Bone Mineral Changes During Tibial Fracture Healing

Cattermole, H.; Cook, J E; Fordham, J N; Muckle, D. S.; Cunningham, J L

doi:10.1097/00003086-199706000-00026

Cited by 47 publications

(33 citation statements)

References 13 publications

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“…A number of studies have attempted to use quantitative radiology to measure the changes in callus mineralization in both experimental [1,13] and clinical fractures [5], but the relationship between these changes and the mechanical properties of the healing fracture is not always clear, unless there is a consistent fracture gap, which is often not the case in clinical fractures.…”

Section: Introductionmentioning

confidence: 99%

Monitoring the Mechanical Properties of Healing Bone

Claes

Cunningham

2009

Clinical Orthopaedics &Amp; Related Research

130

109

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Fracture healing is normally assessed through an interpretation of radiographs, clinical evaluation, including pain on weight bearing, and a manual assessment of the mobility of the fracture. These assessments are subjective and their accuracy in determining when a fracture has healed has been questioned. Viewed in mechanical terms, fracture healing represents a steady increase in strength and stiffness of a broken bone and it is only when these values are sufficiently high to support unrestricted weight bearing that a fracture can be said to be healed. Information on the rate of increase of the mechanical properties of a healing bone is therefore valuable in determining both the rate at which a fracture will heal and in helping to define an objective and measurable endpoint of healing. A number of techniques have been developed to quantify bone healing in mechanical terms and these are described and discussed in detail. Clinical studies, in which measurements of fracture stiffness have been used to identify a quantifiable end point of healing, compare different treatment methods, predictably determine whether a fracture will heal, and identify factors which most influence healing, are reviewed and discussed.

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Section: Introductionmentioning

confidence: 99%

Monitoring the Mechanical Properties of Healing Bone

Claes

Cunningham

2009

Clinical Orthopaedics &Amp; Related Research

130

109

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“…A fixator in place for extended periods is not only a considerable psychological burden on the patient [10] but also can lead to persistent pain [15], increased risk of pin tract infections [32], and osteopenia [6]. The standard method to monitor regenerate bone formation and to determine when to remove the fixator is based on orthogonal radiographs and the formation of cortices in the region of the regenerate.…”

Section: Introductionmentioning

confidence: 99%

DEXA as a Predictor of Fixator Removal in Distraction Osteogenesis

Saran

Hamdy

2008

Clinical Orthopaedics &Amp; Related Research

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Premature removal of the fixator after a lengthening procedure can result in gradual bending or acute fracture of the regenerate. We reviewed the records of 26 patients who underwent 28 limb lengthenings between 1997 and 2005 to assess the post lengthening regenerate fracture rate and bone healing index when using dual energy xray absorptiometry (DEXA) to aid in deciding on when to remove the fixator. Sixteen male and 10 female patients with an average age at lengthening of 12.3 years underwent an average lengthening of 5.2 cm (range, 3-9.1 cm). Nineteen femurs and nine tibiae were lengthened. Serial monthly DEXA scans were analyzed for bone mineral density. Bone healing indices and post fixator removal complications were assessed. The fixators were removed once the bone mineral density had plateaued to a less than 10% increase and plain radiographs showed no obvious defects precluding fixator removal. There were no regenerate fractures and only one fracture in the proximal segment of the lengthened bone after apparatus removal and the healing index for the series averaged 47 d/cm (range, 20-73 d/cm). Using serial DEXA scans during the consolidation phase of lengthening has a low rate (3.6%) of fractures while maintaining an acceptable bone healing index without excessively increasing fixation time.

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“…Osteotomy procedure was performed on the right tibia in all cases, but both tibiae were used in the ultrasonometric analysis, because of the need to compare operated side to the healthy one. The comparison with the contralateral healthy limb co-validates the methodology because it presents safer and accurate results (8,9,10,11,12) . The shortcoming regarding the use of sheep is the poor availability of those animals, which must be found in slaughterhouses at a relatively high cost by animal, which makes the use of such animals to be expensive and difficult, also due to lodging limitations.…”

Section: Discussionmentioning

confidence: 58%

“…A single value proposed for speed cannot be used as an indicative of the full osseous union. The intact contralateral bone can be used as control, indicating the value of the end-point osseous healing, because some authors demonstrated that significant changes do not occur on a contralateral, non-fractured bone density, from the moment of the fracture until the complete healing of the fractured bone (10,11,12) .…”

Section: * Soundscan 2000mentioning

confidence: 99%

Avaliação ultra-sonométrica da consolidação de osteotomias mediodiafisárias transversas em diferentes períodos: estudo experimental em tíbias de carneiro

Barbieri

Matos

et al. 2005

Acta ortop. bras.

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Foi realizado um estudo experimental sobre a avaliação ultra-sonométrica da consolidação de tíbias de carneiros submetidas a osteotomia transversal mediodiafisária, utilizando 15 carneiros, com pêso médio de 37 Kg, divididos em três grupos experimentais de cinco animais cada, conforme o período de observação pós-operatória de 30, 45 e 60 dias. As osteotomias foram realizadas nas tíbias direitas dos animais, ficando as tíbias esquerdas como controle. Foi feita avaliação radiográfica da consolidação a cada duas semanas e, ao fim do período de observação, os animais foram sacrificados e as tíbias, removidas para a análise ultra-sonométrica. Foram medidos e correlacionados o diâmetro da tíbia e a velocidade de propagação transversal do ultra-som na região da osteotomia, em duas direções diferentes (perpendicular e paralela ao plano da tuberosidade anterior da tíbia). A velocidade de propagação do ultra-som aumentou com o avançar da consolidação (±5%), sendo as diferenças significantes em relação ao grupo-controle, mas não entre os grupo experimentais. Os diâmetros diminuíram nas duas direções medidas, sendo as diferenças significantes entre os grupos, com forte correlação negativa com a velocidade. Concluiu-se que o método de avaliação da consolidação pela ultra-sonometria é factível, com resultados confiáveis e precisos.

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Bone Mineral Changes During Tibial Fracture Healing

Cited by 47 publications

References 13 publications

Monitoring the Mechanical Properties of Healing Bone

Monitoring the Mechanical Properties of Healing Bone

DEXA as a Predictor of Fixator Removal in Distraction Osteogenesis

Avaliação ultra-sonométrica da consolidação de osteotomias mediodiafisárias transversas em diferentes períodos: estudo experimental em tíbias de carneiro

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