V Fontaine1, M Grunberg1, J Soret1, K El-Youssef1, L-E Gayet1, R Taberne2. 1. Service de chirurgie orthopédique et traumatologique, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers cedex, France. 2. Service de chirurgie orthopédique et traumatologique, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers cedex, France. Electronic address: romaintaberne@hotmail.fr.
Abstract
BACKGROUND: Die-punch intra-articular fractures of the distal radius raise surgical challenges. The residual articular step-off must be less than 1mm to prevent the development of radio-carpal osteoarthritis. The objectives of this cadaver study were to evaluate whether cementoplasty was effective in reducing die-punch fractures and to determine whether this technique was feasible as an arthroscopic procedure. HYPOTHESIS: Cementoplasty performed as an arthroscopic procedure is effective in treating die-punch fractures. MATERIAL AND METHODS: Eleven cadaver forearms collected at a laboratory were studied. In each, a depressed fracture of the lunate fossa of the radial articular surface was created using a Tinius Olsen H25K-S compression test machine. A Kyphon XPander® balloon (Medtronic) was used to lift the depressed area, and calcium-phosphate cement was then injected to stabilise the reduction. Cementoplasty under arthroscopic guidance was performed on an additional forearm. RESULTS: Computed tomography of the wrists after fracture induction showed a mean depression of 4.66mm (range, 4.01-5.25mm). Arthroscopic cementoplasty proved feasible with the arthroscope inserted through the 3-4 radio-carpal portal. Positioning the balloon under the depressed area ensured satisfactory reduction and allowed the injection of cement. DISCUSSION: Cementoplasty may be useful for the treatment of die-punch fractures. Additional indications may be other types of distal radius fractures with articular surface depression. LEVEL OF EVIDENCE: IV, cadaver study.
BACKGROUND: Die-punch intra-articular fractures of the distal radius raise surgical challenges. The residual articular step-off must be less than 1mm to prevent the development of radio-carpal osteoarthritis. The objectives of this cadaver study were to evaluate whether cementoplasty was effective in reducing die-punch fractures and to determine whether this technique was feasible as an arthroscopic procedure. HYPOTHESIS: Cementoplasty performed as an arthroscopic procedure is effective in treating die-punch fractures. MATERIAL AND METHODS: Eleven cadaver forearms collected at a laboratory were studied. In each, a depressed fracture of the lunate fossa of the radial articular surface was created using a Tinius Olsen H25K-S compression test machine. A Kyphon XPander® balloon (Medtronic) was used to lift the depressed area, and calcium-phosphate cement was then injected to stabilise the reduction. Cementoplasty under arthroscopic guidance was performed on an additional forearm. RESULTS: Computed tomography of the wrists after fracture induction showed a mean depression of 4.66mm (range, 4.01-5.25mm). Arthroscopic cementoplasty proved feasible with the arthroscope inserted through the 3-4 radio-carpal portal. Positioning the balloon under the depressed area ensured satisfactory reduction and allowed the injection of cement. DISCUSSION: Cementoplasty may be useful for the treatment of die-punch fractures. Additional indications may be other types of distal radius fractures with articular surface depression. LEVEL OF EVIDENCE: IV, cadaver study.