Relevance of in-depth skeletal assessment by high-resolution peripheral quantitative computed tomography (HR-pQCT) in orthopedics and trauma surgery

Abstract Background High-resolution imaging receives increasing attention and leads to an improved understanding of skeletal diseases. Before the introduction of high-resolution peripheral quantitative computed tomography (HR-pQCT), the evaluation of bone microstructure was not feasible in vivo but required bone biopsies. Methods With HR-pQCT, it is possible to evaluate the bone microarchitecture three-dimensionally and with a high spatial resolution (60.7 μm voxel size). Results In multiple studies, relevant insights of bone microarchitecture have been revealed by HR-pQCT at the distal tibia and radius in both health and disease, accompanied by superior correlations with the incidence of fragility fractures compared to bone mineral density measurement by dual-energy X-ray absorptiometry. Conclusions Consequently, HR-pQCT offers great potential to improve the understanding of bone and joint diseases, especially in foot and ankle surgery, as it enables the evaluation of individualized bone regions at the microstructural level (e.g., bone erosion, fracture healing) within the clinical routine.