using the 3D bone density measurement, which were statistically significant for all comparisons. 2D measurements were highly correlated to 3D bone density measurements (Spearman’s correlation coefficient (R) = 0.85 to 0.95). Using 2D measurements, ROC curve analysis revealed the optimal cutoffs of 90.8% and 116.3% for distal and proximal fragments. This led to a sensitivity of 1.00 if either cutoff is met and a specificity of 0.82 when both cutoffs are met. Conclusion Using 3D modelling software, nonunions were found to exhibit bone density increases in both the distal and proximal fragments in CTs performed between four to 18 weeks after fracture during the course of treatment. 2D bone density measurements using standard CT scans correlate well with 3D models. In patients with scaphoid fractures, CT bone density measurements may be useful in predicting the likelihood of nonunion. Cite this article: Bone Joint J 2020;102-B(9):1200–1209.

Quantitative 3-D CT Demonstrates Distal Row Pronation and Translation and Radiolunate Arthritis in the SNAC Wrist

“…The volumetric bone densities for the ROIs (capitate head, distal lunate, proximal lunate, lunate fossa, and radial styloid) were calculated as the average voxel density in Hounsfield units (HU) [13][14][15][16] . As a reference value, we also computed the bone density of the pisiform, which provided an internal standard to obviate problems that arise from variations among individuals (bone quality, bone metabolic profile, etc.…”

The effect of anti-retroviral therapy on fracture healing

“…[23][24][25][26][27] However, the true effect of aRT on the fracture repair process has not been previously investigated in in vivo or clinical studies. Yet given the devastating morbidity of nonunion, 28,29 there is a pressing need to identify developing nonunion before it becomes established, 30,31 remove any inhibitors to fracture repair, [32][33][34] and potentially intervene early with surgery or novel treatments such as stem cells, exosomes, or growth factors. [35][36][37] The aim of this study was to analyze how a combination aRT regimen affects the fracture repair process.…”

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“…Delays in diagnosing and inadequately treating dire scaphoid fractures can result in osteoarthritis, avascular necrosis, and nonunion [15][16][17]. In subjects with fractures in the middle part of the bone (waist of scaphoid) or the proximal pole, healing is more difficult [18,19]. These areas of the scaphoid do not have a very good blood supply [20].…”