Schwarzenberg and Dailey wanted to do the same thing for bones - apply a force and see how much the bone flexed.
#Help with shin pain after tib fib fracture software
Schwarzenberg then ran the models through finite element analysis software - the same program used by civil engineers to simulate how much deformation happens to a bridge when a load (like cars or pedestrians) is applied to it. Using specialized, commercially available software on the scans, Dailey's PhD student and study co-author, Peter Schwarzenberg, built 3-D mechanical structural models that identified the regions of bone and new bone, or callus. These scans provided a detailed, three-dimensional picture of what was going on inside each patient. Low-dose computed tomography (CT) scans were done at 12 weeks. Patient follow-up included radiographs and completion of patient-reported outcome measures, all performed at 6, 12, 18, and 24 weeks post-surgery. The screws allow the patient to bear weight soon after surgery by keeping the upper bone fragment from collapsing onto the lower bone fragment. In this study, adults with tibial shaft fractures were prospectively recruited for observation following standard reamed intramedullary nailing, a procedure in which a titanium rod is inserted in the hollow space of the tibia and secured at the top and bottom with screws. "Instead of using X-rays to determine, 'Yes, healed,' or 'No, not healed,' can we be more accurate? By using engineering tools, the answer was, yes. "Our approach was, 'Can we measure healing in a structural way, and put a number on how healed a bone is?'" says Dailey. X-rays, however, are two-dimensional, often fuzzy, and can reveal an incomplete picture. Pinpointing that crucial difference between who needs additional surgery and who does not is difficult because surgeons typically rely on X-rays to determine the extent of bone healing. If it's the latter, it may be better for the patient to wait and avoid the risk and expense of another operation. If it's the former, a second surgery is imperative. But differentiating between a true nonunion - where no new bone is forming at all - and a bone that is healing - just very slowly - is difficult. Ideally, she says, surgeons would re-operate early on a patient with a nonunion. "And when a bone isn't healing properly, patients can be in pain for weeks or months." "Musculoskeletal injuries are very, very painful," says Dailey. This failure to heal is called a nonunion, and it can be utterly debilitating. Patients typically come in for X-rays at regular intervals, and as long as the images reveal there's increasingly more callus in the region, all is well.īut some people don't heal normally.
Callus starts out as a spongy material that over time hardens into bone that is just as strong - or stronger - than it was before the break. As the weeks go by, more and more new bone called callus forms along the fracture line. Most people who break their tibia, or shin bone, proceed along a normal healing timeline. "When we put it all together, we were able to answer the question, 'Can the virtual mechanical test predict how long it will take the patient to heal?' We found that it could."ĭailey, who is also affiliated with Lehigh's Institute for Functional Materials and Devices (I-FMD), is the lead author of "Virtual Mechanical Testing Based On Low-Dose Computed Tomography Scans for Tibial Fracture." The paper appeared in the July 3 issue of the Journal of Bone and Joint Surgery.
Rossin School of Engineering and Applied Science. "What was exciting about our project was that all the mechanical analysis was done blinded to the clinical treatment of the patients, and the surgeon never saw any of our data," says Hannah Dailey, an assistant professor of mechanical engineering and mechanics at Lehigh University's P.C.
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