Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-12-2018 | Orthopaedic Surgery

Bone density correlates with clinical outcomes after ankle fracture fixation

Authors: Stephen J. Warner, Matthew R. Garner, Peter D. Fabricant, Dean G. Lorich

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 12/2018

Abstract

Introduction

Osteoporosis and decreased bone density are known to increase fracture incidence and severity. Although much is known regarding the effects of bone density on fracture risk and the treatment options for prevention of fragility fractures, whether bone quality alters clinical outcomes after fracture fixation is unknown. The purpose of this study was to determine whether bone quality correlates with clinical outcomes after fracture fixation.

Materials and methods

A prospective database of all operatively treated ankle fractures by a single surgeon from 2003 to 2013 was used to identify patients. All patients included in the study had preoperative computed tomography (CT) imaging of the injured ankle and postoperative CT imaging of the contralateral ankle. Hounsfield unit (HU) measurement values were determined by placing an elliptical region of interest confined to the cancellous metaphyseal region of the distal tibia and fibula. The primary and secondary clinical outcomes included Foot and Ankle Outcome Scores (FAOS) and ankle range of motion (ROM). Included patients had at least 12 months of clinical outcome data.

Results

Sixty-four patients met the inclusion criteria. Comparison of HU values from the injured and contralateral side demonstrated almost perfect agreement (ICC(2,1) = 0.938), suggesting that HU values can be accurately measured in the setting of a fracture. Increased HU values of the injured distal tibia and fibula significantly correlated with improved outcomes in four of five FAOS domains, including pain, activities of daily living, sports, and quality of life (beta = 0.285–0.344; P ≤ 0.05 for all). Range of motion outcomes did not significantly correlate with HU values.

Conclusions

Our results suggest that decreased bone quality, as measured using preoperative CT, significantly correlates with inferior short-term clinical outcomes. These results have significant implications for integrating bone quality into treatment algorithms for fracture patients.

Unnanuntana A, Gladnick BP, Donnelly E, Lane JM (2010) The assessment of fracture risk. J Bone Jt Surg Am 92:743–753. https://doi.org/10.2106/JBJS.I.00919 CrossRef

Rosen CJ (2005) Clinical practice. Postmenopausal osteoporosis. N Engl J Med 353:595–603. https://doi.org/10.1056/NEJMcp043801 CrossRefPubMed

Ali AM, Saleh M, Eastell R et al (2006) Influence of bone quality on the strength of internal and external fixation of tibial plateau fractures. J Orthop Res 24:2080–2086. https://doi.org/10.1002/jor.20270 CrossRefPubMed

Johanson N, Litrenta J, Zampini JM et al (2011) Surgical treatment options in patients with impaired bone quality. Clin Orthop Relat Res 469:2237–2247. https://doi.org/10.1007/s11999-011-1838-6 CrossRefPubMedPubMedCentral

Link TM (2012) Osteoporosis imaging: state of the art and advanced imaging. Radiology 263:3–17. https://doi.org/10.1148/radiol.2633201203 CrossRefPubMedPubMedCentral

Eckstein F, Lochmüller E-M, Lill CA et al (2002) Bone strength at clinically relevant sites displays substantial heterogeneity and is best predicted from site-specific bone densitometry. J Bone Miner Res 17:162–171. https://doi.org/10.1359/jbmr.2002.17.1.162 CrossRefPubMed

Groll O, Lochmüller EM, Bachmeier M et al (1999) Precision and intersite correlation of bone densitometry at the radius, tibia and femur with peripheral quantitative CT. Skelet Radiol 28:696–702CrossRef

Schreiber JJ, Anderson P, Hsu WK (2014) Use of computed tomography for assessing bone mineral density. Neurosurg Focus 37:E4. https://doi.org/10.3171/2014.5.FOCUS1483 CrossRefPubMed

Schreiber JJ, Gausden EB, Anderson PA et al (2015) Opportunistic osteoporosis screening—gleaning additional information from diagnostic wrist CT scans. J Bone Jt Surg Am 97:1095–1100. https://doi.org/10.2106/JBJS.N.01230 CrossRef

10.

Schreiber JJ, Anderson P, Rosas HG et al (2011) Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Jt Surg Am 93:1057–1063. https://doi.org/10.2106/JBJS.J.00160 CrossRef

11.

Roos EM, Brandsson S, Karlsson J (2001) Validation of the foot and ankle outcome score for ankle ligament reconstruction. Foot Ankle Int 22:788–794CrossRef

12.

Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRef

13.

Callréus M, McGuigan F, Akesson K (2013) Adverse effects of smoking on peak bone mass may be attenuated by higher body mass index in young female smokers. Calcif Tissue Int 93:517–525. https://doi.org/10.1007/s00223-013-9785-8 CrossRefPubMed

14.

Lee JJ, Patel R, Biermann JS, Dougherty PJ (2013) The musculoskeletal effects of cigarette smoking. J Bone Jt Surg Am 95:850–859. https://doi.org/10.2106/JBJS.L.00375 CrossRef

15.

Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767. https://doi.org/10.1016/S0140-6736(02)08657-9 CrossRefPubMed

16.

Meredith DS, Schreiber JJ, Taher F et al (2013) Lower preoperative Hounsfield unit measurements are associated with adjacent segment fracture after spinal fusion. Spine (Phila Pa 1976) 38:415–418. https://doi.org/10.1097/BRS.0b013e31826ff084 CrossRef

17.

Schreiber JJ, Hughes AP, Taher F, Girardi FP (2014) An association can be found between Hounsfield units and success of lumbar spine fusion. HSS J 10:25–29. https://doi.org/10.1007/s11420-013-9367-3 CrossRefPubMed

18.

Tingart MJ, Lehtinen J, Zurakowski D et al (2006) Proximal humeral fractures: regional differences in bone mineral density of the humeral head affect the fixation strength of cancellous screws. J Shoulder Elbow Surg 15:620–624. https://doi.org/10.1016/j.jse.2005.09.007 CrossRefPubMed

19.

Gausden E, Garner MR, Fabricant PD et al (2017) Do clinical outcomes correlate with bone density after open reduction and internal fixation of tibial plateau fractures. Arch Orthop Trauma Surg 137:1–6. https://doi.org/10.1007/s00402-017-2679-x CrossRef

Title: Bone density correlates with clinical outcomes after ankle fracture fixation
Authors: Stephen J. Warner
Matthew R. Garner
Peter D. Fabricant
Dean G. Lorich
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 12/2018
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-3017-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Bone density correlates with clinical outcomes after ankle fracture fixation

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2018

Arthroscopic meniscal surgery versus conservative management in patients aged 40 years and older: a meta-analysis

Reverse shoulder arthroplasty: the role of physical therapy on the clinical outcome in the mid-term to long-term follow-up

Does discoid lateral meniscus have inborn peripheral rim instability? Comparison between intact discoid lateral meniscus and normal lateral meniscus

Course of pain after total hip arthroplasty within a standardized pain management concept: a prospective study examining influence, correlation, and outcome of postoperative pain on 103 consecutive patients

Poor static balance is a risk factor for non-contact anterior cruciate ligament injury

The value of radiography in the follow-up of extremity fractures: a systematic review