Predicting the Strength of Volar Screw Purchase in the Distal Radius: Comparison Between DEXA and a New ' Smart' Surgical Tool

摘要

The distal radius is a common site of fracture with volar plates and screws as the current clinical practice for fracture fixation [1]. Local measurements of bone quality at the sites of screw insertion aid in providing the most stable fixation with the least amount of hardware, minimizing the risk of construct failure and irritation to soft tissue [2, 3]. The clinical standard for pre-operative bone mineral density (BMD) assessment uses dual x-ray absorptiometry (DEXA). However, DEXA scans provide global BMD values and cannot accurately predict variations in BMD within a given anatomical site [4]. Furthermore, patients frequently present without a pre-operative DEXA scan, so intra-operative assessment would be ideal. We developed a simple sensor system that would be appropriate for assessing local BMD intra-operatively. The system consists of a "smart" Weber clamp instrumented with a single uniaxial strain gage that provides real-time feedback regarding the local BMD.rnThe purpose of this study is to evaluate the in situ performance of the "smart" Weber clamp in predicting local bone strength in the distal radius. Specific aims include 1) to validate the smart Weber clamp for inter and intra-user reliability, 2) to compare Weber clamp bone strength to clinical DEXA measurements in the distal radius, and 3) to compare screw pull-out strength with Weber clamp bone strength.