Dominick Casciato, Daniel T DeGenova, Zachary Hill, Jia Bao Lin, Tucker Peabody, Nolan Schmitz, Benjamin Taylor
{"title":"Association Between Pronation External Rotation IV Fracture Pattern and Regional Bone Density.","authors":"Dominick Casciato, Daniel T DeGenova, Zachary Hill, Jia Bao Lin, Tucker Peabody, Nolan Schmitz, Benjamin Taylor","doi":"10.1177/19386400231173163","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Throughout the musculoskeletal system, fracture patterns and subsequent healing rely partly on bone density. In the foot and ankle, bone density has been shown to play a role in supination and external rotation fracture patterns. Adding to previous research, this investigation examines the association between bone density and trimalleolar versus trimalleolar equivalent fracture patterns following pronation and external rotation injuries using computed tomography (CT)-derived Hounsfield units (HU).</p><p><strong>Methods: </strong>A retrospective chart review was conducted among patients without a history of fracture or osteoporosis who sustained a PER IV fracture. Demographic data were collected. Fractures were separated between PER IV equivalent and fracture groups. CT-derived HU was assessed at the distal tibia and fibula. Density was compared between PER IV equivalent and fracture groups and among posterior malleolar fracture patterns.</p><p><strong>Results: </strong>Seventy-five patients met the selection criteria, with 17 comprising the equivalent group and 58 in the fracture group. There were 38 type 1, 9 type 2, and 11 type 3 posterior malleolus fractures. The ankle bone density of the PER fracture equivalent group (331.98 ± 65.71HU) was greater than the PER fracture group (281.61 ± 76.99HU; <i>P</i> = .008). A statistically significant difference in tibial bone densities among equivalent and all PER fracture types (<i>P</i> = .01) with the equivalent group (331.98 ± 65.71HU) maintaining a greater tibial bone density than the type 2 posterior malleolus fracture group (252.35 ± 57.33HU; <i>P</i> = .009).</p><p><strong>Conclusion: </strong>Higher bone density was associated with PER IV equivalent fractures; however, there was no density difference among posterior malleolus fracture types. When presented with PER IV fractures, consider fixation that addresses a lower bone density.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"598-603"},"PeriodicalIF":0.0000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Foot & ankle specialist","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/19386400231173163","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/5/17 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Throughout the musculoskeletal system, fracture patterns and subsequent healing rely partly on bone density. In the foot and ankle, bone density has been shown to play a role in supination and external rotation fracture patterns. Adding to previous research, this investigation examines the association between bone density and trimalleolar versus trimalleolar equivalent fracture patterns following pronation and external rotation injuries using computed tomography (CT)-derived Hounsfield units (HU).
Methods: A retrospective chart review was conducted among patients without a history of fracture or osteoporosis who sustained a PER IV fracture. Demographic data were collected. Fractures were separated between PER IV equivalent and fracture groups. CT-derived HU was assessed at the distal tibia and fibula. Density was compared between PER IV equivalent and fracture groups and among posterior malleolar fracture patterns.
Results: Seventy-five patients met the selection criteria, with 17 comprising the equivalent group and 58 in the fracture group. There were 38 type 1, 9 type 2, and 11 type 3 posterior malleolus fractures. The ankle bone density of the PER fracture equivalent group (331.98 ± 65.71HU) was greater than the PER fracture group (281.61 ± 76.99HU; P = .008). A statistically significant difference in tibial bone densities among equivalent and all PER fracture types (P = .01) with the equivalent group (331.98 ± 65.71HU) maintaining a greater tibial bone density than the type 2 posterior malleolus fracture group (252.35 ± 57.33HU; P = .009).
Conclusion: Higher bone density was associated with PER IV equivalent fractures; however, there was no density difference among posterior malleolus fracture types. When presented with PER IV fractures, consider fixation that addresses a lower bone density.
导言:在整个肌肉骨骼系统中,骨折模式和随后的愈合部分取决于骨密度。在足部和踝部,骨密度已被证明在上翻和外旋骨折模式中发挥作用。在以往研究的基础上,本研究使用计算机断层扫描(CT)得出的胡恩斯菲尔德单位(HU),对骨密度与代偿和外旋损伤后的三极与三极等效骨折模式之间的关系进行了研究:方法:对无骨折史或骨质疏松症史的 PER IV 骨折患者进行了回顾性病历审查。收集了人口统计学数据。将骨折分为 PER IV 等效组和骨折组。评估胫骨远端和腓骨的 CT 导出 HU。比较了PER IV等效组和骨折组之间以及后臼壁骨折形态之间的密度:75名患者符合选择标准,其中17名患者为等效组,58名患者为骨折组。后踝臼骨骨折类型为 1 型 38 例、2 型 9 例、3 型 11 例。PER骨折等效组的踝关节骨密度(331.98 ± 65.71HU)高于PER骨折组(281.61 ± 76.99HU;P = .008)。同等骨折和所有 PER 骨折类型的胫骨骨密度差异有统计学意义(P = .01),同等骨折组(331.98 ± 65.71HU)的胫骨骨密度高于 2 型后踝骨骨折组(252.35 ± 57.33HU;P = .009):结论:较高的骨密度与 PER IV 型等效骨折有关;但后踝骨骨折类型之间不存在密度差异。当出现 PER IV 骨折时,应考虑针对骨密度较低的骨折进行固定:证据等级:III。