Forces in the Distal Radius During a Pushup or Active Wrist Motions

Smith, Jared M.; Werner, Frederick W.; Harley, Brian J.

doi:10.1016/j.jhsa.2018.05.020

Cited by 7 publications

(9 citation statements)

References 17 publications

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“…As such, this step may have limited the transmission of moment load at the interface between calcified-and soft-tissue. When comparing our results with a cadaveric study investigating distal radius load during various wrist motions (Smith et al, 2018), we find similar load-to-moment ratios indicating that additional padding may lead to an overestimation of momentum load. Our data also suggests that estimates in the distal radius may vastly vary from patient to patient.…”

Section: Discussionsupporting

confidence: 60%

Bone mechanoregulation allows subject-specific load estimation based on time-lapsed micro-CT and HR-pQCTin vivo

Walle

Marques

Ohs

et al. 2021

Preprint

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Patients at high risk of fracture due to metabolic diseases frequently undergo long-term antiresorptive therapy. However, in some patients treatment is unsuccessful in preventing fractures or causes severe adverse health outcomes. Understanding load driven bone remodelling, i.e. mechanoregulation, is critical to understand which patients are at risk for progressive bone degeneration and may enable better patient selection or adaptive therapeutic intervention strategies. Bone microarchitecture assessment using high-resolution peripheral quantitative computed tomography (HR-pQCT) combined with computed mechanical loads has successfully been used to investigate bone mechanoregulation at the trabecular level. To obtain the required mechanical loads that induce local variances in mechanical strain and cause bone remodelling, estimation of physiological loading is essential. Yet, current models homogenise strain patterns throughout the bone to estimate load distribution in vivo, which may be a flawed assumption for investigating alterations in bone mechanoregulation. By further utilizing available spatiotemporal information of time-lapsed bone imaging studies, we developed a mechanoregulation-based load estimation algorithm (MR). MR calculates organ scale loads by scaling and superimposing a set of predefined independent unit loads to optimise measured bone formation in high, quiescence in medium and resorption in low strain regions. We benchmarked our algorithm against a previously published load history algorithm (LH) using synthetic data, micro-CT images of murine vertebrae under defined experimental in vivo loadings and HR-pQCT images from seven patients. Our algorithm consistently outperformed LH in all three datasets. In silico generated time evolutions of distal radius geometries (n = 5) indicated significantly higher sensitivity, specificity, and accuracy for MR than LH (p < 0.01). This increased performance led to substantially better discrimination between physiological and extra-physiological loading in mice (n = 8). Moreover, a significantly (p < 0.01) higher association between remodelling events and computed local mechanical signals were found using MR (CCR = 0.42) than LH (CCR = 0.38) to estimate human distal radius loading. Future applications of MR may enable clinicians to link subtle changes in bone strength to changes in day-to-day loading, identifying weak spots in the bone micro-structure for local intervention and personalised treatment approaches.

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Section: Discussionsupporting

confidence: 60%

Bone mechanoregulation allows subject-specific load estimation based on time-lapsed micro-CT and HR-pQCTin vivo

Walle

Marques

Ohs

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Differences in prediction within and between groups with p < 0.05 are indicated ( * * p < 0.001; * * * * p < 0.0001; ns p > 0.05, two-tailed paired t-test within groups, two-tailed individual t-test between groups). cadaveric study investigating distal radius load during various wrist motions (Smith et al, 2018), we find similar load-tomoment ratios, indicating that additional padding may lead to an overestimation of momentum load. Finally, processes such as calcium homeostasis, wherein random bone remodelling may occur, will influence MR estimations.…”

Section: Discussionsupporting

confidence: 53%

Bone Mechanoregulation Allows Subject-Specific Load Estimation Based on Time-Lapsed Micro-CT and HR-pQCT in Vivo

Walle

Marques

Ohs

et al. 2021

Front. Bioeng. Biotechnol.

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Patients at high risk of fracture due to metabolic diseases frequently undergo long-term antiresorptive therapy. However, in some patients, treatment is unsuccessful in preventing fractures or causes severe adverse health outcomes. Understanding load-driven bone remodelling, i.e., mechanoregulation, is critical to understand which patients are at risk for progressive bone degeneration and may enable better patient selection or adaptive therapeutic intervention strategies. Bone microarchitecture assessment using high-resolution peripheral quantitative computed tomography (HR-pQCT) combined with computed mechanical loads has successfully been used to investigate bone mechanoregulation at the trabecular level. To obtain the required mechanical loads that induce local variances in mechanical strain and cause bone remodelling, estimation of physiological loading is essential. Current models homogenise strain patterns throughout the bone to estimate load distribution in vivo, assuming that the bone structure is in biomechanical homoeostasis. Yet, this assumption may be flawed for investigating alterations in bone mechanoregulation. By further utilising available spatiotemporal information of time-lapsed bone imaging studies, we developed a mechanoregulation-based load estimation (MR) algorithm. MR calculates organ-scale loads by scaling and superimposing a set of predefined independent unit loads to optimise measured bone formation in high-, quiescence in medium-, and resorption in low-strain regions. We benchmarked our algorithm against a previously published load history (LH) algorithm using synthetic data, micro-CT images of murine vertebrae under defined experimental in vivo loadings, and HR-pQCT images from seven patients. Our algorithm consistently outperformed LH in all three datasets. In silico-generated time evolutions of distal radius geometries (n = 5) indicated significantly higher sensitivity, specificity, and accuracy for MR than LH (p < 0.01). This increased performance led to substantially better discrimination between physiological and extra-physiological loading in mice (n = 8). Moreover, a significantly (p < 0.01) higher association between remodelling events and computed local mechanical signals was found using MR [correct classification rate (CCR) = 0.42] than LH (CCR = 0.38) to estimate human distal radius loading. Future applications of MR may enable clinicians to link subtle changes in bone strength to changes in day-to-day loading, identifying weak spots in the bone microstructure for local intervention and personalised treatment approaches.

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“…The ANAFAB procedure appears to have the ability to reverse the scapholunate diastasis and proximal scaphoid subluxation, but still retain functional motion. Significant load on the carpus and radius is generated during a push-up (Scordino et al., 2016; Smith et al., 2018). The ability of the ANAFAB reconstruction to allow patients to perform push-ups provides compelling evidence of its ability to restore longitudinal stability of the carpus without a significant loss of motion, indicating the successful restoration of functional carpal biomechanics.…”

Section: Discussionmentioning

confidence: 99%

Anatomical anterior and posterior reconstruction for scapholunate dissociation: preliminary outcome in ten patients

Sandow

Fisher

2019

J Hand Surg Eur Vol

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This study reviews the efficacy of a reconstruction to address scapholunate dissociation using an anterior and posterior approach with a hybrid synthetic tape/tendon weave between the trapezium, scaphoid, lunate and radius: an anatomical front and back (ANAFAB) repair. This repair is a compilation of the components of a number of previously reported repair techniques, and based on published kinematic evidence. It aims to restore the anatomical mechanical constraints on both anterior and posterior aspects of the carpus. Patients were immobilized in a cast for 6 weeks, but no stabilizing wires were used. Ten patients have undergone the reconstruction and were assessed at a minimum 24-month follow-up. They achieved excellent realignment of the carpus, a postoperative median scapholunate gap of 3 mm and a recovery of more than 75% of grip strength and range of motion. No patient required secondary surgery or treatment related to the carpal stabilization. Level of evidence: IV

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Forces in the Distal Radius During a Pushup or Active Wrist Motions

Abstract: This study may help surgeons and therapists better treat complicated distal radius fractures as well as provide for better comparisons of existing or new distal radius plates and constructs that are designed to treat these complicated loading patterns.

Cited by 7 publications

References 17 publications

Bone mechanoregulation allows subject-specific load estimation based on time-lapsed micro-CT and HR-pQCTin vivo

Bone mechanoregulation allows subject-specific load estimation based on time-lapsed micro-CT and HR-pQCTin vivo

Bone Mechanoregulation Allows Subject-Specific Load Estimation Based on Time-Lapsed Micro-CT and HR-pQCT in Vivo

Anatomical anterior and posterior reconstruction for scapholunate dissociation: preliminary outcome in ten patients

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