Effect of Calcium Phosphate Bone Cement Augmentation on Volar Plate Fixation of Unstable Distal Radial Fractures in the Elderly
ABSTRACT Calcium phosphate bone cement increases the stability of implant-bone constructs in patients with an osteoporotic fracture. The purpose of this randomized study was to determine whether augmentation of volar locking plate fixation with calcium phosphate bone cement has any benefit over volar locking plate fixation alone in patients older than sixty-five years of age who have an unstable distal radial fracture.
Forty-eight patients (fifty unstable distal radial fractures) were recruited for this study. The mean patient age was seventy-three years. Surgical procedures were randomized between volar locking plate fixation alone (Group 1) and volar locking plate fixation with injection of calcium phosphate bone cement (Group 2). The patients were assessed clinically at three and twelve months postoperatively. Clinical assessments included determinations of grip strength, wrist motion, wrist pain, modified Mayo wrist scores, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Radiographic evaluations were performed immediately postoperatively and at one year following surgery. The adequacy of the reduction was assessed by measuring radial inclination, volar angulation, and ulnar variance.
The two groups were comparable with regard to age, sex, fracture type, injury mechanism, and bone mineral density. No significant differences were observed between the groups with regard to the clinical outcomes at the three or twelve-month follow-up examination. No significant intergroup differences in radiographic outcomes were observed immediately after surgery or at the one-year follow-up visit. Furthermore, no complication-related differences were observed, and there were no nonunions.
Augmentation of metaphyseal defects with calcium phosphate bone cement after volar locking plate fixation offered no benefit over volar locking plate fixation alone in elderly patients with an unstable distal radial fracture.
Full-textDOI: · Available from: Jae Kwang Kim, Feb 20, 2014
- [Show abstract] [Hide abstract]
ABSTRACT: The lack of structural support remains a challenge in the treatment of comminuted distal radius fractures. Calcium phosphate and calcium sulfate bone cement has been used in other fracture locations in addition to fixation and has been shown to allow for retention of reduction in difficult cases. A case-control retrospective review of 34 consecutive distal radius fractures treated with surgery was performed with the patients classified by Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. Complications and postoperative radiographs were evaluated. Cement was used in the most difficult cases. Radial height was retained in both groups. Volar tilt was significantly better in the cement group. There were no significant differences between the case and control groups for any complication. No complications related to the use of the cement were found. The use of bone cement as an adjunct to fixation of distal radius fractures seems to include minimal risks and may afford a technical advantage in maintaining reduction during surgery for difficult fractures. Since there is an aspect of fracture difficulty that we cannot control for by using radiographic assessment alone, cement may provide an advantage over fixation without cement, despite similar outcomes. Bone cement can be part of the "tool box" for difficult distal radius fractures. Further study is necessary to define the technical advantages and limitations of each particular cement product.Hand 12/2013; 8(4):387-91. DOI:10.1007/s11552-013-9548-z
- [Show abstract] [Hide abstract]
ABSTRACT: Distal radius fractures represent the most common fractures in adults. Volar locking plating to correct unstable fractures has become increasingly popular. Although reasonable primary reduction is possible in most cases, maintenance of reduction until the fracture is healed is often problematic in osteoporotic bone. To our knowledge, no biomechanical studies have compared the effect of enhancement with biomaterial on two different volar fixed-angle plates. Human fresh-frozen cadaver pairs of radii were used to simulate an AO/OTA 23-A3 fracture. In a total of four groups (n = 7 for each group), two volar fixed-angle plates (Aptus 2.5 mm locking fracture plate, Medartis, Switzerland and VA-LCP two-column distal radius plate 2.4, volar, Synthes, Switzerland) with or without an additional injection of a biomaterial (Hydroset Injectable HA Bone Substitute, Stryker, Switzerland) into the dorsal comminution zone were used to fix the distal metaphyseal fragment. Each specimen was tested load-controlled under cyclic loading with a servo-hydraulic material testing machine. Displacement, stiffness, dissipated work and failure mode were recorded. Improved mechanical properties (decreased displacement, increased stiffness, decreased dissipated work) were found in both plates if the biomaterial was additionally injected. Improvement of mechanical parameters after biomaterial injection was more evident in the Synthes plate compared to the Aptus plate. Pushing out of the screws was noticed as a failure mode only in samples lacking supplementary biomaterial. Injection of a biomaterial into the dorsal comminution zone increases stability after volar locking plating of distal radius fractures in vitro.European Journal of Orthopaedic Surgery & Traumatology 08/2013; DOI:10.1007/s00590-013-1285-z · 0.18 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Background: Bisphosphonates can adversely affect fracture-healing because they inhibit osteoclastic bone resorption. It is unclear whether bisphosphonates can be initiated safely for patients who have sustained an acute distal radial fracture. The purpose of this randomized study was to determine whether the early use of bisphosphonate affects healing and outcomes of osteoporotic distal radial fractures treated with volar locking plate fixation. Methods: Fifty women older than fifty years of age who had undergone volar locking plate fixation of a distal radial fracture and had been diagnosed with osteoporosis were randomized to Group I (n = 24, initiation of bisphosphonate treatment at two weeks after the operation) or Group II (n = 26, initiation of bisphosphonate treatment at three months). Patients were assessed for radiographic union and other radiographic parameters (radial inclination, radial length, and volar tilt) at two, six, ten, sixteen, and twenty-four weeks, and for clinical outcomes that included Disabilities of the Arm, Shoulder and Hand (DASH) scores, wrist motion, and grip strength at twenty-four weeks. The two groups were compared with regard to the time to radiographic union, the radiographic parameters, and the clinical outcomes. Results: No significant differences were observed between the two groups with respect to radiographic or clinical outcomes after volar locking plate fixation. All patients obtained fracture union, and the mean times to radiographic union in Groups I and II were similar (6.7 and 6.8 weeks, respectively; p = 0.65). Furthermore, the time to radiographic union was not related to osteoporosis severity or fracture type. Conclusions: In patients with an osteoporotic distal radial fracture treated with volar locking plate fixation, the early initiation of bisphosphonate treatment did not affect fracture-healing or clinical outcomes.The Journal of Bone and Joint Surgery 08/2012; 94A(19). DOI:10.2106/JBJS.K.01434 · 4.31 Impact Factor