Computational techniques for the assessment of fracture repair

Abstract

The combination of high-resolution three-dimensional medical imaging, increased computing power, and modern computational methods provide unprecedented capabilities for assessing the repair and healing of fractured bone. Fracture healing is a natural process that restores the mechanical integrity of bone and is greatly influenced by the prevailing mechanical environment. Mechanobiological theories have been proposed to provide greater insight into the relationships between mechanics (stress and strain) and biology. Computational approaches for modeling these relationships have evolved from simple tools to analyse fracture healing at a single point in time to current models that capture complex biological events such as angiogenesis, stochasticity in cellular activities, and cell-phenotype specific activities. The predictive capacity of these models has been established using corroborating physical experiments. For clinical application, mechanobiological models accounting for patient-to-patient variability hold the potential to predict fracture healing and thereby help clinicians to customize treatment. Advanced imaging tools permit patient-specific geometries to be used in such models. Refining the models to study the strain fields within a fracture gap and adapting the models for case-specific simulation may provide more accurate examination of the relationship between strain and fracture healing in actual patients. Medical imaging systems have significantly advanced the capability for less invasive visualization of injured musculoskeletal tissues, but all too often the consideration of these rich datasets has stopped at the level of subjective observation. Computational image analysis methods have not yet been applied to study fracture healing, but two comparable challenges which have been addressed in this general area are the evaluation of fracture severity and of fracture-associated soft tissue injury. CT-based methodologies developed to assess and quantify these factors are described and results presented to show the potential of these analysis methods.

Bone fracture healing in mechanobiological modeling: A review of principles and methods

“…A primary limitation, when considering both the mechanical and biological aspects, is that is it necessary to solve a series of PDEs and formulate a FE implementation within an iterative procedure (Isaksson, 2012, Anderson et al, 2014, Betts and Müller, 2014). …”

A mechano-regulatory model for bone healing predictions under the influence of ultrasound

“…Several computational studies have been performed to simulate bone healing in order to elucidate the underlying mechanisms of cell activities and angiogenesis [14,15]. In 2005 a fuzzy logic model was proposed to model fracture healing [16] and the fracture vascularity.…”

Motion Predicts Clinical Callus Formation

“…Conversely, computational modeling, specifically finite element (FE) analysis, permits parametric investigation at a fraction of the economic cost. Such computational analysis has been proposed as a tool by which fracture-healing may be studied in the setting of various orthopaedic treatments and allows pre-production analysis of implant design 25,26 .…”