What combination of imaging modalities is used to evaluate preoperative bone stock and canal morphology?

• A. X-ray and CT; DEXA for osteoporosis
• B. CT only
• C. MRI only
• D. PET scan

Answer: (A)

Evaluating preoperative bone stock and canal morphology relies on two complementary imaging approaches. Plain X-ray provides a broad view of bone architecture, alignment, and gross bone stock in a quick, cost-effective way. It helps identify deformities, prior hardware, and general quality of the bone that will influence implant choice. However, to plan precisely for implant size and to understand the exact geometry of the canal, a 3D assessment is needed, and that’s where CT shines. CT offers detailed measurements of canal width, cortico-cancellous boundaries, and the metaphyseal and diaphyseal relationships, giving accurate information about how the canal will accommodate an implant and how it might behave under load.

DEXA scanning isn’t used to map canal geometry; it assesses bone mineral density and osteoporosis risk, which is important for overall surgical planning and fixation strategy but does not describe the canal morphology. MRI and PET scans don’t provide the targeted, quantitative information about cortical bone geometry and canal dimensions that CT paired with X-ray does.

So, combining X-ray for an initial, broad overview with CT for precise canal and bone stock assessment gives the most complete preoperative picture, with DEXA added when osteoporosis risk needs to be quantified.