Document Type

Thesis

Date of Degree

Fall 2015

Degree Name

MS (Master of Science)

Degree In

Biomedical Engineering

First Advisor

Donald D. Anderson

Abstract

Adequately assessing injury severity is critical in treating articular fractures. Severity assessment is used to inform clinical and surgical decision making through anticipation of patient outcomes. The assessments generally involve interpreting radiographs or CT image data. In recognition of the poor reliability of existing clinical severity assessments, objective severity metrics have been developed that are firmly rooted in mechanics and provide capable alternatives for use in research, where reliable data is paramount. Their broader clinical utility remains to be established.

An existing CT-based method for determining the energy expended in a bone fracture was extended to facilitate its use in more fracture types. Its utility in different articular joints was evaluated. Specifically, the severities of articular fractures of the proximal tibia (plateau), of the distal tibia (plafond), and of the calcaneus were compared with present clinical severity metrics, patient outcomes, and/or surgeon rankings of severity. Differences in the fracture energies in the different joints were also compared.

The objective fracture energy metric compared favorably with present clinical severity metrics. The fracture energies for fractures of the tibial plateau had between 71% and 78% concordance with surgeon rankings of severity. The calcaneal fracture energies had a 75% concordance with the present clinical standard. Fracture energy was also predictive of later radiographic indicators of post-traumatic osteoarthritis.

The fracture energy metric is a capable tool for analyzing fracture severity in various joints. Fracture energy correlated well with outcomes and present clinical gold standards for severity assessment. The methods for assessing fracture energy described are highly useful for orthopaedic research and have potential as an important clinical tool.

Public Abstract

Adequately assessing injury severity is critical in treating articular fractures. Severity assessment is used to guide clinical and surgical decision making through anticipation of clinical outcomes. The assessments generally involve interpreting medical image data. The poor reliability of existing clinical severity assessments led to the development of objective severity metrics that have proven capable alternatives for use in research, where reliable data is paramount.

A new means for measuring the energy expended in fractures was developed for objectively assessing injury severity. Its capability in different anatomical regions was evaluated. Specifically, it was compared with present clinical metrics, patient outcomes, and/or surgeon rankings of injury severity in the knee, ankle, and in the calcaneus. The different distributions of fracture energies in these different regions were also compared.

The objective fracture energy metric compared favorably with present clinical metrics. The fracture energy metric in the tibial plateau had between 71% and 78% concordance with surgeon rankings of severity. The calcaneal fractures analyzed had a 75% concordance with the present clinical standard. The fracture energy was also predictive of later development of post-traumatic osteoarthritis.

The fracture energy metric is a capable tool for analyzing injury severity in various joints. This utility had previously been shown in fractures of the tibial plafond, but improvements have allowed for extension to other joints and bones. The resulting severity metric shows good correlation with outcomes and present clinical gold standards for severity assessment. The methods for assessing fracture energy developed are highly useful for orthopaedic research and have potential to be an important clinical tool.

Keywords

publicabstract, Assessment, Fracture, Injury, Orthopaedics, Severity, Trauma

Pages

viii, 74

Bibliography

72-74

Copyright

Copyright 2015 Kevin Dibbern

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