Clinical feasibility of fracture healing assessment through continuous monitoring of implant load

2020 ◽  
pp. 110188
Author(s):  
Manuela Ernst ◽  
Heiko Baumgartner ◽  
Stefan Döbele ◽  
Dankward Höntzsch ◽  
Tim Pohlemann ◽  
...  
1985 ◽  
Vol 14 (1) ◽  
pp. 13-20 ◽  
Author(s):  
A E Churches ◽  
K E Tanner ◽  
M Evans ◽  
J Gwillim

2020 ◽  
Vol 103 (11) ◽  
pp. 1148-1154

Background: The fracture healing assessment in subtrochanteric femoral fracture (SFF) is essential due to a high rate of implant failure and non-union. It requires an effective diagnostic tool for determining fracture union status. However, significant disagreement exists among clinicians for SFF union diagnosis, and no standardized method is available. Previous studies showed that radiographic union score (RUS) is reliable and highly correlated with fracture healing status. Objective: To evaluate the reliability and diagnostic accuracy of the RUS method for assessing the fracture healing status in the treatment of SFFs. Materials and Methods: The present study was a retrospective review study conducted on 44 SFFs. A panel of seven reviewers, which included five orthopedic surgeons and two musculoskeletal radiologists, assessed the radiographic healing of SFF based on both the RUS method and the physician impression method. The interobserver and intraobserver reliabilities were calculated using the intraclass correlation coefficient (ICC) and Cohen’s kappa coefficient. The correlation and diagnostic accuracy between RUS and the clinical union were also evaluated. Results: The RUS method resulted in higher intraobserver and interobserver agreement compared to the physician impression method. Inter-rater agreements of the RUS method and physician impression method were moderate (ICC=0.60) and minimal (kappa=0.37), respectively. The RUS method had a higher correlation with clinical union outcome compared to the physician impression method in SFFs (AUC 0.908 versus 0.640). A RUS of 7 or more at 12 weeks had 88% sensitivity and 63% specificity for predicting clinical union outcome. Conclusion: The application of the RUS method is reliable for determining the fracture healing status in SFFs and has better correlation with clinical union than the physician impression method. The RUS method may also be useful for predicting clinical union in SFFs. These results support the use of the radiographic scoring system for fracture healing assessment in SFFs. Keywords: Hip fracture, Subtrochanteric fracture, Fracture healing assessment, Radiographic union, Clinical union, Physician impression


2007 ◽  
Vol 457 ◽  
pp. 214-219 ◽  
Author(s):  
D McClelland ◽  
P B M Thomas ◽  
G Bancroft ◽  
C I Moorcroft

Sensors ◽  
2022 ◽  
Vol 22 (2) ◽  
pp. 670
Author(s):  
Benjamin Steven Vien ◽  
Wing Kong Chiu ◽  
Matthias Russ ◽  
Mark Fitzgerald

Reliable and quantitative assessments of bone quality and fracture healing prompt well-optimised patient healthcare management and earlier surgical intervention prior to complications of nonunion and malunion. This study presents a clinical investigation on modal frequencies associations with musculoskeletal components of human legs by using a prototype device based on a vibration analysis method. The findings indicated that the first out-of-plane and coupled modes in the frequency range from 60 to 110 Hz are associated with the femur length, suggesting these modes are suitable quantitative measures for bone evaluation. Furthermore, higher-order modes are shown to be associated with the muscle and fat mass of the leg. In addition, mathematical models are formulated via a stepwise regression approach to determine the modal frequencies using the measured leg components as variables. The optimal models of the first modes consist of only femur length as the independent variable and explain approximately 43% of the variation of the modal frequencies. The subsequent findings provide insights for further development on utilising vibration-based methods for practical bone and fracture healing monitoring.


1990 ◽  
Author(s):  
J.J. Kaufman ◽  
A. Chiabrera ◽  
N. Hakim ◽  
M. Hatem ◽  
M. Figueiredo ◽  
...  

2017 ◽  
Vol 09 (07) ◽  
pp. 1750098 ◽  
Author(s):  
Francesca Di Puccio ◽  
Lorenza Mattei ◽  
Antonia Longo ◽  
Stefano Marchetti

In clinical practice, bone healing is monitored with X-rays and manipulation. Its assessment is thus subjective, depending on the skills of the operator. Alternative and quantitative approaches have been proposed, generally based on the estimation of bone stiffness, which is known to increase with the healing process. The present study investigates the application of experimental modal analysis to fracture healing assessment focusing on fractures treated with an external fixator. The aim is to ascertain the capability of this approach to detect changes in the bone-callus stiffness as variations in the resonant frequencies despite the presence of the fixator, which might hide the bone response. In vitro tests were performed on a tibia phantom where the healing process was simulated creating three different types of callus surrogates, using glue and resin. The resonant frequencies of the phantom with screwed pins and of the phantom with the complete fixator were estimated. Results confirm an increase in the frequencies as the simulated bone-callus stiffness increases, encouraging the application of experimental modal analysis to fracture healing monitoring. This approach can offer remarkable advantages with respect to the actual standards: being non-invasive and quantitative, it would allow a more frequent healing monitoring.


2018 ◽  
Vol 15 (142) ◽  
pp. 20180068 ◽  
Author(s):  
Lorenza Mattei ◽  
Francesca Di Puccio ◽  
Stefano Marchetti

Non-invasive methods for assessing fracture healing are crucial for biomedical engineers. An approach based on mechanical vibrations was tried out in the 1990s, but was soon abandoned due to insufficiently advanced technologies. The same approach is re-proposed in the present study in order to monitor the healing process of a lengthened femur with an external fixator. The pins screwed into the bone were exploited for the impact testing (IT) to excite the bone and capture its response. Transmission through the soft tissues was thus prevented, and the quality of the signals was improved. Impact tests were performed every three to four weeks for five months. Unfortunately, after seven weeks, some pins were removed due to infection, and thus, the system was modified. Two different configurations were considered: before and after pin removal. An additional configuration was examined in the last two sessions, when the fixator body was removed, while four pins were left in the femur. The evolution of the frequency response function and of the resonant frequencies of the system were analysed for the duration of the monitoring period. The IT results were compared to the indications provided by X-ray images. During the evolution of the callus from the soft phase to the woven bone, the resonant frequencies of the system were found to increase by approximately 2–3% per week. The largest increase (approx. 22%) was observed for the first resonant frequency. After formation of the woven bone, the vibratory response remained almost the same, suggesting that the healing assessment could be related to the relative variation in the resonant frequencies. The results presented support the application of the IT approach for fracture healing assessment.


2020 ◽  
Vol 3 ◽  
Author(s):  
Adam Knoximprs ◽  
Anthony McGuire ◽  
Christopher Collier ◽  
Melissa Kacena ◽  
Roman Natoli

Background/Objective: Long bone fractures are of the most common and costly medical traumas humans experience.  Adequate characterization of the fracture healing process and development of potential medical interventions generally involves fracture induction operations on animal models of varying treatment or genetic groups, then analyzing relative repair success via synthesis of diverse assessment methodologies.  This review discusses the procedures, relevant parameters, special considerations, and key correlations of these major methodologies of fracture repair quantification.  Methods: A literature review was conducted for articles discussing the procedures or identifying correlations between each of the major fracture healing assessment methodologies.    Results: These methodologies include biomechanical testing, which provides the most direct quantification of skeletal functionality; micro-computed tomography, which enables high resolution visualization of fracture callus architecture; histology which helps elucidate the intricate processes underlying fracture repair; and x-ray which offers a non-invasive and clinically relevant view of fracture repair progress.  Each of these methodologies measure parameters directly correlating to restored functionality of fractured bone.  Conclusion: When appropriately integrated, synthesis of relevant parameters from each methodology of fracture repair assessment enables a comprehensive understanding of varying fracture healing outcomes and associated causalities.  Scientific/Clinical Policy Impact and Implications: This review may guide the interpretation and planning of fracture healing studies utilizing murine models. 


1990 ◽  
Vol 9 (3) ◽  
pp. 23-30 ◽  
Author(s):  
J.J. Kaufman ◽  
A. Chiabrera ◽  
M. Hatem ◽  
N.Z. Hakim ◽  
M. Figueiredo ◽  
...  

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