Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Engineering Science

Program

Biomedical Engineering

Collaborative Specialization

Musculoskeletal Health Research

Supervisor

Lalone, Emily

2nd Supervisor

Suh, Nina

Abstract

Wrist injuries are common and can lead to the development of post-traumatic osteoarthritis. For example, one major complication after a wrist fracture, is when the fractured bone heals in a mal-aligned position, called malunion. It has been assumed that a malunion after wrist fractures alters joint congruency and mechanics leading to the development of post-traumatic osteoarthritis and poor functional outcomes. It is unclear whether anatomical restoration is a key component for the management of wrist injuries and to limit the progression of post-traumatic osteoarthritis. However, the mechanistic pathways between joint structure (and mal-alignment) and patient outcomes, such as the development of osteoarthritis and joint function, are not clearly understood due to the limitations in current techniques. The present work advances our understanding of the relationship between joint structure (and mal-alignment) and joint contact mechanics using image-based 3D measurement tools. The purpose of the present work was to employ CT imaging and inter-bone distance mapping to determine the 3D implications of a wrist fracture on 3D joint space area (a measure of joint congruency). This image-based tool was then extended to 4DCT (3DCT and time) to examine the dynamic effects of wrist movement on joint contact mechanics, in the presence of a wrist injury. This research is an important step in the quest to determine a causal relationship between joint structure and patient function.

Summary for Lay Audience

The wrist joint consists of eight articulating carpal bones that allow for complex motions while maintaining stability. The bones and ligaments of the wrist are critical to normal function and any damage to them requires prompt evaluation and proper treatment. When wrist fractures are undetected or improperly treated, the damaged bones can heal in the wrong positions leading to significant pain, stiffness, and progress to osteoarthritis; this is called a malunion. The pathomechanics of malunions are not well understood in the literature and the clinical consequences are controversial. This makes it difficult for surgeons to decide on the best treatment plan

Furthermore, current imaging modalities are unable to reliably detect wrist injuries because of their static nature and some patients will go on to have lifelong wrist pain and stiffness. It is thought that wrist injuries can be better visualised by having patients replicate movements causing the discomfort. Recent advances in 4D (three dimensions and time) Computed Tomography can capture the mechanical abnormalities causing the patients’ symptoms. The results from this work will help investigators gain a greater understanding of the biomechanical impact of wrist fractures.

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