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Journal ArticleDOI

A Case Report of Abnormal Fracture Healing as Detected With High-Resolution Peripheral Quantitative Computed Tomography.

TL;DR: The authors would like to thank Liesbeth Jutten and Margareth Winants from the Trial Bureau of the Department of Orthopedics for their efforts during this study.
About: This article is published in Journal of Clinical Densitometry.The article was published on 2017-10-01 and is currently open access. It has received 1 citations till now.

Summary (1 min read)

Introduction

  • Fracture healing is a complex repair process with the primary objective of restoring the mechanical function of the fractured bone (1).
  • Quantifying outcome in clinical fracture healing trials remains challenging (2,3).
  • Using highresolution peripheral quantitative computed tomography (HR-pQCT) in combination with micro finite element analysis (µFEA), the authors previously described the typical healing of a distal radius fracture.
  • In the present case report, the authors describe a patient who deviated from this usually observed pattern of fracture healing.

Case Report

  • A 54-yr-old woman visited their emergency department with a displaced distal radius fracture of the left arm after a fall from standing height.
  • After a successful closed reduction at the emergency room, the patient was treated by cast immobilization.
  • Six weeks post fracture, the patient complained of increased pain, swelling, and stiff fingers.
  • At the 8-wk outpatient clinic visit, a decreased motor function of the extensor muscles of the left wrist and all digits without sensory disturbances was observed.

HR-pQCT Measurements

  • HR-pQCT is a low-dose radiographic imaging modality with an isotropic voxel size of 82 (XtremeCT-1; Scanco Medical AG, Brüttisellen, Switzerland).
  • Results Incongruent with the healing pattern observed with HRpQCT described earlier (4,5), a decrease in trabecular density was detected at 6 wk post fracture (−11.9 mgHA/ cm3), where the typical healing response showed an increase (median +35.4 mgHA/cm3).
  • This deviation was not restored even after 115 wk (Fig. 1A).
  • In contrast, the cortical region healed normally, following a similar pattern as the other patients in the study (Fig. 1C).
  • This is especially evident in the segmented 3-dimensional reconstructions.

Discussion

  • The present case report demonstrates the potential of HR-pQCT to distinguish different patterns of fracture healing in a clinical setting.
  • The relevance of CRPS in the present case report is uncertain.
  • Using HR-pQCT, the incidence and role of localized bone loss within the CRPS population could be further elucidated.
  • A limitation of the present case report is that it only presents a single affected patient to illustrate the detection of abnormal fracture healing using HR-pQCT.
  • Additionally, based on the current data available to us, the etiology of the observed bone loss is not certain and can only be speculated on.

Acknowledgments

  • The authors would like to thank Liesbeth Jutten and Margareth Winants from the Trial Bureau of the Department Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health Volume 20, 2017 of Orthopedics for their efforts during this study.
  • This study was funded by the Weijerhorst Foundation (grant no.WH2).

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Citations
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Journal ArticleDOI
01 Oct 2019-Bone
TL;DR: This exploratory study indicates that HR-pQCT with μFEA performed within four weeks after a distal radius fracture captures biomechanical fracture characteristics that are associated with long-term functional outcome and therefore could be a valuable early outcome measure in clinical trials and clinical practice.

9 citations

References
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Journal ArticleDOI
TL;DR: Using a reproducible model of experimental fracture healing in the rat, the integrated cellular responses that signal the pathways and the role of the extracellular matrix components in orchestrating the events of fracture healing are elucidated.
Abstract: Fracture healing is a complex physiologic process that involves the coordinated participation of several cell types. By using a reproducible model of experimental fracture healing in the rat, it is possible to elucidate the integrated cellular responses that signal the pathways and the role of the extracellular matrix components in orchestrating the events of fracture healing. Histologic characterization of fracture healing shows that intramembranous ossification occurs under the periosteum within a few days after an injury. Events of endochondral ossification occur adjacent to the fracture site and span a period of up to 28 days. Remodeling of the woven bone formed by intramembranous and endochondral ossification proceeds for several weeks. Spatial and temporal expression of genes for major collagens (Types I and II), minor fibrillar collagens (Types IV and XI), and several extracellular matrix components (osteocalcin, osteonectin, osteopontin, fibronectin and CD44) are detected by in situ hybridization. Immunohistochemical studies show that expression of proliferating cell nuclear antigen is both time and space dependent and differentially expressed in the callus tissues formed by the intramembranous and endochondral processes. Chondrocytes involved in endochondral ossification undergo apoptosis (programmed cell death), and early events in fracture healing may be initiated by the expression of early response genes such as c-fos. Additional characterization and elucidation of fracture healing will lay the foundation for subsequent studies aimed at identifying mechanisms for enhancing skeletal repair.

1,234 citations


"A Case Report of Abnormal Fracture ..." refers background in this paper

  • ...Fracture healing is a complex repair process with the primary objective of restoring the mechanical function of the fractured bone (1)....

    [...]

Journal ArticleDOI
TL;DR: HR-pQCT appears promising to assess bone density and microarchitecture at peripheral sites in terms of reproducibility and ability to detect age- and disease-related changes.
Abstract: Context: Assessment of trabecular microarchitecture may enhance the prediction of fracture risk and improve monitoring of treatment response. A new high-resolution peripheral quantitative computed tomography (HR-pQCT) system permits in vivo assessment of trabecular architecture and volumetric bone mineral density (BMD) at the distal radius and tibia with a voxel size of 82 μm3. Objective and Patients: We determined the short-term reproducibility of this device by measuring 15 healthy volunteers three times each. We compared HR-pQCT measurements in 108 healthy premenopausal, 113 postmenopausal osteopenic, and 35 postmenopausal osteoporotic women. Furthermore, we compared values in postmenopausal osteopenic women with (n = 35) and without previous fracture history (n = 78). Design and Setting: We conducted a cross-sectional study in a private clinical research center. Intervention and Main Outcome Measure: We took HR-pQCT measurements of the radius and tibia. Femoral neck and spine BMD were measured in post...

1,124 citations


"A Case Report of Abnormal Fracture ..." refers background in this paper

  • ...The high resolution enables the assessment of bone microarchitecture in vivo (7) and estimation of bone strength μFEA (8)....

    [...]

Journal ArticleDOI
01 Jun 2008-Bone
TL;DR: The combined numerical-experimental procedure for FE model validation on the patient micro-CT technology demonstrated that bone strength can be estimated non-invasively, and this may provide important insight into fracture risk in patient populations.

423 citations


"A Case Report of Abnormal Fracture ..." refers background in this paper

  • ...Using highresolution peripheral quantitative computed tomography (HR-pQCT) in combination with micro finite element analysis (µFEA), we previously described the typical healing of a distal radius fracture....

    [...]

  • ...The high resolution enables the assessment of bone microarchitecture in vivo (7) and estimation of bone strength µFEA (8)....

    [...]

  • ...As a result, calculated compression stiffness using µFEA was comparable to the other patients (Fig....

    [...]

  • ...The high resolution enables the assessment of bone microarchitecture in vivo (7) and estimation of bone strength μFEA (8)....

    [...]

  • ...From these images, bone density, geometry, and microarchitectural and µFEA parameters were derived (4,5)....

    [...]

Journal ArticleDOI
TL;DR: The fourth edition of diagnostic and treatment guidelines for complex regional pain syndrome (CRPS; aka reflex sympathetic dystrophy) is presented in this paper, where expert practitioners in each discipline traditionally utilized in the treatment of CRPS systematically reviewed the available and relevant literature; due to the paucity of levels 1 and 2 studies, less rigorous, preliminary research reports were included.
Abstract: Objective This is the fourth edition of diagnostic and treatment guidelines for complex regional pain syndrome (CRPS; aka reflex sympathetic dystrophy). Methods Expert practitioners in each discipline traditionally utilized in the treatment of CRPS systematically reviewed the available and relevant literature; due to the paucity of levels 1 and 2 studies, less rigorous, preliminary research reports were included. The literature review was supplemented with knowledge gained from extensive empirical clinical experience, particularly in areas where high-quality evidence to guide therapy is lacking. Results The research quality, clinical relevance, and “state of the art” of diagnostic criteria or treatment modalities are discussed, sometimes in considerable detail with an eye to the expert practitioner in each therapeutic area. Levels of evidence are mentioned when available, so that the practitioner can better assess and analyze the modality under discussion, and if desired, to personally consider the citations. Tables provide details on characteristics of studies in different subject domains described in the literature. Conclusions In the humanitarian spirit of making the most of all current thinking in the area, balanced by a careful case-by-case analysis of the risk/cost vs benefit analysis, the authors offer these “practical” guidelines.

408 citations

Journal ArticleDOI
TL;DR: A detailed critical overview of not only the history of CRPS, but also the epidemiology, the clinical features, the pathophysiological studies, the proposed criteria, the therapy and an emphasis that future research should apply more rigorous standards to allow a better understanding ofCRPS are provided.

176 citations

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