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Technical Brief

A New Method to Intra-Operatively Measure Local Bone Strength in Osteoporotic Bone Using a Modified Surgical Tool

[+] Author and Article Information
Kate Liddle

Orthopaedic Trauma Institute,
San Francisco General Hospital,
University of California–San Francisco,
2550 23rd Street, Building 9, 2nd Floor,
San Francisco, CA 94110
e-mail: k8liddle@gmail.com

Jenni M. Buckley

Orthopaedic Trauma Institute,
San Francisco General Hospital,
University of California–San Francisco,
2550 23rd Street, Building 9, 2nd Floor,
San Francisco, CA 94110
e-mail: jbuckley@udel.edu

Amir Matitiyahu

Orthopaedic Trauma Institute,
San Francisco General Hospital,
University of California–San Francisco,
2550 23rd Street, Building 9, 2nd Floor,
San Francisco, CA 94110
e-mail: matitiyahua@orthosurg.ucsf.edu

Meir Marmor

Orthopaedic Trauma Institute,
San Francisco General Hospital,
University of California–San Francisco,
2550 23rd Street, Building 9, 2nd Floor,
San Francisco, CA 94110
e-mail: marmorm@orthosurg.ucsf.edu

1Corresponding author.

Manuscript received May 15, 2014; final manuscript received September 1, 2014; published online October 14, 2014. Assoc. Editor: Rita M. Patterson.

J. Med. Devices 8(4), 044508 (Oct 14, 2014) (4 pages) Paper No: MED-14-1178; doi: 10.1115/1.4028475 History: Received May 15, 2014; Revised September 01, 2014

The aim of this study was to test a novel method for intra-operative assessment of osteoporotic bone fracture strength using a surgical tool instrumented with a strain gauge and compare the device with cortical width (CW) measurements in the distal radius. The force needed to puncture the cortex (FNP) was quantified with the device and found to strongly correlate with bone mineral density (BMD) in the diaphysis (adj. R2= 0.66, p < 0.001). Screw pullout studies were performed and correlation between FNP and screw pullout strength (SPS) was modest (adj. R2= 0.34 with p < 0.05). CW correlated well with BMD (adj. R2= 0.7, p < 0.0001) and SPS (adj. R2= 0.5, p = 0.002) in the diaphysis. This technology may allow objective intra-operative assessment of bone strength to provide surgeons another tool for decision making on fixation strategies appropriate to the area of bone treated.

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Figures

Grahic Jump Location
Fig. 1

Strain gauge instrumented PRC with load cell for calibration. The arrow points to strain gauge.

Grahic Jump Location
Fig. 2

(Left) DEXA zones for measuring BMD: 1/3 (proximal third) = diaphyseal region. MID (middle distal) = metadiaphyseal region. UD (ultradistal diaphyseal) = metaphyseal region. (Right) Sites on tested with the PRC.

Grahic Jump Location
Fig. 3

Distal radius specimen attached to a custom jig connected to a ball joint (left) oriented so that the head of the tested screw was parallel to the bottom plate. Bicortical screws were inserted and pulled out at a rate of 3 mm/min (right).

Grahic Jump Location
Fig. 4

Load curve for penetration force of cadaveric bone with the instrumented PRC

Grahic Jump Location
Fig. 5

A high correlation was observed between CW and DEXA-BMD in the distal diaphyseal (MID) region and is compared to correlations between FNP and DEXA-BMD

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