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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/17023

Title: Assessment of the healing process in distal radius fractures by high resolution peripheral quantitative computed tomography
Authors: de Jong, Joost J. A.
Willems, Paul C.
Arts, Jacobus J.C.
Bours, Sandrine G. P.
Brink, Peter R. G.
van Geel, Tineke A. C. M.
Poeze, Martijn
GEUSENS, Piet
van Rietbergen, Bert
VAN DEN BERGH, Joop
Issue Date: 2014
Publisher: ELSEVIER SCIENCE INC
Citation: BONE, 64, p. 65-74
Abstract: In clinical practice, fracture healing is evaluated by clinical judgment in combination with conventional radiography. Due to limited resolution, radiographs don't provide detailed information regarding the bone micro-architecture and bone strength. Recently, assessment of in vivo bone density, architectural and mechanical properties at the microscale became possible using high resolution peripheral quantitative computed tomography (HR-pQCT) in combination with micro finite element analysis (mu FEA). So far, such techniques have been used mainly to study intact bone. The aim of this study was to explore whether these techniques can also be used to assess changes in bone density, micro-architecture and bone stiffness during fracture healing. Therefore, the fracture region in eighteen women, aged 50 years or older with a stable distal radius fracture, was scanned using HR-pQCT at 1-2 (baseline), 3-4,6-8 and 12 weeks post-fracture. At 1-2 and 12 weeks post-fracture the distal radius at the contra-lateral side was also scanned as control. Standard bone density, micro-architectural and geometric parameters were calculated and bone stiffness in compression, torsion and bending was assessed using mu FEA. A linear mixed effect model with time post-fracture as fixed effect was used to detect significant (p-value <= 0.05) changes from baseline. Wrist pain and function were scored using the patient-rated wrist evaluation (PRWE) questionnaire. Correlations between the bone parameters and the PRWE score were calculated by Spearman's correlation coefficient. At the fracture site, total and trabecular bone density increased by 11% and 20%, respectively, at 6-8 weeks, whereas cortical density was decreased by 4%. Trabecular thickness increased by 23-31% at 6-8 and 12 weeks and the intertrabecular area became blurred, indicating intertrabecular bone formation. Compared to baseline, calculated bone stiffness in compression, torsion and bending was increased by 31% after 12 weeks. A moderate negative correlation was found between the stiffness and the PRWE score. No changes were observed at the contra-lateral side. The results demonstrate that it is feasible to assess clinically relevant and significant longitudinal changes in bone density, micro-architecture and mechanical properties at the fracture region during the healing process of stable distal radius fractures using HR-pQCT. (C) 2014 Elsevier Inc. All rights reserved.
Notes: [de Jong, Joost J. A.; Poeze, Martijn; van den Bergh, Joop P. W.] Maastricht Univ, Res Sch NUIRIM, NL-6202 AZ Maastricht, Netherlands. [de Jong, Joost J. A.; Bours, Sandrine G. P.; van den Bergh, Joop P. W.] Maastricht Univ, Med Ctr, Dept Rheumatol, NL-6202 AZ Maastricht, Netherlands. [Willems, Paul C.; Arts, Jacobus J.] Maastricht Univ, Med Ctr, Dept Orthoped, NL-6202 AZ Maastricht, Netherlands. [Willems, Paul C.; Arts, Jacobus J.; van Geel, Tineke A. C. M.; Geusens, Piet P.] Maastricht Univ, Res Sch CAPHRI, NL-6202 AZ Maastricht, Netherlands. [Brink, Peter R. G.; Poeze, Martijn] Maastricht Univ, Med Ctr, Dept Surg, NL-6202 AZ Maastricht, Netherlands. [van Geel, Tineke A. C. M.] Maastricht Univ, Dept Gen Practice, NL-6202 AZ Maastricht, Netherlands. [Geusens, Piet P.; van den Bergh, Joop P. W.] Hasselt Univ, Fac Med & Life Sci, Diepenbeek, Belgium. [van Rietbergen, Bert] Eindhoven Univ Technol, Fac Biomed Engn, NL-5600 MB Eindhoven, Netherlands. [van den Bergh, Joop P. W.] Viecuri Med Ctr Venlo, Dept Internal Med, Venlo, Netherlands. joost.dejong@maastrichtuniversity.nl
URI: http://hdl.handle.net/1942/17023
DOI: 10.1016/j.bone.2014.03.043
ISI #: 000337011500010
ISSN: 8756-3282
Category: A1
Type: Journal Contribution
Validation: ecoom, 2015
Appears in Collections: Research publications

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