Can patient-specific finite element models better predict fractures in metastatic bone disease than experienced clinicians?: Towards computational modelling in daily clinical practice

Bone & Joint Research

article

F. Eggermont¹  L. C. Derikx¹  N. Verdonschot²  I. C. M. van der Geest¹  M. A. A. de Jong⁴  A. Snyers¹  Y. M. van der Linden⁵  E. Tanck¹ 

[1] Radboud Institute for Health Sciences, Radboud university medical center;Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud university medical center;Laboratory of Biomechanical Engineering;Radiotherapeutic Institute Friesland;Department of Radiotherapy, Leiden University Medical Center

关键词: Finite element modelling;    Fracture prediction;    Femur;    Metastatic bone disease;   

DOI  :  10.1302/2046-3758.76.BJR-2017-0325.R2

学科分类：骨科学

来源: British Editorial Society Of Bone And Joint Surgery

【 摘 要 】

ObjectivesIn this prospective cohort study, we investigated whether patient-specific finite element (FE) models can identify patients at risk of a pathological femoral fracture resulting from metastatic bone disease, and compared these FE predictions with clinical assessments by experienced clinicians.MethodsA total of 39 patients with non-fractured femoral metastatic lesions who were irradiated for pain were included from three radiotherapy institutes. During follow-up, nine pathological fractures occurred in seven patients. Quantitative CT-based FE models were generated for all patients. Femoral failure load was calculated and compared between the fractured and non-fractured femurs. Due to inter-scanner differences, patients were analyzed separately for the three institutes. In addition, the FE-based predictions were compared with fracture risk assessments by experienced clinicians.ResultsIn institute 1, median failure load was significantly lower for patients who sustained a fracture than for patients with no fractures. In institutes 2 and 3, the number of patients with a fracture was too low to make a clear distinction. Fracture locations were well predicted by the FE model when compared with post-fracture radiographs. The FE model was more accurate in identifying patients with a high fracture risk compared with experienced clinicians, with a sensitivity of 89% versus 0% to 33% for clinical assessments. Specificity was 79% for the FE models versus 84% to 95% for clinical assessments.ConclusionFE models can be a valuable tool to improve clinical fracture risk predictions in metastatic bone disease. Future work in a larger patient population should confirm the higher predictive power of FE models compared with current clinical guidelines.

【 授权许可】

CC BY-NC