Treatment of fractures of the distal radius with a remodellable bone cement

Abstract

We performed a prospective, randomised study on 110 patients more than 50 years old with fractures of the distal radius to compare the outcome of conservative treatment with that using remodellable bone cement (Norian skeletal repair system, SRS) and immobilisation in a cast for two weeks. Patients treated with SRS had less pain and earlier restoration of movement and grip strength. The results at one year were satisfactory in 81.54% of the SRS patients and 55.55% of the control group. The rates of malunion were 18.2% and 41.8%, respectively. There was a significant relationship between the functional and radiological results. Soft-tissue extrusion was present initially in 69.1% of the SRS patients; most deposits disappeared progressively, but persisted in 32.73% at one year. We conclude that the injection of a remodellable bone cement into the trabecular defect of fractures of the distal radius provides a better clinical and radiological result than conventional treatment.

A New Injectable Brushite Cement: First Results in Distal Radius and Proximal Tibia Fractures

“…Therefore, it must be emphasized that the combined use of internal fixation is essential when using chronOS Inject; its main role is not to provide mechanical stabilization, but to adequately fill fracture gaps and, as a result, should not fail when used accordingly. In a number of studies using Norian SRS as the treatment for distal radius and tibial plateau fractures in combination with cast immobilization or internal screw fixation, loss of reduction has been documented as one of the main complications occurring in 16-29% of patients [5,32,34]; the occurrence of 17% (13/75) loss of reduction in our study falls well within the range reported.…”

“…This is in contrast to the study of Sanchez-Sotelo et al [34], where extraosseous extrusion of Norian SRS was reported to be the main complication (69.1%), but was not removed despite transient discomfort being reported for 88.2% of the patients with dorsal cement leakage and persistence of the extraosseous cement deposit in 47.4% of patients.…”

“…Cement leakage can be of concern when using injectable bone substitutes. It has been reported in up to 70% of distal radius cases [5,34]. Radiological evaluation of the postoperative X-rays revealed 20 cases in our study.…”

“…Radiological evaluation of the postoperative X-rays revealed 20 cases in our study. Although the occurrence of leakage at 41% (15/ 37) was higher for the distal radius than for the tibia, this is considerably lower when compared to the risk of Norian SRS extraosseous extrusion as reported by the working groups of Sanchez-Sotelo et al [34] and Cassidy et al [5] (69.1 and 69.6%, respectively). Lower occurrences of leakage have, nonetheless, been reported for Calcibon (21%) [33] and Norian SRS (33%) [35] in the treatment of vertebral and distal radius fractures, respectively; pain and a finger flexion defect during the first 3 months after treatment accompanied the softtissue extrusions of Norian SRS noted in the latter study.…”

Tibiakopfplateaufrakturen - Erste Erfahrungen mit einem resorbierbaren Knochenzement zur Augmentation

“…Norian SRS wurde bisher klinisch bei Radiusfrakturen [17,26], Kalkaneusfrakturen [8,28], Tibiakopffrakturen [9,20], Humeruskopfluxationsfrakturen [11] sowie pertrochantären Oberschenkel-und Schenkelhalsfrakturen [15] angewandt. Durch die früher mögliche Belastungsaufnahme konnte sowohl die Dauer der Rehabilitation als auch die Dauer der Arbeitsunfähigkeit zum Teil erheblich reduziert werden [8].…”