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Mechanical stability in a human radius fracture treated with a novel tissue‐engineered bone substitute: a non‐invasive, longitudinal assessment using high‐resolution pQCT in combination with finite element analysis
Author(s) -
Mueller Thomas L.,
Wirth Andreas J.,
van Lenthe G. Harry,
Goldhahn Joerg,
Schense Jason,
Jamieson Virginia,
Messmer Peter,
Uebelhart Daniel,
Weishaupt Dominik,
Egermann Marcus,
Müller Ralph
Publication year - 2011
Publication title -
journal of tissue engineering and regenerative medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.835
H-Index - 72
eISSN - 1932-7005
pISSN - 1932-6254
DOI - 10.1002/term.325
Subject(s) - quantitative computed tomography , finite element method , biomedical engineering , cancellous bone , materials science , stiffness , bone healing , medicine , osteoporosis , bone density , surgery , structural engineering , pathology , composite material , engineering
The clinical gold standard in orthopaedics for treating fractures with large bone defects is still the use of autologous, cancellous bone autografts. While this material provides a strong healing response, the use of autografts is often associated with additional morbidity. Therefore, there is a demand for off‐the‐shelf biomaterials that perform similar to autografts. Biomechanical assessment of such a biomaterial in vivo has so far been limited. Recently, the development of high‐resolution peripheral quantitative computed tomography (HR‐pQCT) has made it possible to measure bone structure in humans in great detail. Finite element analysis (FEA) has been used to accurately estimate bone mechanical function from three‐dimensional CT images. The aim of this study was therefore to determine the feasibility of these two methods in combination, to quantify bone healing in a clinical case with a fracture at the distal radius which was treated with a new bone graft substitute. Validation was sought through a conceptional ovine model. The bones were scanned using HR‐pQCT and subsequently biomechanically tested. FEA‐derived stiffness was validated relative to the experimental data. The developed processing methods were then adapted and applied to in vivo follow‐up data of the patient. Our analyses indicated an 18% increase of bone stiffness within 2 months. To our knowledge, this was the first time that microstructural finite element analyses have been performed on bone‐implant constructs in a clinical setting. From this clinical case study, we conclude that HR‐pQCT‐based micro‐finite element analyses show high potential to quantify bone healing in patients. Copyright © 2010 John Wiley & Sons, Ltd.