Bone reconstruction: Subjective evaluation and objective analysis based on conventional digital X-rays - a...

Area of Science:

• Orthopedics
• Radiology
• Biomedical Engineering

Background:

• Evaluating callus stiffness is crucial in distraction osteogenesis to prevent complications like refracture.
• Objective assessment methods are needed to complement subjective evaluations for bone lengthening procedures.

Purpose of the Study:

• To verify the objective Pixel Value Ratio (PVR) for assessing callus tissue development.
• To define an evaluation scheme for internal and external bone lengthening using PVR and subjective parameters.

Main Methods:

• Retrospective study of 24 patients undergoing lower limb distraction osteogenesis (10 external, 14 internal).
• Callus tissue evaluated using PVR on digital X-rays and the X-ray Evaluation System for Distraction Osteogenesis (XESDO).
• Subjective parameters included continuity, signal intensity, and homogeneity of regeneration tissue.

Main Results:

• PVR increased during consolidation, with values between 0.7 and 1.0 for both groups, showing high interobserver agreement.
• Subjective evaluation showed increased continuity and signal intensity over time.
• Significant differences in homogeneity were noted between external and internal groups after four weeks.

Conclusions:

• PVR is a practical tool for radiological evaluation of callus development in distraction osteogenesis.
• PVR and XESDO can assist surgeons in decision-making during bone lengthening, aiding early detection of complications.
• Further research is needed to assess image-based determination of callus tissue stability.