Application of peripheral quantitative computed tomography to fracture healing assessment
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2023-09
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Melbourne Authors
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Minerva Elements
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PhD thesis
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Open Access
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Description
© 2024 Michael Edward Bullen
Abstract
Background
Fracture healing is a complex, well-co-ordinated physiological process that ultimately results in the replacement of fracture callus by new bone, without the formation of a fibrous scar. Current practice of assessment of fracture healing involves a combination of clinical and radiological examination, although there is a lack of a standardised, quantitative method for the assessment of fracture stiffness and strength.
Aims
The primary aim of this thesis was to assess the application of peripheral quantitative computed tomography to, and its clinical utility in, fracture healing assessment.
Methods
Four studies were undertaken. The first assessed the effect of two common cast materials on pQCT derived measurements, to validate its use in the setting of a cast. An in-vitro component utilised a hydroxyapatite phantom to evaluate increasing cast thickness, and an in-vivo component assessed the effect of synthetic and plaster of Paris cast material on adult forearm measurements. The second study assessed the application of pQCT to evaluate the moulding ability of common cast materials each applied to 25 healthy adults. The third study was a prospective clinical trial to assess the feasibility of using pQCT in paediatric patients to monitor acute distal radius fracture healing. Healing fracture callus density and strength was assessed at different stages of union to provide descriptive results. The final study utilised pQCT to investigate the effect of vitamin D deficiency on fracture healing. A randomized controlled trial of vitamin D supplementation in the setting of vitamin D deficiency was performed, with pQCT as the primary assessment tool in 28 paediatric patients.
Results
The first study established the accuracy of pQCT in the setting of cast material, and validated its use in the setting of a cast. The second study demonstrated that plaster of Paris casts were able to achieve a closer mould than polyester casts, and a closely moulded fit was able to be more consistently achieved when using plaster of Paris to immobilise simulated distal radius fractures. The third study demonstrated that pQCT is a feasible imaging modality for monitoring the progress of distal radius fracture healing. The final study found no effect on distal radius fracture healing with vitamin D supplementation.
Conclusions
pQCT is a safe, feasible and practical imaging modality in the assessment of forearm fracture healing in a paediatric population.
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Keywords
Fracture healing, Peripheral quantitative computed tomography, Imaging, Paediatric, Vitamin D