Mithun Neral1, Mario Solari1, Chad Purnell1, Ronit Wollstein1. 1. Department of Plastic Surgery, University of Pittsburgh Medical Center, M.D. 3550 Terrace Street, Pittsburgh, PA 15261 USA ; Department of Orthopedic Surgery, University of Pittsburgh Medical Center, M.D. 3550 Terrace Street, Pittsburgh, PA 15261 USA.
Abstract
BACKGROUND: The lack of structural support remains a challenge in the treatment of comminuted distal radius fractures. Calcium phosphate and calcium sulfate bone cement has been used in other fracture locations in addition to fixation and has been shown to allow for retention of reduction in difficult cases. METHODS: A case-control retrospective review of 34 consecutive distal radius fractures treated with surgery was performed with the patients classified by Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. Complications and postoperative radiographs were evaluated. RESULTS: Cement was used in the most difficult cases. Radial height was retained in both groups. Volar tilt was significantly better in the cement group. There were no significant differences between the case and control groups for any complication. No complications related to the use of the cement were found. CONCLUSIONS: The use of bone cement as an adjunct to fixation of distal radius fractures seems to include minimal risks and may afford a technical advantage in maintaining reduction during surgery for difficult fractures. Since there is an aspect of fracture difficulty that we cannot control for by using radiographic assessment alone, cement may provide an advantage over fixation without cement, despite similar outcomes. Bone cement can be part of the "tool box" for difficult distal radius fractures. Further study is necessary to define the technical advantages and limitations of each particular cement product.
BACKGROUND: The lack of structural support remains a challenge in the treatment of comminuted distal radius fractures. Calcium phosphate and calcium sulfate bone cement has been used in other fracture locations in addition to fixation and has been shown to allow for retention of reduction in difficult cases. METHODS: A case-control retrospective review of 34 consecutive distal radius fractures treated with surgery was performed with the patients classified by Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. Complications and postoperative radiographs were evaluated. RESULTS: Cement was used in the most difficult cases. Radial height was retained in both groups. Volar tilt was significantly better in the cement group. There were no significant differences between the case and control groups for any complication. No complications related to the use of the cement were found. CONCLUSIONS: The use of bone cement as an adjunct to fixation of distal radius fractures seems to include minimal risks and may afford a technical advantage in maintaining reduction during surgery for difficult fractures. Since there is an aspect of fracture difficulty that we cannot control for by using radiographic assessment alone, cement may provide an advantage over fixation without cement, despite similar outcomes. Bone cement can be part of the "tool box" for difficult distal radius fractures. Further study is necessary to define the technical advantages and limitations of each particular cement product.
Entities:
Keywords:
Arbeitsgemeinschaft für Osteosynthesefragen Osteosynthesefragen (AO) classification; Bone cement; Distal radius fractures
Authors: M D Vlad; E V Sindilar; M L Mariñoso; I Poeată; R Torres; J López; M Barracó; E Fernández Journal: Acta Biomater Date: 2009-07-14 Impact factor: 8.947