Using HR-pQCT and finite element analysis to inform clinical assessment of distal radius fractures

Distal radius fractures (DRFs) are commonly treated non-operatively with cast immobilization; however, there are no standardized clinical practice guidelines to direct optimal duration of immobilization following a DRF. Finite element (FE) modelling coupled with high-resolution peripheral quantitative computed tomography (HR-pQCT) allows for non-invasive in vivo assessment of bone density and stiffness throughout the fracture healing process, which may inform fracture healing progression and cast removal. Many fracture assessment instruments have been developed for clinical use, but a lack of validation and standardization has led to considerable variability in the assessment of fracture healing. We hypothesized that changes in bone stiffness and bone mineral density measured using HR-pQCT can better inform the duration of casting following a DRF. We aimed to identify clinical assessment instruments that were good predictors of fracture stiffness and could inform cast removal. Participants (n=30) with a stable DRF were followed for two week intervals from the time of fracture until two months post-fracture, then at three months and six months post-fracture. At each follow-up, participants underwent clinical, radiographic, and functional assessments, as well as had their fractured wrist scanned using HR-pQCT. Recovery of bone stiffness during fracture healing was determined from micro-FE (µFE) models generated from HR-pQCT image data. During fracture healing, significant longitudinal changes were found in µFE-estimated stiffness, patient-reported outcomes, grip strength, range of motion (ROM), tenderness, number of cortices healed based on radiographs, and fracture line visibility (p<0.05); however, no significant change was detected in HR-pQCT based total bone mineral density. Grip strength, ROM, and patient-reported outcomes such as the Patient-Rated Wrist Evaluation (PRWE) and the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) questionnaire correlated strongly with µFE-estimated stiffness (0.61≥ rm ≥0.71). Based on µFE-estimated stiffness, PRWE and QuickDASH are the best predictors of stiffness recovery (p<0.05) and may be used to guide duration of cast immobilization in the clinical setting.

Name thesis:degree_name

Master of Science (MSc)

Discipline thesis:degree_discipline

Engineering – Biomedical

Grantor dc:publisher.institution

Schulich School of Engineering

Year dc:date.issued

2020

Author dc:creator

• Spanswick, Phillip

Advisors dc:contributor.advisor

• Schneider, Prism Steorra
• Boyd, Steven Kyle

Committee members dc:contributor.committeemember

• Manske, Sarah Lynn
• Korley, Robert E. C.

• Fracture
• Medical Imaging
• Finite Element Analysis
• Fracture Healing
• Radius

Statement dc:rights

• University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.

Language dc:language.iso

eng

DOI

http://dx.doi.org/10.11575/PRISM/38078

OAI identifier oai:identifier

oai:ucalgary.scholaris.ca:1880/112387