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

Garcés-Zarzalejo, C.; Sánchez-Crespo, M.R.; Peñas-Díaz, F.; Ayala, Higinio; Giménez-Rico, Juan Ramón Sanz; Alfonso-Fernández, A.; Burgos-Palacios, V.; Canto-Álvarez, F. del

doi:10.1016/j.recote.2015.01.004

Cited by 4 publications

(9 citation statements)

References 24 publications

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“…Furthermore, the functional scores of the patients were not recorded in this study to judge clinical outcomes; only the radiographic outcomes were evaluated, but they could not be directly linked to clinical results. Although previous studies have reported that patients undergoing volar locking plate fixation for a distal radius fracture have some degree of deterioration of radiographic parameters on postoperative follow-up, they still had good clinical outcomes [14,[22][23][24]. Among our included patients, the number of patients in the bone augmentation group was relatively small, which may also bias our statistical results.…”

Section: Discussionmentioning

confidence: 93%

“…In a prospective study by Garcés-Zarzalejo et al [14], 60 patients with unstable distal radius fractures were treated with the volar locking plate. All operations were performed without bone augmentation and all fractures achieved union without a significant loss of reduction after 1 year of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Although the other parameters were slightly worse, this result is still generally consistent with that of other studies. That is, there is little effect on clinical outcomes, and most patients can achieve bone healing and satisfactory functional outcomes [14,[23][24][25].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, surgical treatment and volar locking plate fixation has become prominent, and it provides particularly good fixation for osteoporotic and comminuted bone fractures [6][7][8][9]. However, whether combination with bone augmentation is necessary to provide better support for fractures remains questionable; our review of the literature revealed that research in this regard is lacking [4,14]. We hypothesized that surgical fixation of distal radius fractures using a volar locking plate with intraoperative bone augmentation could effectively prevent metaphyseal collapse.…”

Section: Introductionmentioning

confidence: 99%

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

Chang

Chen

Lee

et al. 2020

BMC Musculoskelet Disord

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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.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Chang

Chen

Lee

et al. 2020

BMC Musculoskelet Disord

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“…Augmentation with calcium phosphate cement also maintained fixation of unstable distal radius fractures(20). Garcés-Zarzalejo et al, on the other hand, stated that bone grafts and bone graft substitutes are not mandatory for the treatment of unstable distal radius fractures with locking compression plates(21). All 60 fractures in their study (treated without graft), healed uneventfully with no significant loss of reduction.…”

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confidence: 91%

Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: what is the evidence?

Lieshout

Alt

2016

Injury

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Despite improvements in implants and surgical techniques, osteoporotic fractures remain challenging to treat. Among other major risk factors, decreased expression of morphogenetic proteins has been identified for impaired fracture healing in osteoporosis. Bone grafts or bone graft substitutes are often used for stabilizing the implant and for providing a scaffold for ingrowth of new bone. Both synthetic and naturally occurring biomaterials are available. Products generally contain hydroxyapatite, tricalcium phosphate, dicalcium phosphate, calcium phosphate cement, calcium sulfate (plaster of Paris), or combinations of the above. Products have been used for the treatment of osteoporotic fractures of the proximal humerus, distal radius, vertebra, hip, and tibia plateau. Although there is generally consensus that screw augmentation increased the biomechanical properties and implant stability, the results of using these products for void filling are not unequivocal. In osteoporotic patients, Bone Morphogenetic Proteins (BMPs) have the potential impact to improve fracture healing by augmenting the impaired molecular and cellular mechanisms. However, the clinical evidence on the use of BMPs in patients with osteoporotic fractures is poor as there are no published clinical trials, case series or case studies. Even pre-clinical literature on in vitro and in vivo data is weak as most articles focus on the beneficial role for BMPs for restoration of the underlying pathophysiological factors of osteoporosis but do not look at the specific effects on osteoporotic fracture healing. Limited data on animal experiments suggest stimulation of fracture healing in ovariectomized rats by the use of BMPs. In conclusion, there is only limited data on the clinical relevance and optimal indications for the use of bone graft substitute materials and BMPs on the treatment of osteoporotic fractures despite the clinical benefits of these materials in other clinical indications. Given the general compromised outcome in osteoporotic fractures and limited alternatives for enhancement of fracture healing, clinicians and researchers should focus on this important topic and provide more data in this field in order to enable a sound clinical use of these materials in osteoporotic fractures.

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

Kandeel

2022

BMC Musculoskelet Disord

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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

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

Cited by 4 publications

References 24 publications

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

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

Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: what is the evidence?

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

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