Bone reconstruction: Subjective evaluation and objective analysis based on conventional digital X-rays – a retrospective evaluation - 30/11/21
, Thomas M. Tiefenboeck, Gerald E. Wozasek
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Highlights |
• | Pixel Value Ratio (PVR) is a practical and straightforward tool for radiological evaluation of callus tissue development. It can help decide when to remove an external fixator, weight-bear an internal nail, or remove it. |
• | PVR shows increasing values during the bone regeneration phases. |
• | The X-ray Evaluation System for Distraction Osteogenesis (XESDO) is an appropriate tool for subjective callus tissue follow-up. |
• | The PVR and the XESDO can influence decisions during all phases of distraction osteogenesis. |
• | Bone healing was different in various regions, with slower development in the anterior area. |
Abstract |
Background |
Various approaches have been used to evaluate callus stiffness in distraction osteogenesis. This assessment becomes even more critical as inadequate corticalization and premature removal of the frame lead to bending, refracture, and loss of length. This study aimed to verify the objective Pixel Value Ratio (PVR) and define an evaluation scheme to assess callus tissue development during internal and external bone lengthening.
Hypothesis |
There are no differences between subjective parameters and objective evaluation for external and internal bone lengthening.
Patients and methods |
We included 24 patients in this retrospective study, treated by distraction osteogenesis of the lower limb. Ten patients were treated with external ring fixators and 14 with intramedullary lengthening devices. The minimum distraction distance was 3cm. Callus tissue was evaluated with the PVR, using digital X-rays during and after treatment. We combined this method with subjective evaluation parameters, including the continuity, signal intensity, and the regeneration tissue's homogeneity, presented in the X-ray Evaluation System for Distraction Osteogenesis (XESDO).
Results |
The subjective evaluation showed an increase of continuity and signal-intensity between 4th postoperative weeks and complete healing with significant differences between the external and internal groups for homogeneity only after four weeks and for all parameters at 3C (p<0.05). The PVR showed an increase during consolidation with values between 0.7 and 1.0 for both groups with almost perfect interobserver agreement. Significant lower values were found in the anterior tibial cases.
Conclusion |
PVR appears to be a practical tool for radiological evaluation of callus tissue development. In combination with the newly introduced XESDO and the surgeon's experience, these methods can be helpful for decisions during all phases of distraction osteogenesis. It is important for adapting alignment or distraction-rate, as various potential complications can be detected early. However, further studies are necessary to assess the image-based determination of callus tissue stability.
Level of evidence |
III; cohort study.
El texto completo de este artículo está disponible en PDF.Keywords : Pixel value ratio, Deformity correction, Distraction osteogenesis, External ring fixation, Intramedullary lengthening
Esquema
Vol 107 - N° 8
Artículo 103081- décembre 2021 Regresar al número
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