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

Elderly unstable distal radius fractures a prospective cohort study of bone substitutes-augmented percutaneous pinning

Background

Based on debatable recommendations of using bone substitutes for filling of metaphyseal void in elderly unstable distal radius fractures; this study investigated the following question “Do bone substitutes effectively contribute to postoperative stability of k-wire fixation construct and accelerate healing in elderly unstable distal radius fractures?”.

Methods

This prospective cohort study was conducted from October 2014 to April 2021. According to use of bone substitutes, 40 patients of elderly unstable distal radius fractures were alternately allocated into; group-(A) of bone substitutes-augmented percutaneous pinning (19 patients); and group-(B) of non-augmented percutaneous pinning (21 patients). Groups were compared for preoperative patients’ demographics and postoperative ROM, Quick-DASH and Mayo Wrist scores, radiographic parameters (palmar tilt, radial height and inclination, ulnar variance and intra-articular step-off) and duration until radiographic fracture healing.

Results

Statistically, augmented and non-augmented groups were matched in terms of patients’ demographics (mean age; 58.7 vs. 62.0 years respectively, P-value = 0.25). All included fractures have healed with insignificantly longer duration in augmented group (7.1 vs. 6.8 weeks, P-value = 0.26). At 12-week postoperative evaluation, radiographic parameters of both groups were comparably well-maintained except for intra-articular step-off which showed significantly less secondary displacement in augmented group (0.1 vs. 0.4 mm, P-value = 0.01). There were insignificant differences in 6-month postoperative ROM, and Quick-DASH and Mayo Wrist scores.

Conclusion

Compared to its bone substitutes-augmented counterpart; non-augmented percutaneous pinning of elderly unstable distal radius fractures can offer advantages of comparable healing rates and functional and radiographic outcomes, less-invasive approach, shorter operative time and lower cost.

Level of evidence

III

When used to augment percutaneous pinning of elderly unstable distal radius fractures, bone substitutes did not significantly offer additional postoperative mechanical stability of fixation construct.

When used to augment percutaneous pinning of elderly unstable distal radius fractures, bone substitutes did not significantly accelerate fracture healing.

Compared to bone substitutes-augmented pinning; stand-alone percutaneous pinning of elderly unstable distal radius fractures can achieve comparable healing rates and satisfactory functional and radiographic outcomes; and in addition, less-invasive approach, shorter operative time and lower cost.

Evaluating the necessity of bone augmentation for distal radius fracture fixed with a volar locking plate: a retrospective study

Background

Multiple approaches for fixation of distal radius fractures exist; nonetheless, there is no consensus on the optimal treatment for these injuries. Although using volar locking plates has become increasingly common as a surgical intervention, the usefulness of bone augmentation remains debatable. Therefore, this study aimed to evaluate the necessity of bone augmentation for distal radius fractures fixed with a volar locking plate.

Methods

This retrospective study enrolled patients with a single distal radius fracture treated with a volar locking plate between January 2014 and December 2016. Overall, 105 fractures were included and divided into two groups (non-bone augmentation: group 1, n = 88; bone augmentation: group 2, n = 17). Images were reviewed, and dorsal cortex collapse, volar tilting, and radial height and inclination were measured immediately after surgery and at the 6-month follow-up.

Results

Both groups exhibited significant differences in dorsal collapse (p < 0.001 and p = 0.001, respectively) and radial height shortening (p < 0.001 and p = 0.039, respectively); volar tilting and radial inclination did not differ significantly. There was no difference in the degree of dorsal collapse (p = 0.715) and radial height shortening (p = 0.651) between the two groups. Of the 105 fractures, 54 were identified as comminuted type according to the AO classification (A3, C2, and C3), and similar radiographic outcomes were noted.

Conclusions

Volar locking plates for the treatment of distal radius fractures with or without bone augmentation do not affect the radiographic outcomes. In comminuted fractures, additional bone augmentation is unnecessary if intraoperative anatomical reduction and fixation are performed when possible.