Predicting Nonunions in Ankle Fractures Using Quantitative Tibial Hounsfield Samples From Preoperative Computed Tomography: A Multicenter Matched Case Control Study

Quantitative Volumetric Measurements of Bone Grafting Sites Within the Lower Extremity on Computed Tomography Scans

The anterior iliac crest is one of the most used options; however, pain and other complications have been reported. Other options for bone harvest in the lower extremity, such as the proximal tibia and calcaneus, can be useful sites for bone grafting. Computed tomography angiography images of the lower extremity were analyzed using 3-D Slicer™ medical imaging software, creating an advanced 3-dimensional model. Bone volume (cm3) and bone mineral density (Hounsfield units) were measured from the cancellous bone in the anterior iliac crest, posterior iliac crest, proximal tibia, and the calcaneus. Fifteen studies were included. The total volume measured it was of 61.88 ± 14.15 cm3, 19.35 ± 4.16 cm3, 32.48 ± 7.49 cm3, 26.40 ± 7.18 cm3, for the proximal tibia, anterior and posterior iliac crest, and calcaneus, respectively. Regarding Hounsfield units, the densities were 116 ± 58.77, 232.4 ± 68.65, 214.4 ± 74.45, 170.5 ± 52.32, for proximal tibia, anterior and posterior iliac crest, and calcaneus. The intraclass correlation coefficients were in average >0.94. In conclusion, the proximal tibia has more cancellous bone than the anterior and posterior iliac crest. The calcaneus has more cancellous bone than the anterior iliac crest. Bone mineral density was highest in the anterior iliac crest and in proximal tibia was the lowest value.

Predictive Factors of Functional Outcomes and Quality of Life in Patients with Ankle Fractures: A Systematic Review

Background: Evaluating the predictors of unfavorable outcomes in patients with ankle fractures is crucial for identifying high-risk patients and implementing personalized treatment strategies. This study aimed to analyze factors that influence quality of life in patients with ankle fractures. Methods: Four databases were consulted. The main outcomes were functionality and quality of life scales combined using the standard mean difference (SMD) (Review Manager 5.4). Results: Eight studies with 2486 patients were included. A significant correlation was found between female sex and worse functionality scores (beta 4.15, 95% CI 1.84-6.46). Additionally, older age was correlated with worse functionality scores (beta -0.24, 95% CI -0.29 to -0.19). Patients with diabetes or metabolic syndrome also had worse outcomes (SMD 0.27, 95% CI 0.18-0.36). High BMI and obesity were also associated with worse quality of life scores (beta 2.62, 95% CI 0.77-4.48). Smokers had greater disability in the analyzed scales (SMD 0.22, 95% CI 0.05-0.39). No significant differences were observed with respect to syndesmotic involvement. Conclusions: Age, sex, diabetes, high BMI, and smoking negatively impact functional outcomes and quality of life in patients with ankle fractures.

Bone Density by Specific Anatomic Location Using Hounsfield Samples of the Lower Extremity: A Multi-center Retrospective Analysis

Understanding bone mineral density and its effects on patient outcomes is a useful tool for lower extremity surgeons. Historically, dual-energy X-ray absorptiometry scans have been the gold standard for quantifying bone mineral density. In this study, we look at an indirect way to measure bone mineral density using Hounsfield units on computed tomography. The aim of this study is to establish normal physiological Hounsfield ranges in specific bones of the foot by analyzing Hounsfield unit measurements and determining associated factors. We hypothesize that there will be a difference in density based on age, sex, and anatomic location. Patient data from January 2010 to January 2020 were retrospectively analyzed from 2 institutions. Nine anatomic locations (calcaneus, talar body, talar head, navicular, cuboid, medial cuneiform, head of first and fifth metatarsal, and base of first proximal phalanx) were measured for bone mineral density averages. In total, 137 patients were evaluated (71 males, 66 females) with an average age of 54 years. Significant differences in density were found between the 9 anatomic locations. Age was confirmed to be a significant covariate with inverse relation to Hounsfield units, p < .001. There were no density differences between sexes at any of the locations, except the talar head, p < .001. This is the first study to our knowledge to establish normal physiological ranges of bone density on computed tomography for specific anatomic locations of the foot. This quantitative approach to bone density and the established effect of age, sex, and location is pivotal for diagnostic and preoperative planning.

Measures of Corticalization

After the insertion of dental implants into living bone, the condition of the peri-implant bone changes with time. Implant-loading phenomena can induce bone remodeling in the form of the corticalization of the trabecular bone. The aim of this study was to see how bone index (BI) values behave in areas of bone loss (radiographically translucent non-trabecular areas) and to propose other indices specifically dedicated to detecting corticalization in living bone. Eight measures of corticalization in clinical standardized intraoral radiographs were studied: mean optical density, entropy, differential entropy, long-run emphasis moment, BI, corticalization index ver. 1 and ver. 2 (CI v.1, CI v.2) and corticalization factor (CF). The analysis was conducted on 40 cortical bone image samples, 40 cancellous bone samples and 40 soft tissue samples. It was found that each measure distinguishes corticalization significantly (p < 0.001), but only CI v.1 and CI v.2 do so selectively. CF or the inverse of BI can serve as a measure of peri-implant bone corticalization. However, better measures are CIs as they are dedicated to detecting this phenomenon and allowing clear clinical deduction.