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

Spanswick, Phillip

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

dc.contributor.advisor	Schneider, Prism Steorra
dc.contributor.advisor	Boyd, Steven Kyle
dc.contributor.author	Spanswick, Phillip
dc.contributor.committeemember	Manske, Sarah Lynn
dc.contributor.committeemember	Korley, Robert E. C.
dc.date	2020-11
dc.date.accessioned	2020-08-14T14:03:00Z
dc.date.available	2020-08-14T14:03:00Z
dc.date.issued	2020-08-05
dc.description.abstract	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.	en_US
dc.identifier.citation	Spanswick, P. (2020). Using HR-pQCT and finite element analysis to inform clinical assessment of distal radius (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.	en_US
dc.identifier.doi	http://dx.doi.org/10.11575/PRISM/38078
dc.identifier.uri	http://hdl.handle.net/1880/112387
dc.language.iso	eng	en_US
dc.publisher.faculty	Schulich School of Engineering	en_US
dc.publisher.institution	University of Calgary	en
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.	en_US
dc.subject	Fracture	en_US
dc.subject	Medical Imaging	en_US
dc.subject	Finite Element Analysis	en_US
dc.subject	Fracture Healing	en_US
dc.subject	Radius	en_US
dc.subject.classification	Engineering--Biomedical	en_US
dc.title	Using HR-pQCT and finite element analysis to inform clinical assessment of distal radius fractures	en_US
dc.type	master thesis	en_US
thesis.degree.discipline	Engineering – Biomedical	en_US
thesis.degree.grantor	University of Calgary	en_US
thesis.degree.name	Master of Science (MSc)	en_US
ucalgary.item.requestcopy	true	en_US