CME OnDemand: 2022 AOFAS Annual Meeting-Weight-Bearing CT Hounsfield Unit Algorithm Assessment of Calcaneal Osteotomy Healing: A Prospective Study Comparing Metallic and Bio-Integrative Screws

Weight-Bearing CT Hounsfield Unit Algorithm Assessment of Calcaneal Osteotomy Healing: A Prospective Study Comparing Metallic and Bio-Integrative Screws

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This study compares the use of metallic and bio-integrative screws in the healing of calcaneal osteotomy using a weight-bearing CT Hounsfield unit (HU) algorithm. The use of bio-integrative implants in orthopedic surgery is increasing due to their benefits of adequate bone healing and lower rates of removal compared to metallic implants. Calcaneal osteotomies have high healing rates and minimal complications, making them suitable procedures for comparing implants or techniques.<br /><br />The objective of the study is to compare radiographic outcomes of healing in calcaneal osteotomies using either bio-integrative or metallic screws. The hypothesis is that both types of implants would yield similar radiographic results.<br /><br />The study is a prospective cohort study conducted at the University of Iowa Hospital and Clinics. Patients undergoing medial displacement calcaneal osteotomy were allocated to either the bio-integrative or metallic group. The surgeon, primary diagnosis, technique, and displacement were the same for both groups.<br /><br />Patients were assessed using weight-bearing CT scans preoperatively and at weeks 2, 6, and 12 postoperatively. HU data was collected and analyzed to compare the radiographic outcomes.<br /><br />The results showed that there were three patients in each group. At two weeks, the metallic group had lower HU intensity on the center and superior lines, but not on the inferior line. At six and twelve weeks, the bio-integrative group had higher HU intensity on the center and superior lines. Contrast was higher in the metallic group in the second and twelfth weeks.<br /><br />The discussion highlights that the HU algorithm found similar results in bone healing between metallic and bio-integrative screws. Maximum HU intensity values were similar, indicating equivalent results at the osteotomy sites. However, contrast was lower in the bio-integrative group, indicating lower variability of bone density. The presence of metallic implants across the osteotomy site made evaluation of HU intensity and contrast challenging.<br /><br />In conclusion, this study demonstrates the comparable radiographic outcomes of healing in calcaneal osteotomies using metallic and bio-integrative screws. The findings suggest that bio-integrative implants may provide advantages in terms of bone density variability.

Asset Subtitle

Nacime SB Mansur, MD, Tutku Tazegul, BBME, Kepler Carvalho, MD, Andrew Behrens, Caleb J. Lehl, BS, Samuel J. Ahrenholz, Matthieu Lalevée, MD, Cesar De Cesar Netto, MD, PhD

Keywords

study

metallic screws

bio-integrative screws

calcaneal osteotomy

weight-bearing CT

HU algorithm

orthopedic surgery

bone healing

radiographic outcomes

prospective cohort study