Analysis of fracture healing process by HR-pQCT in patients with distal radius fracture
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ORIGINAL ARTICLE
Analysis of fracture healing process by HR‑pQCT in patients with distal radius fracture Yuichiro Nishino1 · Ko Chiba1 · Makoto Era1 · Narihiro Okazaki1 · Takashi Miyamoto1 · Akihiko Yonekura1 · Masato Tomita1 · Makoto Osaki1 Received: 2 January 2020 / Accepted: 7 April 2020 © The Japanese Society Bone and Mineral Research and Springer Japan KK, part of Springer Nature 2020
Abstract Introduction High-resolution peripheral quantitative computed tomography (HR-pQCT) has enabled us to observe the changes in bone microarchitecture over time in vivo. In this study, the process of fracture healing was analyzed using HRpQCT in patients with distal radius fracture who underwent osteosynthesis. Materials and methods A total of 10 fracture sites identified from four patients with a distal radius fracture who underwent internal fixation with a volar locking plate (mean age 68.8 years, all women) were investigated. HR-pQCT was performed within a week (baseline) 4, 12, and 24 weeks after fracture. Rectangular region of interest (ROI) was established in the fracture site, inner callus, and external callus area, and the changes in bone mineral density (BMD) in each region were analyzed. Results From baseline to 24 weeks post-fracture, the BMD changed from 105.5 (95% CI 98.6–113) to 428.0 (331– 554) mgHA/ccm at the fracture site, from 111.0 (104–119) to 375.3 (290–486) mgHA/ccm at the inner callus area, and from 98.5 (91.6–106) to 171.6 (132–222) mgHA/ccm at the external callus area. The BMD increased at the fracture site and inner callus area, but increased only slightly at the external callus area. At 24 weeks post-fracture, the BMD at the fracture site and inner callus area was significantly higher than the external callus area. Conclusion In the healing process of postoperative distal radius fractures, increased BMD at the inner surface of the fracture site was confirmed in all fractures. Bone formation on the endosteal side may be a necessary condition for bone union of distal radius fractures. Keywords Fracture healing · High-resolution peripheral quantitative computed tomography (HR-pQCT) · Distal radius fracture
Introduction The fracture healing process is classified into four stages: an inflammatory stage, soft calluses formation stage, hard calluses formation stage, and remodeling stage [1, 2]. Inflammatory stage occurs soon after a fracture. By releasing powerful cytokines accompanying the destruction of platelets, hematoma replaced with granulation tissue. Then a soft callus formation occurs with membranous ossification. Hard callus formation begins after the continuity of the fractured
* Ko Chiba [email protected] 1
Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1‑7‑1, Sakamoto, Nagasaki 852‑8501, Japan
ends with soft calluses. Remodeling begins when the fracture site is tilled with woven bone. The analyses of the fracture healing process have been performed basically with animal experiments [3, 4]. However, microlevel analyses of fra
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