Cortical Bone Thickness of the Distal Part of the Tibia Predicts Bone Mineral Density

Patterson, Jason; Rungprai, Chamnanni; Hartog, Taylor Den; Gao, Yubo; Amendola, Annunziato; Phisitkul, Phinit; Femino, John E.

doi:10.2106/jbjs.15.00795

Cited by 26 publications

(27 citation statements)

References 25 publications

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“…Various studies in different bones where consideration could be given are listed above in the Introduction section and also in others including more recent studies that have summarized some of the relevant literature. 13,[37][38][39][40][41][42][43] In conclusion, we found minimal inter-observer variations (mean error, 1.5 AE 1.4 mm) when the CFM was used to establish diaphyseal locations for making CI and MCCT measurements when compared to each of the Tingart and Mather methods (mean error range, 10.7 AE 5.9 to 13.3 AE 6.7 mm, respectively) (p < 0.001). When compared to the relatively minor variations in the CFM, the variations in the other methods are also clinically relevant because they can adversely affect the interpretation of the relationships of CI and MCCT with ultimate fracture load.…”

Section: Discussionmentioning

confidence: 89%

“…The results of the present study suggest that there could be novel ways to more reliably measure CI and MCCT in other long bones that have relied on measurement locations based on endocortical parallelism, diaphyseal landmarks, or percentages of bone or diaphyseal length. Various studies in different bones where consideration could be given are listed above in the Introduction section and also in others including more recent studies that have summarized some of the relevant literature …”

Section: Discussionmentioning

confidence: 99%

“…6,10 Mean combined cortical thickness (MCCT ¼ (OD-ID)), which is obtained from two levels of the proximal humerus diaphysis (hence "combines" four cortical thickness measurements), is a related measurement that has been shown to even more strongly correlate with bone strength. 1,5,7,11 CI and MCCT are clinically relevant: (i) surgeons can evaluate radiographs of the fractured humerus and the non-fractured side and make decisions regarding choices for techniques used for surgical reconstruction, 2,3,12 (ii) age-related changes in these simple measurements correlate with reduced bone quality and fracture strength of the proximal humerus 1,5,8 and other bones (see overview in, 13 ) and (iii) age-related changes can result in complications of shoulder arthroplasty and fracture fixation. 3,6 One of the more popular methods for making CI and MCCT measurements on A-P radiographs of the proximal humerus diaphysis is that of Tingart et al (2003) 5 ( Fig.…”

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Humeral head circle‐fit method greatly increases reliability and accuracy when measuring anterior–posterior radiographs of the proximal humerus

Mears

Langston

Phippen

et al. 2017

Journal Orthopaedic Research

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Measurements made on routine A-P radiographs can predict strength/quality of the proximal humerus, as shown in terms of two easy-to-measure parameters: Cortical index (CI) and mean-combined cortical thickness (MCCT). Because of high variability inherent when using established methods to measure these parameters, we describe a new orientation system. Using digitized radiographs of 33 adult proximal humeri, five observers measured anatomical reference locations in accordance with: (i) Tingart et al. (2003) method, (ii) Mather et al. (2013) method, and (iii) our new humeral head Circle-Fit method (CFM). The Tingart and Mather methods measure CI and MCCT with respect to upper and lower edges of 20 mm tall rectangles fit to a proximal diaphyseal location where endosteal (Tingart) or periosteal (Mather) cortical margins become parallel. But high intra- and inter-observer variability occurs when placing the rectangles because of uncertainty in identifying cortical parallelism. With the CFM an adjustable circle is fit to the humeral head articular surface, which reliably and easily establishes a proximal metaphyseal landmark (M1) at the surgical neck. Distal locations are then designated at successive 10 mm increments below M1, including a second metaphyseal landmark (M2) followed by diaphyseal (D) locations (D1, D2 ⋯D6). D1 corresponds most closely to the proximal edges of the rectangles used in the other methods. Results showed minimal inter-observer variations (mean error, 1.5 ± 1.1 mm) when the CFM is used to establish diaphyseal locations for making CI and MCCT measurements when compared to each of the other methods (mean error range, 10.7 ± 5.9 to 13.3 ± 6.7 mm) (p < 0.001). © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2313-2322, 2017.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Humeral head circle‐fit method greatly increases reliability and accuracy when measuring anterior–posterior radiographs of the proximal humerus

Mears

Langston

Phippen

et al. 2017

Journal Orthopaedic Research

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“…The thickness of the first layer representing the skin was assumed 1-3 mm, 51 and of the second layer was assumed 37-39 mm. 52 The physical source-detector distance was 1 cm (detector A) and 2 cm (detector B), respectively. The desired chromophore concentration changes in each layer are obtained as follows.…”

Section: Discussionmentioning

confidence: 99%

“…The average scattering coefficients for skin and bone were 23.91 mm -1 49 and 24.44 mm -1 50 , respectively. The thickness of the first layer representing the skin was assumed 1 - 3 mm 51 , and of the second layer was assumed 37 - 39 mm 52 . The physical source-detector distance was 1 cm (detector A) and 2 cm (detector B), respectively.…”

Section: Methodsmentioning

confidence: 99%

Near infrared spectroscopy for measuring changes in bone hemoglobin content after exercise in individuals with spinal cord injury

Draghici

Potart

Hollmann

et al. 2017

Journal Orthopaedic Research

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Bone blood perfusion has an essential role in maintaining a healthy bone. However, current methods for measuring bone blood perfusion are expensive and highly invasive. This study presents a custom built near-infrared spectroscopy (NIRS) instrument to measure changes in bone blood perfusion. We demonstrated the efficacy of this device by monitoring oxygenated and deoxygenated hemoglobin changes in the human tibia during and after exercise in able-bodied and in individuals with spinal cord injury (SCI), a population with known impaired peripheral blood perfusion. Nine able-bodied individuals and six volunteers with SCI performed a 10 min rowing exercise (functional electrical stimulation rowing for those with SCI). With exercise, during rowing, able-bodied showed an increase in deoxygenated hemoglobin in the tibia. Post rowing, able-bodied showed an increase in total blood content, characterized by an increase in total hemoglobin content due primarily to an increase in deoxygenated hemoglobin. During rowing and post-rowing, those with SCI showed no change in total blood content in the tibia. The current study demonstrates that NIRS can non-invasively detect changes in hemoglobin concentration in the tibia. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:183-191, 2018.

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Development of a simple numerical model for trabecular bone structures

et al. 2019

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Purpose: Advances in additive manufacturing processes are enabling the fabrication of surrogate bone structures for applications including use in high-resolution anthropomorphic phantoms. In this research, a simple numerical model is proposed that enables the generation of microarchitecture with similar statistical distribution to trabecular bone. Methods: A human humerus, radius, ulna, and several vertebrae were scanned on the Imaging and Medical beamline at the Australian Synchrotron and the proposed numerical model was developed through the definition of two complex functions that encode the trabecular thickness and positiondependant spacing to generate volumetric surrogate trabecular structures. The structures reproduced those observed at 19 separate axial locations through the experimental bone volumes. The applicability of the model when incorporating a two-material approximation to absorption-and phase-contrast CT was also investigated through simulation. Results: The synthetic structures, when compared with the real trabecular microarchitecture, yielded an average mean thickness error of 2 lm, and a mean difference in standard deviation of 33 lm for the humerus, 24 lm for the ulna and radius, and 15 lm for the vertebrae. Simulated absorption-and propagation-based phase contrast CT projection data were generated and reconstructed using the derived mathematical simplifications from the two-material approximation, and the phase-contrast effects were successfully demonstrated. Conclusions: The presented model reproduced trabecular distributions that could be used to generate phantoms for quality assurance and validation processes. The implication of utilizing a twomaterial approximation results in simplification of the additive manufacturing process and the generation of synthetic data that could be used for training of machine learning applications.

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Cortical Bone Thickness of the Distal Part of the Tibia Predicts Bone Mineral Density

Abstract: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 26 publications

References 25 publications

Humeral head circle‐fit method greatly increases reliability and accuracy when measuring anterior–posterior radiographs of the proximal humerus

Humeral head circle‐fit method greatly increases reliability and accuracy when measuring anterior–posterior radiographs of the proximal humerus

Near infrared spectroscopy for measuring changes in bone hemoglobin content after exercise in individuals with spinal cord injury

Development of a simple numerical model for trabecular bone structures

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