Palmar plating with calcium phosphate bone cement for unstable Colles' fractures

Computer-Assisted Three-Dimensional Corrective Osteotomy for Malunited Fractures of the Distal Radius Using Prefabricated Bone Graft Substitute

BACKGROUND

Three-dimensional computed tomography (3D-CT) imaging has enabled more accurate preoperative planning. The purpose of this study was to investigate the results of a novel, computer-assisted, 3D corrective osteotomy using prefabricated bone graft substitute to treat malunited fractures of the distal radius.

METHODS

We investigated 19 patients who underwent the computer-assisted 3D corrective osteotomy for a malunited fracture of the distal radius after the operation was stimulated with CT data. A prefabricated bone graft substitute corresponding to the patient's bone defect was implanted and internal fixation was performed using a plate and screws. We compared postoperative radiographic parameters of the patient's operated side with their sound side and analyzed clinical outcomes using Mayo wrist score.

RESULTS

All patients achieved bone union on X-ray imaging at final follow-up. The mean differences of palmar tilt, radial inclination and ulnar variance between the operation side and the sound side were 4.3°, 2.3° and 1.2 mm, respectively. The Mayo wrist score was fair in 4 patients and poor in 15 patients before surgery. At the final follow-up after surgery, the scores improved to excellent in 3 patients, good in 11 patients and fair in 5 patients. There were two patients with correction loss at the final follow-up, but no patient complained of hand joint pain.

CONCLUSIONS

We believe that computer-assisted 3D corrective osteotomy using prefabricated bone graft substitute achieved good results because it worked as a guide to the accurate angle.

The Unstable Distal Radius Fracture-How Do We Define It? A Systematic Review

Background Unstable distal radius fractures are a popular research subject. However, to appreciate the findings of studies that enrolled patients with unstable distal radius fractures, it should be clear how the authors defined an unstable distal radius fracture. Questions In what percentage of studies involving patients with unstable distal radius fractures did the authors define unstable distal radius fracture? What are the most common descriptions of an unstable distal radius fracture? And is there one preferred evidence-based definition for future authors? Methods A systematic search of literature was performed to identify any type of study with the term unstable distal radius fracture. We assessed whether a definition was provided and determined the level of evidence for the most common definitions. Results The search yielded 2,489 citations, of which 479 were included. In 149 studies, it was explicitly stated that patients with unstable distal radius fractures were enrolled. In 54% (81/149) of these studies, the authors defined an unstable distal radius fracture. Overall, we found 143 different definitions. The seven most common definitions were: displacement following adequate reduction; Lafontaine's definition; irreducibility; an AO type C2 fracture; a volarly displaced fracture; Poigenfürst's criteria; and Cooney's criteria. Only Lafontaine's definition originated from a clinical study (level IIIb). Conclusion In only half of the studies involving patients with an unstable distal radius fracture did the authors defined what they considered an unstable distal radius fracture. None of the definitions stood out as the preferred choice. A general consensus definition could help to standardize future research.

Accelerated rehabilitation compared with a standard protocol after distal radial fractures treated with volar open reduction and internal fixation: a prospective, randomized, controlled study

BACKGROUND

There are relatively few studies in the literature that specifically evaluate accelerated rehabilitation protocols for distal radial fractures treated with open reduction and internal fixation (ORIF). The purpose of this study was to compare the early postoperative outcomes (at zero to twelve weeks postoperatively) of patients enrolled in an accelerated rehabilitation protocol with those of patients enrolled in a standard rehabilitation protocol following ORIF for a distal radial fracture. We hypothesized that patients with accelerated rehabilitation after volar ORIF for a distal radial fracture would have an earlier return to function compared with patients who followed a standard protocol.

METHODS

From November 2007 to November 2010, eighty-one patients with an unstable distal radial fracture were prospectively randomized to follow either an accelerated or a standard rehabilitation protocol after undergoing ORIF with a volar plate for a distal radial fracture. Both groups began with gentle active range of motion at three to five days postoperatively. At two weeks, the accelerated group initiated wrist/forearm passive range of motion and strengthening exercises, whereas the standard group initiated passive range of motion and strengthening at six weeks postoperatively. Patients were assessed at three to five days, two weeks, three weeks, four weeks, six weeks, eight weeks, twelve weeks, and six months postoperatively. Outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) scores (primary outcome) and measurements of wrist flexion/extension, supination, pronation, grip strength, and palmar pinch.

RESULTS

The patients in the accelerated group had better mobility, strength, and DASH scores at the early postoperative time points (zero to eight weeks postoperatively) compared with the patients in the standard rehabilitation group. The difference between the groups was both clinically relevant and statistically significant.

CONCLUSIONS

Patients who follow an accelerated rehabilitation protocol that emphasizes motion immediately postoperatively and initiates strengthening at two weeks after volar ORIF of a distal radial fracture have an earlier return to function than patients who follow a more standard rehabilitation protocol.

LEVEL OF EVIDENCE

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Calcium phosphate cement-assisted balloon osteoplasty for a Colles' fracture on arteriovenous fistula forearm of a maintenance hemodialysis patient

We report a case of a Colles' fracture on the arteriovenous fistula forearm of a maintenance hemodialysis patient treated with percutaneous pinning with the aid of Chinese finger trap reduction combined with cavity creation using a pediatric uromatic balloon with calcium phosphate cement augmentation. Five months after surgery, the arteriovenous fistula was patent, and the range of motion, grip strength, and radiographic findings were comparable with a non-arteriovenous fistula forearm. Wrist x-rays showed a complete union of the distal radius with progressive absorption of the calcium phosphate cement.

In VitroOssification and Remodeling of Mineralized Collagen I Scaffolds

A promising strategy of bone tissue engineering is to repair bone defects by implanting biodegradable scaffolds that can undergo remodeling and be replaced completely by autologous bone tissue. For this purpose, it is necessary to create scaffolds that can be degraded by osteoclasts and enable osteoblasts to build new mineralized bone matrix. In order to achieve this goal a new porous material has been developed using biomimetically mineralized collagen I. These scaffolds were co-cultured with osteoclast-like cells and osteoblasts in order to characterize the capacity of these cells to remodel the material in vitro. It was possible to show the development of biologically active osteoclast- like cells that were able to invade and degrade the scaffold. They degraded the scaffold by internalizing it as intracellular vesicles, thereby making room for osteoblasts to invade and build new bone matrix. In addition, it could be shown that osteoblasts proliferated, differentiated, and produced new mineralized extracellular matrix. Hence, it could be shown that co-culture of osteoclastlike cells and osteoblasts on biomimetically mineralized collagen I is a promising approach for bone tissue engineering. In addition, it can be applied to study the process of bone remodeling in vitro.

Calcium phosphate cement in musculoskeletal tumor surgery

BACKGROUND AND OBJECTIVES

Calcium phosphate cement (CPC) is an injectable biocompatible bone substitute that has been used for various applications in orthopedic surgery. However, no extensive clinical studies of the use of CPC to fill bone cavities after curettage of musculoskeletal tumors have been reported. The present study reviewed the results for 56 musculoskeletal tumors treated by curettage and CPC implantation.

METHODS

Assessment was based on clinical examination and radiographic findings. Variables for clinical assessment included pain, limb function, and complications. Median follow-up was 18.5 months (range 6-47 months).

RESULTS

One patient experienced post-operative fractures. Three patients displayed local recurrence. One patient developed post-operative superficial wound infection, and two patients with large bony defect exhibited non-infectious serous discharge. No serious adverse effects such as deep venous thrombosis, pulmonary embolism were encountered. In all cases, CPC was radiographically well adapted to the surrounding host bone as of final follow-up.

CONCLUSIONS

CPC appears to offer a useful bone substitute for the treatment of musculoskeletal tumors. As the follow-up period for this study was short, further long-term follow-up studies are needed.

Palmar plating system for Colles' fractures--a preliminary report

PURPOSE

To present our results of the palmar plating system that we developed for the treatment of Colles' fractures.

METHODS

By using the palmar plating system that we developed a consecutive series of 40 acute Colles' fractures were treated surgically. There were 12 men and 28 women with a mean age of 57 years at the time of the injury (range, 25-90 y). All patients had internal fixation using the trans-flexor carpi radialis tendon approach. The system has 3 main features. First, the plate is small in size, being 1.1 mm in thickness and 47 mm in length. Only a 3- to 4-cm skin incision is required for application of the plate. Second, the screw is cannulated and cancellous in type, with a low-profile head. Subchondral screw fixation is achieved both easily and safely by using a guidewire. Third, the plate has a window through which injectable bone cement can be placed.

RESULTS

Union was achieved in all patients. The palmar tilt, radial inclination, radial length, and ulnar variance were maintained after surgery. According to the Gartland and Werley rating scale that was modified by Sarmiento there were 12 excellent and 28 good results. There were no extensor tendon injuries that could occur when the dorsal approach was used.

CONCLUSIONS

This palmar plating system can make fixation of the distal radius easy, safe, and effective in the treatment of unstable Colles' fractures.

Functional outcomes after open reduction and internal fixation for treatment of displaced distal radius fractures in patients over 60 years of age

OBJECTIVE

To evaluate the clinical, radiographic, and functional outcomes of patients aged 60 and older treated with open reduction and internal fixation using plates and screws for displaced and comminuted fractures of the distal radius.

DESIGN

Retrospective, clinical research.

SETTING

Tertiary care center (Level 1 trauma center) located in a large urban area.

PATIENTS

Eighteen patients with an average age of 71 years (range 60-86) form the basis of this study. Patients were obtained from a surgical database of 2 hand surgeons in a tertiary care center.

INTERVENTION

Open reduction and internal fixation of fractures of the distal radius using metal plates and screws designed for treatment of these injuries.

MAIN OUTCOME MEASUREMENTS

Clinical (history and physical examination), plain radiographic, and functional assessments were performed at an average follow-up of 26 months (range 12-40 months). Functional outcomes were assessed using the Gartland and Werley and Disabilities of the Arm, Shoulder, and Hand scoring systems.

RESULTS

Satisfactory reduction was achieved in all 18 fractures at the time of operative fixation with no instances of loss of fracture reduction during the study period. There were no cases of malunion, nonunion, or instances of device failure. We identified 4 minor complications. No patients required reoperation. Fifteen patients had an excellent (83%) and 3 had a good (17%) result according to the Gartland and Werley scoring system. The mean Disabilities of the Arm, Shoulder, and Hand score was 4.4 (range 0-14) out of a maximum 100.

CONCLUSION

Our findings suggest that open reduction and internal fixation with plates and screws in patients 60 years and older with displaced and comminuted fractures of the distal radius represents a safe and effective treatment alternative.