Journal article
Expedited CT-Based Methods for Evaluating Fracture Severity to Assess Risk of Post-Traumatic Osteoarthritis After Articular Fractures
The Iowa orthopaedic journal, Vol.36, pp.46-52
2016
PMCID: PMC4910808
PMID: 27528835
Appears in Diamond Open Access
Abstract
Post-traumatic osteoarthritis (PTOA) is common after intra-articular fractures of the tibial plafond. An objective CT-based measure of fracture severity was previously found to reliably predict whether PTOA developed following surgical treatment of such fractures. However, the extended time required obtaining the fracture energy metric and its reliance upon an intact contralateral limb CT limited its clinical applicability. The objective of this study was to establish an expedited fracture severity metric that provided comparable PTOA predictive ability without the prior limitations.
An expedited fracture severity metric was computed from the CT scans of 30 tibial plafond fractures using textural analysis to quantify disorder in CT images. The expedited method utilized an intact surrogate model to enable severity assessment without requiring a contralateral limb CT. Agreement between the expedited fracture severity metric and the Kellgren-Lawrence (KL) radiographic OA score at two-year follow-up was assessed using concordance. The ability of the metric to differentiate between patients that did or did not develop PTOA was assessed using the Wilcoxon Ranked Sum test.
The expedited severity metric agreed well (75.2% concordance) with the KL scores. The initial fracture severity of cases that developed PTOA differed significantly (p = 0.004) from those that did not. Receiver operating characteristic analysis showed that the expedited severity metric could accurately predict PTOA outcome in 80% of the cases. The time required to obtain the expedited severity metric averaged 14.9 minutes/ case, and the metric was obtained without using an intact contralateral CT.
The expedited CT-based methods for fracture severity assessment present a solution to issues limiting the utility of prior methods. In a relatively short amount of time, the expedited methodology provided a severity score capable of predicting PTOA risk, without needing to have the intact contralateral limb included in the CT scan. The described methods provide surgeons an objective, quantitative representation of the severity of a fracture. Obtained prior to the surgery, it provides a reasonable alternative to current subjective classification systems. The expedited severity metric offers surgeons an objective means for factoring severity of joint insult into treatment decision-making.
Details
- Title: Subtitle
- Expedited CT-Based Methods for Evaluating Fracture Severity to Assess Risk of Post-Traumatic Osteoarthritis After Articular Fractures
- Creators
- Donald D Anderson - Department of Orthopedics and RehabilitationThe University of Iowa; 2Department of Biomedical EngineeringThe University of IowaAnthony T Kilburg - Department of Orthopedics and RehabilitationThe University of Iowa; 2Department of Biomedical EngineeringThe University of IowaThaddeus P Thomas - Department of Orthopedics and RehabilitationThe University of Iowa; 2Department of Biomedical EngineeringThe University of IowaJ Lawrence Marsh - Department of Orthopedics and Rehabilitation The University of Iowa
- Resource Type
- Journal article
- Publication Details
- The Iowa orthopaedic journal, Vol.36, pp.46-52
- Publisher
- Dept. of Orthopaedics, The University of Iowa; United States
- PMID
- 27528835
- PMCID
- PMC4910808
- ISSN
- 1541-5457
- eISSN
- 1555-1377
- Grant note
- P50 AR055533 / NIAMS NIH HHS P50 AR048939 / NIAMS NIH HHS
- Language
- English
- Date published
- 2016
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation; Industrial and Systems Engineering
- Record Identifier
- 9984040584402771
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