Current studies

Proximal humerus fractures (PHFs) are a common upper extremity injury. Controversies and challenges in PHF management result in suboptimal patient outcomes and significant health care costs. Surgical management of PHFs remain challenging due to variations in patient comorbidities, bone quality, age, activity, among other factors that influence surgical decision making. Common treatments for PHFs suffer from varied clinical outcomes and high re-operation rates. Success and choice of intervention in complex fracture cases are partially attributed to the ability to accurately visualize fracture morphology. A lack of quantitative data and understanding of parameters associated with common fracture patterns contribute to the large variation in outcomes in complex surgical cases. This project aims to overcome these limitations by developing advanced imaging techniques to optimize fracture evaluation in a cadaveric PHF model.

RA project lead: Nicole Lerch (2024 - 2025)

MSc project lead: Daniel Beshay (2022 - 2024)

Project funding: Natural Sciences and Engineering Research Council Canada (NSERC) Discovery Grant

Shoulder osteoarthritis (OA) is becoming more prevalent due to an aging population. Understanding of shoulder OA pathophysiology is poor, limiting our ability to develop strategies to halt disease progression. Anterior shoulder instability – resulting from a traumatic dislocation – may be one contributing factor to shoulder OA initiation and progression. Current disease severity classifications and OA phenotyping are based on progressive knee OA and MRI techniques, limiting applicability across imaging modalities and joints. In all joints, early detection remains a problem, primarily due to slow progression and large variability in symptoms during early OA stages. Dual-energy CT (DECT) is a technology now common on many clinical CT scanners and allows for improved visualization of hard and soft tissues by decomposing images to highlight materials of varying density. This project aims to use DECT to measure early OA-related joint changes in a post acute shoulder injury cohort.

MSc project lead: Sarah Quayyum

Project funding: Arthritis Society Canada Ignite Innovation Grant

Project collaborators/partners: George Athwal, CAPA

Demand for shoulder replacements is increasing exponentially due to an aging population. With younger patients driving much of the demand, bone preserving joint replacement implants are gaining popularity. New designs rely on existing bone for fixation and support, but little data exists to guide surgeons in determining which patients would benefit from these designs, and which are at increased risk of early failure. Bone strength is a measure that relates bone density and other characteristics to bones mechanical properties and may distinguish individuals who are ideal candidates for new implant designs or at risk of early failure. This project aims to validate computational models of the proximal humerus that link bone density to mechanical properties, with the overarching objective of integrating bone mechanics with risk-stratification tools for the improved surgical management of the proximal humerus.

MSc project lead: Chloe Stiles

RA project support: Zara Garofalo

Project funding: Centre for Bioengineering and Biotechnology (CBB) Seed Grant

Project collaborators: Andrew Laing, Jack Callaghan, Alan Cudlip

Current point-of-care imaging following fracture use single exposure x-ray to detect fracture occurrence. This standard of care provides fracture visualization but provides limited quantitative data to assess fracture severity or healing. Dual-energy x-ray absorptiometry (DXA) can add quantitative information, such as areal bone mineral density (aBMD), that may provide important information to guide personalized treatment and improve patient outcomes. DXA-based imaging is currently limited to standardized hip, spine, or forearm aBMD assessment in at-risk populations, and not currently used as a point-of-care imaging modality. This study will validate upper-extremity aBMD measures using cadaveric tissues and within a prospective cohort that have sustained an upper-extremity fracture.

MSc project lead: Jonathan Ying

Project funding: Waterloo Institute for Nanotechnology (WIN)-CBB Seed Grant

Project collaborators/partners: Karim Karim (ECE) and Grand River Hospital

Fractures of the acromion occur following reverse shoulder arthroplasty, primarily due to changes in the biomechanics of the glenohumeral joint that change the moment arm of the deltoid increasing the stress on the acromion. Despite the commonality of these fractures, current finite element models (FEMs) of acromion fractures lack validation against experimental models. This project aims to validate acromion fractures using cadaver models.

RA project team: Annelise Pageau, Yusra Pervez, Zora Yang

Project funding: NSERC Discovery Grant

Project collaborators: Andrew Laing, Jack Callaghan, Alan Cudlip