Distal radius fractures: Should we use supplemental bone grafts or substitutites in cases of severe osteoporotic or conminution?

Rev Esp Cir Ortop Traumatol. Mar-Apr 2015;59(2):97-103. doi: 10.1016/j.recot.2014.07.009. Epub 2014 Aug 28.
[Article in English, Spanish]

Abstract

Objectives: The purpose of this study was to assess the need of bone graft or bone substitutes in unstable distal radius fractures (DRF) treated with locking compression plates (LCP) PATIENTS AND METHODS: An observational and prospective study was conducted on 60 patients with DRF AO-type A3 and AO-type C3, treated surgically by LCP plates without bone grafts or substitutes. Ranges of motion in flexion (F), extension (E), pronation (P), and supination (S) were measured in the injured wrist and compared with the healthy contralateral wrist. X-ray parameters: palmar tilt (PT), radial inclination (RI), ulnar variance (UV), and radial height (RH) were calculated in the injured wrist one year after surgery and then compared, with those parameters in the healthy contralateral wrist and in the follow-up postoperative x-ray of the injured wrist. PRWE and DASH scores were used to evaluate patient satisfaction.

Results: The range of motion loss was F 12° ± 16.1°, E 9° ± 13.1°, P 2.5° ± 7.5°, and S 5°±10°, but they remained within functional parameters. Good results were also obtained in the PRWE and DASH scores (DASH 12.6 ± 14.16 and PRWE 9.5 ± 9.5). All the fractures were healed without significant collapse (IP 0.55 ± 1.7°, IR 0.31 ± 1.5°, VC 0.25±0.8mm, and AR 0.1 ± 0.9 mm).

Conclusions: All fractures healed without problems or with significant loss of reduction. Bone graft and bone substitutes are not mandatory for treatment of unstable DRF with LCP plates. Their use increases the cost and is not exempt of morbidities. This study also reinforces the role of LCP plates in surgical treatment of unstable DRF.

Keywords: Abordaje volar; Aloinjerto óseo; Bone allograft; Bone autograft; Bone substitutes; Distal radius fractures; Fracturas de radio distal; Injerto autólogo de hueso; Placa volares bloqueadas; Sustitutivo óseo; Volar approach; Volar locking plates.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Plates
  • Bone Substitutes / therapeutic use*
  • Bone Transplantation*
  • Female
  • Follow-Up Studies
  • Fracture Fixation, Internal / instrumentation
  • Fracture Fixation, Internal / methods*
  • Fractures, Comminuted / diagnostic imaging
  • Fractures, Comminuted / surgery*
  • Humans
  • Male
  • Middle Aged
  • Osteoporotic Fractures / diagnostic imaging
  • Osteoporotic Fractures / surgery*
  • Patient Satisfaction
  • Prospective Studies
  • Radiography
  • Radius Fractures / diagnostic imaging
  • Radius Fractures / surgery*
  • Treatment Outcome

Substances

  • Bone Substitutes