A practical, quantitative, fracture healing endpoint assessment criterion for tibial fractures treated with external fixation

Ogrodnik, Peter; Thomas, Peter

doi:10.1177/0954411919835453

Cited by 4 publications

(6 citation statements)

References 19 publications

(43 reference statements)

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“…3,5,6,7 The literature has highlighted the need for devices measuring stiffness to operate in multiple planes and the necessity for a uniform loading rate 3 The IOS fixator has been developed taking these requirements into account by incorporating a visual guide for fracture healing end-point. 4 This study aims to investigate the outcomes from patients treated with a single design of mono-lateral external fixator over a 7-year period, thus confirming the principles of external fixation described earlier.…”

Section: Introductionmentioning

confidence: 52%

“…The justification for this assessment method is described in Ogrodnik and Thomas. 4 This provides a unique, quantifiable fracture healing end point.…”

Section: Description Of the External Fixatormentioning

confidence: 99%

“…From the work of Ogrodnik et al, 3,4 and in addition to the usual safety factors associated with maximum static load and fatigue at gait loading to at least 1 million cycles, we propose four principles by which external fixation should be designed (and applied):…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tibial fractures treated with mono-lateral fixation: Principles of design and application

Ogrodnik,

Thomas,

Collingwood

2024

Proc Inst Mech Eng H

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This paper presents the outcome of a data review of patients treated with the IOS external fixation system at the Royal Stoke University Hospital: a fixation designed to meet four requirements for external fixation proposed in this paper. Demographic data and outcome were collected and assessed. From 69 initial patients, 64 patients (55 males and 9 females) had an average age of 35.9 years. The mean time to union was 127 days. There were no incidences of malunion, or refracture post fixation removal attributable to the treatment method. In addition, in this cohort, there was no incidence of pin tract infection resulting in osteomyelitis. Of all the factors assessed the only factor to have any significant effect on healing was smoking: an average delay of 31 days. An examination of RUST (radiographic union score tibia) and modified RUST scores illustrated a potential false negative of up to 80%. Hence, this study cannot support the use of either scoring system to diagnose fracture healing. IOS external fixation was shown to be an effective method for the treatment of unstable tibial fractures. The reduction at fixation removal was shown to be very good. There was no incidence of osteomyelitis. It is, therefore, suggested that appropriately used external fixation is a viable alternative to intramedullary nailing if designed and surgically applied using four design principles outlined in this paper. Furthermore, it is proposed that external fixation be designed and applied to meet these four principles.

show abstract

Section: Introductionmentioning

confidence: 52%

“…The justification for this assessment method is described in Ogrodnik and Thomas. 4 This provides a unique, quantifiable fracture healing end point.…”

Section: Description Of the External Fixatormentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Tibial fractures treated with mono-lateral fixation: Principles of design and application

Ogrodnik,

Thomas,

Collingwood

2024

Proc Inst Mech Eng H

Self Cite

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show abstract

“…For the diagnosis of bone healing in fracture patients, most clinicians usually rely on clinical and imaging examinations, but the evaluation criteria vary greatly [3]. Therefore, Peter JO and Field JR started to use quantitative indicators to judge bone healing from the perspective of mechanics and imaging, respectively [4,5]. The fracture healing process is a continuous process over time [6].…”

Section: Introductionmentioning

confidence: 99%

Individualized Modeling Differential Ratio Method for Judging the Degree of Lower Extremity Long Bone Healing

Liu

Tong

Yang

et al. 2021

Preprint

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Background:There are no recognized quantitative diagnostic criteria, which is one of the difficulties faced in trauma orthopedics. The purpose of this study is to quantitatively evaluate the degree of bone healing after internal fracture fixation with the individualized differential ratio method.Methods:Patients with a lower limb fracture treated at the Orthopedics Department of our hospital were recruited. At the time of follow-up, the degree of bone healing was evaluated by two orthopedic physicians and one imaging physician. Patients were divided into the bone healing group (group A), the poor bone healing group (group B), and the nonunion group (group C). Three-dimensional geometric models of the unaffected limb and the affected limb after simulated removal of the internal fixation were established, corresponding to the basic phase and the simulated phase, respectively, and the average CT gray value (average CT value) was obtained. Wall thickness analysis was performed to obtain the median wall thickness after meshing. R2 (median wall thickness ratio), R4 (CT value ratio), and R5 (healing index ratio) were obtained by calculating the ratio of each value in the simulated phase to that in the basic phase. Results:A total of 79 patients were included in the study, and 112 CT scans were performed. The frequency of categorization in groups A, B, and C was 49, 37 and 26, respectively. The correlation coefficient between the degree of bone healing and R2, R4 and R5 was 0.654, 0.060 and 0.542, respectively. The median R2 in groups A, B, and C was 0.91, 0.80, and 0.67, respectively. On ROC curve analysis, R2 was more effective in evaluating bone healing and nonunion than R5. The best cutoff point for R2 in predicting bone healing was 0.84, and the best cutoff point in predicting bone nonunion was 0.74.The individualized differential ratio method can be used to quantitatively evaluate the fracture healing state, with the median wall thickness ratio as a more intuitive and reliable judgment index.

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Wall thickness analysis method for judging the degree of lower extremity long bone healing

Li,

Yang,

Tong

et al. 2023

Sci Rep

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To evaluate the possibility of judging the degree of bone healing by wall thickness analysis provide reference for quantitative analysis of bone healing. Patients with lower limb fracture from April 2014 to October 2019 were recruited and divided into bone healing (group A), poor bone healing (group B), and nonunion (group C). Models were built in Mimics 20.0 with DICOM 3.0 data obtained from patient’s CT. Three-dimensional geometric models of unaffected limb and affected limb after simulated removal of internal fixation were established, corresponding to basic phase and simulated phase, respectively. Wall thickness analysis was performed to obtain median wall thickness after meshing. R2 (median wall thickness ratio), R4 (CT value ratio), and R5 (healing index ratio) were obtained by calculating the ratio of each value in simulated phase to that in basic phase. Receiver operating characteristic curve analysis was used to evaluate the ability of Wall Thickness Analysis to indicate fracture healing. 112 CT scans of 79 patients were included in the study. The frequency of categorization in groups A, B, and C was 49, 37 and 26, respectively. The median R2 in groups A, B, and C was 0.91, 0.80, and 0.67, respectively (group A > group B > group C, all P < 0.05). The best cutoff point for R2 in predicting bone healing was 0.84, and predicting bone nonunion was 0.74. The Wall Thickness Analysis can be used to quantitatively evaluate fracture healing state, with median wall thickness ratio as a more intuitive and reliable judgment index.

show abstract

A practical, quantitative, fracture healing endpoint assessment criterion for tibial fractures treated with external fixation

Cited by 4 publications

References 19 publications

Tibial fractures treated with mono-lateral fixation: Principles of design and application

Tibial fractures treated with mono-lateral fixation: Principles of design and application

Individualized Modeling Differential Ratio Method for Judging the Degree of Lower Extremity Long Bone Healing

Wall thickness analysis method for judging the degree of lower extremity long bone healing

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