ArticleTrauma case reports2025
Quantitative assessment of fracture healing using patient-specific CT finite element analysis: A novel approach to external fixation management.
Article in Trauma case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Posttreatment decisions regarding fracture care primarily rely on physicians' subjective judgment based on clinical and imaging findings. This study aimed to evaluate whether patient-specific computed tomography (CT) finite element analysis could allow for the quantitative assessment of fracture site strength as an objective indicator of treatment decisions. Methods: Our patient was a 37-year-old male who underwent external fixation for an open comminuted tibial fracture of the right lower leg. Monthly CT scans were taken starting 2 months postinjury. Patient-specific CT finite element analysis was used to evaluate weight-bearing capacity both with external fixation and after its removal. Treatment decisions were based on the analysis of the minimum principal strain and callus failure risk in the callus region. Results: For the first 3 months postfixation, destructive strain occurred in the callus even with the external fixator, indicating a risk for nonunion with full weight bearing. At 4 months postsurgery, the mechanical stability of the callus improved, indicating potential bone union under daily activity loads. At 5 months, CT images showed partial callus bridging in the posterior tibia, with finite element analysis demonstrating its capacity for withstanding loads of up to 1724 N after external fixator removal. These results suggest the need for careful management of weight-bearing load early after external fixation. Conclusion: This study demonstrated the possibility of implementing postoperative weight-bearing management among patients with external fixation based on quantitative assessment using patient-specific CT finite element analysis rather than relying solely on clinical experience. Further accumulation of clinical data is expected to improve analytical accuracy and contribute to the establishment of fracture treatments based on more objective indicators. Clinical relevance: This study demonstrated the potential clinical application of patient-specific CT finite element analysis in fracture treatment.
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