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Gengatharan D, Wong W, Chia DS. Outcomes of Autologous and Synthetic Bone Grafts in Locking Plate Fixation of Comminuted Distal Radius Fractures. Cureus 2024; 16:e60595. [PMID: 38894790 PMCID: PMC11184631 DOI: 10.7759/cureus.60595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
Background The introduction of locking plate technology has improved the feasibility of distal radius fracture fixation without the need for bone grafting, yet challenges persist in cases of severely comminuted fractures and small, unstable intra-articular fragments. This study aimed to assess the outcomes of bone grafting in severely comminuted distal radius fractures treated with locking plates. Methods We performed a retrospective analysis involving 450 patients who underwent distal radius fracture fixations. We evaluated wrist motion, grip strength, and radiographic parameters, including radial inclination, radial tilt, ulnar variance, articular step, and fracture union at standardized intervals. In addition, at the 12- and 24-month marks, we assessed the disabilities of the arm, shoulder, and hand (DASH) questionnaire score. Results Out of the 450 patients who underwent distal radius fracture fixation using volar locking plate systems, 59 individuals (13%) required either autologous bone graft (n = 24) or synthetic bone substitutes (n = 35). In the final follow-up, all fractures had successfully united, displaying an average volar tilt of 4°, radial inclination of 18.8°, and an articular step or gap of 0.1 mm. Conclusion There was no significant difference between the use of autologous or synthetic bone grafts on clinical or radiological outcomes in the long term. Bone grafts are useful in severe metaphyseal comminution and aid in the reduction of articular fragments and bi-cortical comminution.
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Affiliation(s)
| | - Walter Wong
- Orthopaedic Surgery, Sengkang General Hospital, Singapore, SGP
| | - Dawn S Chia
- Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore, SGP
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Reschke P, Koch V, Mahmoudi S, Booz C, Yel I, Gotta J, Stahl A, Reschke R, Scholtz JE, Martin SS, Gruber-Rouh T, Eichler K, Vogl TJ, Gruenewald LD. Predictive Value of Dual-Energy CT-Derived Metrics for the Use of Bone Substitutes in Distal Radius Fracture Surgery. Diagnostics (Basel) 2024; 14:697. [PMID: 38611610 PMCID: PMC11011262 DOI: 10.3390/diagnostics14070697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Low bone mineral density (BMD) is a significant risk factor for complicated surgery and leads to the increased use of bone substitutes in patients with distal radius fractures (DRFs). No accepted model has yet been established to predict the use of bone substitutes to facilitate preoperative planning. (2) Methods: Unenhanced dual-energy CT (DECT) images of DRFs were retrospectively acquired between March 2016 and September 2020 using the internal PACS system. Available follow-up imaging and medical health records were reviewed to determine the use of bone substitutes. DECT-based BMD, trabecular Hounsfield units (HU), cortical HU, and cortical thickness ratio were measured in non-fractured segments of the distal radius. Diagnostic accuracy parameters were calculated for all metrics using receiver-operating characteristic (ROC) curves and associations of all metrics with the use of bone substitutes were evaluated using logistic regression models. (3) The final study population comprised 262 patients (median age 55 years [IQR 43-67 years]; 159 females, 103 males). According to logistic regression analysis, DECT-based BMD was the only metric significantly associated with the use of bone substitutes (odds ratio 0.96, p = 0.003). However, no significant associations were found for cortical HU (p = 0.06), trabecular HU (p = 0.33), or cortical thickness ratio (p = 0.21). ROC-curve analysis revealed that a combined model of all four metrics had the highest diagnostic accuracy with an area under the curve (AUC) of 0.76. (4) Conclusions: DECT-based BMD measurements performed better than HU-based measurements and cortical thickness ratio. The diagnostic performance of all four metrics combined was superior to that of the individual parameters.
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Affiliation(s)
- Philipp Reschke
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (P.R.); (V.K.); (I.Y.); (J.G.); (A.S.); (L.D.G.)
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (P.R.); (V.K.); (I.Y.); (J.G.); (A.S.); (L.D.G.)
| | - Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (P.R.); (V.K.); (I.Y.); (J.G.); (A.S.); (L.D.G.)
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (P.R.); (V.K.); (I.Y.); (J.G.); (A.S.); (L.D.G.)
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (P.R.); (V.K.); (I.Y.); (J.G.); (A.S.); (L.D.G.)
| | - Jennifer Gotta
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (P.R.); (V.K.); (I.Y.); (J.G.); (A.S.); (L.D.G.)
| | - Adrian Stahl
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (P.R.); (V.K.); (I.Y.); (J.G.); (A.S.); (L.D.G.)
| | - Robin Reschke
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, 20537 Hamburg, Germany
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (P.R.); (V.K.); (I.Y.); (J.G.); (A.S.); (L.D.G.)
| | - Simon S. Martin
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (P.R.); (V.K.); (I.Y.); (J.G.); (A.S.); (L.D.G.)
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (P.R.); (V.K.); (I.Y.); (J.G.); (A.S.); (L.D.G.)
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (P.R.); (V.K.); (I.Y.); (J.G.); (A.S.); (L.D.G.)
| | - Thomas J. Vogl
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (P.R.); (V.K.); (I.Y.); (J.G.); (A.S.); (L.D.G.)
| | - Leon D. Gruenewald
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (P.R.); (V.K.); (I.Y.); (J.G.); (A.S.); (L.D.G.)
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Sudo Y, Nishida Y, Nakashima H, Arai T, Takatsu T. Clinical Outcomes of a Novel Unidirectional Porous β-Tricalcium Phosphate Filling in Distal Radius Fracture with Volar Locking Plate Fixation: Secondary Publication of the Japanese Version. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:1. [PMID: 38276035 PMCID: PMC10817542 DOI: 10.3390/medicina60010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
Postoperative loss of correction is a concern in cases of distal radius fracture with bone loss after surgery. The purpose of this study was to evaluate the usefulness of a β-tricalcium phosphate (β-TCP) with unidirectional pore structure (Affinos®: Kuraray Co., Ltd, Tokyo, Japan) with internal fixation in patients with bone defects during the correction of distal radius fractures. Thirty-nine patients (40 radii) treated between 2016 and August 2020 were included in the study. There were 8 males and 31 females; the mean age was 70.9 (32-88). The mean postoperative observation period was 14.6 (3.4-24) months. The bone defect that occurred in the surgery was filled with Affinos® and fixed with a locking plate. Radial inclination (RI), volar tilt (VT), and ulnar variance (UV) were evaluated after the operation and at the final observation. The start of absorption and the completion of replacement to the host bone of Affinos® were also evaluated. There were no complications associated with grafts of Affinos®. The mean time of translucent findings around artificial bone was 1.85 (0.5-6) months, and that of complete resorption was 10.6 (1.5-16.5) months after surgery. The mean RI was 21.82° after surgery and 21.16° at final observation. The mean VT was 8.54° after surgery and 8.50° at final observation. The mean UV was -0.3 mm after surgery and 0.5 mm at final observation. Affinos® was resorbed relatively early, and host bone formation was observed. Filling of unidirectional pore structure β-TCP with internal fixation showed favorable outcomes in the surgery of distal radius fractures with bone defects.
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Affiliation(s)
- Yoshito Sudo
- Department of Orthopaedic Surgery, Gifu Prefectural Tajimi Hospital, Gifu 507-8522, Japan; (Y.S.); (H.N.); (T.A.); (T.T.)
| | - Yoshihiro Nishida
- Department of Rehabilitation Medicine, Nagoya University Hospital, Nagoya 466-8550, Japan
| | - Hiroatsu Nakashima
- Department of Orthopaedic Surgery, Gifu Prefectural Tajimi Hospital, Gifu 507-8522, Japan; (Y.S.); (H.N.); (T.A.); (T.T.)
- Medical Corporation Rokujukai, Goto Orthopaedic Clinic, Tsuhima 496-0072, Japan
| | - Tetsuya Arai
- Department of Orthopaedic Surgery, Gifu Prefectural Tajimi Hospital, Gifu 507-8522, Japan; (Y.S.); (H.N.); (T.A.); (T.T.)
| | - Tetsuro Takatsu
- Department of Orthopaedic Surgery, Gifu Prefectural Tajimi Hospital, Gifu 507-8522, Japan; (Y.S.); (H.N.); (T.A.); (T.T.)
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Tai TH, Chu PJ, Lu KY, Wu JJ, Wong CC. Current Management and Volar Locking Plate Fixation with Bone Cement Augmentation for Elderly Distal Radius Fractures-An Updated Narrative Review. J Clin Med 2023; 12:6801. [PMID: 37959267 PMCID: PMC10648218 DOI: 10.3390/jcm12216801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Distal radius fractures (DRFs) are the most common among all kinds of fractures with an increase in incidence due to the rapidly expanded size of the elderly population in the past decades. Both non-surgical and surgical treatments can be applied for this common injury. Nowadays, more and more elderly patients with DRFs undergo surgical treatments to restore pre-injury activity levels faster. However, optimal treatment for geriatric DRFs is still debated, and careful evaluation and selection of patients are warranted considering clinical and functional outcomes, and complications following surgical treatments. Furthermore, osteoporosis is a predominant factor in elderly DRFs mostly deriving from a low-energy trauma, so many treatment modalities are developed to enhance better bone healing. Among various options for bone augmentation, bone cement is one of the most widely used measures. Bone cement such as calcium phosphate theoretically improves fracture stability and healing, but whether the elderly patients with DRFs can significantly benefit from surgical fixation with bone cement augmentation (BCA) remains controversial. Hence, in the present review, the latest literature regarding current concepts of management and evidence about volar locking plate fixation (VLPF) with BCA for elderly DRFs was searched in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science; out of >1000 articles, full texts of 48 and 6 articles were then examined and analyzed separately for management and VLPF with BCA for elderly DRFs. We aim to provide the readers with updates concerning the above issues.
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Affiliation(s)
- Ting-Han Tai
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City 235041, Taiwan (P.-J.C.)
| | - Po-Jui Chu
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City 235041, Taiwan (P.-J.C.)
- Department of Primary Care Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei City 235041, Taiwan
| | - Kuan-Yu Lu
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City 235041, Taiwan (P.-J.C.)
| | - Jeffrey J. Wu
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City 235041, Taiwan (P.-J.C.)
| | - Chin-Chean Wong
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City 235041, Taiwan (P.-J.C.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Research Center of Biomedical Devices, Taipei Medical University, Taipei 110301, Taiwan
- International PhD Program for Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
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