Qualitative and Quantitative Radiological Measures of Fracture Healing

Abstract

The formulation of appropriate postoperative strategies, following fracture repair, currently involves an understanding of radiological and clinical outcome measures. This study has evaluated several modalities used to assess the progression of bone healing in a sheep tibial segmental defect model. Measures of defect optical density and volumetric data including bone density (BD), bone volume (BV) and bone mass (BM) were compared with qualitative data involving visual appraisal of radiographs [% bridging callus and modified radiographic union score tibia (mRUST)] and a clinical outcome measure (locomotory function). Percent bridging callus and mRUST measures displayed strong correlation ( = 0.999), while locomotory function was weakly correlated with bridging callus ( = 0.029) and mRUST ( = 0.046). There was moderate to strong correlation between the qualitative and quantitative data. Bone density, BV and BM showed strong correlations within this dataset (BD-BV, = 0.814; BD-BM, = 0.818; BV-BM, = 1.000). Likewise, optical density measures were strongly correlated with BD ( = 0.824), BV ( = 0.957) and BM ( = 0.959). The utilization of both qualitative and quantitative data, in assessment of the progression of fracture healing, has provided valuable insight. Measures of optical density have been shown to make a substantial contribution to this assessment and which should be considered for use in studies evaluating fracture healing.

Locking compression plate fixation of critical-sized bone defects in sheep. Development of a model for veterinary bone tissue engineering

“…Implant failure, infection and severe fractures requiring subject exclusion have been reported in bone tissue engineering studies involving external fixation or internal fixation with intramedullary pins in sheep 2 , 27 , 28 . Field and Ruthenbeck 23 reported no complications following interlocking nail fixation in sheep. However, animals in their study were supported by a sling in the first three weeks after surgery.…”

“…It must also replicate clinical conditions and be consistent with gait and biomechanical characteristics of the target species. Lastly, it should be amenable to imaging-based assessment while not compromising the well-being 21 – 23 . In this study, the dorsomedial approach was selected to expose the middle third of the tibial shaft.…”

A Retrospective Study of Postoperative Development of Implant-Induced Osteoporosis in Radial–Ulnar Fractures in Toy Breed Dogs Treated with Plate Fixation

“…Studies on bone formation and fracture healing that evaluated PV and the PVR found that bone formation was correlated with PV on digital radiographs. 12,13,17,18 Although this study was performed as a multi-hospital case study, PVR was used as a measure of bone mineral areal density because measured data had been normalized to the values recorded on the humeral condyle at each time point. Since IIO involves decreased bone mineral density in the cortical bone beneath the plate, we defined IIO as a decrease in the PVR.…”

“…Although dual energy X-ray absorptiometry and quantitative computed tomography are the most popular methods for measuring bone mineral density, the pixel value of digital radiographs is correlated with bone mineral density in human medicine. 11,12 Radiographic regions of interest have been useful in assessing the healing process of tibial fractures in sheep 13 ; however, the use of radiographic bone density (grey levels) in evaluating the healing process of radial fractures in toy breeds have not been reported yet.…”

Individualized Modeling Differential Ratio Method for Judging the Degree of Lower Extremity Long Bone Healing

“…For the diagnosis of bone healing in fracture patients, most clinicians usually rely on clinical and imaging examinations, but the evaluation criteria vary greatly [3]. Therefore, Peter JO and Field JR started to use quantitative indicators to judge bone healing from the perspective of mechanics and imaging, respectively [4,5]. The fracture healing process is a continuous process over time [6].…”