Treatment of the Communited Distal Radius Fracture Using Volar Locking Plate Fixation with Allogenic Cancellous Bone Graft in the Elderly

Je Kang Hong; Chang Hyun Shin

doi:10.12671/jkfs.2015.28.1.8

Journal List > J Korean Fract Soc > v.28(1) > 1038051

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Hong and Shin: Treatment of the Communited Distal Radius Fracture Using Volar Locking Plate Fixation with Allogenic Cancellous Bone Graft in the Elderly

Original Article

Journal of the Korean Fracture Society 2015; 28(1): 8-16.

Published online: 20 January 2015

DOI: https://doi.org/10.12671/jkfs.2015.28.1.8

Treatment of the Communited Distal Radius Fracture Using Volar Locking Plate Fixation with Allogenic Cancellous Bone Graft in the Elderly

Je Kang Hong, M.D., Chang Hyun Shin, M.D.

Department of Orthopedic Surgery, Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, Korea.

Address reprint requests to: Hong Je Kang, M.D. Department of Orthopedic Surgery, Wonkwang University College of Medicine, 460 Iksan-daero, Iksan 570-749, Korea. Tel: 82-63-859-1360, Fax: 82-63-852-9329, kanghongje@hanmail.net

Received 9 June 2014 Revised 18 August 2014 Accepted 25 September 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We studied results of the communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate in the elderly.

Materials and Methods

We studied 29 cases of communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate from April 2009 to April 2013. Fracture was classified according to AO/OTA classification. Postoperative clinical evaluation was performed with measurement of wrist range of motion (ROM) at last follow-up, modified Mayo wrist scoring system (MMWS), and visual analogue pain scale (VAS). Radiologic evaluation was performed with measurement of radial length on immediate postoperation and last follow-up, radial inclination, volar tilt and ulnar variance checked at the last follow-up using Sarmiento criteria.

Results

Using the MMWS, 13 cases were classified as 'good', 10 'fair', and 5 'normal'. The average wrist ROM was 88.5% for flexion, 92.2% for extension, 90.5% for adduction, and 94.0% for abduction. The average VAS was 1.7. On the last follow-up, average radius length, radial inclination and volar tilt did not show statistically significant improvement (p>0.05) compared to immediate post operation measurements, and according to Sarmiento criteria, 5 cases were classified as 'good', 14 'fair', and 7 'normal'.

Conclusion

Treatment of severe communited distal radius fracture accompanied by bone defect with volar locking plate and allogenic cancellous bone graft is a satisfying and effective treatment method in the elderly.

Keywords: Distal radius fracture, Allogenic Cancellous Bone Graft, Volar Locking Plate

Figures and Tables

Fig. 1

A 71-year-old woman with an AO/OTA classification C3.2 type fracture. (A) Preoperative anteroposterior and lateral radiographs. (B) Preoperative 3-dimensional computed tomography. (C) Piled up allogenous cancellous bone chip at bone defect lesion (arrow). (D) Postoperative anteroposterior and lateral radiographs. (E) Postoperative 12 months anteroposterior and lateral radiographs.

Fig. 2

A 78-year-old woman with an AO/OTA classification C3.3 type fracture. (A) Preoperative anteroposterior and lateral radiographs. (B) Preoperative 3-dimensional computed tomography. (C) Piled up allogenous cancellous bone chip at bone defect lesion (arrow). (D) Postoperative anteroposterior and lateral radiographs. (E) Postoperative 15 months anteroposterior and lateral radiographs.

Table 1

Demographic Data of the Patients (n=29)

Values are presented as number (%), medians (range), or number only.

Table 2

Clinical Outcome of Communited Distal Radius Fracture according to Modified Mayo Wrist Scoring System

Values are presented as number (%) or number only. ^*Classification according to the standard of AO/OTA fracture type.

Table 3

Wrist Functional Outcomes at Last Follow-Up

The angle of the joint is shown in percentile compared to normal side. ^*Classification according to the standard of AO/OTA fracture type. VAS: Visual analogue pain scale.

Table 4

Radiological Outcomes Immediate Postoperative Date and Last Postoperative Follow-Up

Values are presented as mean±standard deviation.

Table 5

Results according to Sarmiento Criteria

Values are presented as number (%) or number only. ^*Classification according to the standard of AO/OTA fracture type.

Notes

Financial support: None.

Conflict of interest: None.

References

1. Edwards GS Jr. Intra-articular fractures of the distal part of the radius treated with the small AO external fixator. J Bone Joint Surg Am. 1991; 73:1241–1250.

2. Ring D. Treatment of the neglected distal radius fracture. Clin Orthop Relat Res. 2005; (431):85–92.

3. Leung F, Tu YK, Chew WY, Chow SP. Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radial fractures. A randomized study. J Bone Joint Surg Am. 2008; 90:16–22.

4. Ring D, Prommersberger K, Jupiter JB. Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius. J Bone Joint Surg Am. 2004; 86:1646–1652.

5. Herrera M, Chapman CB, Roh M, Strauch RJ, Rosenwasser MP. Treatment of unstable distal radius fractures with cancellous allograft and external fixation. J Hand Surg Am. 1999; 24:1269–1278.

6. Leung KS, Shen WY, Leung PC, Kinninmonth AW, Chang JC, Chan GP. Ligamentotaxis and bone grafting for comminuted fractures of the distal radius. J Bone Joint Surg Br. 1989; 71:838–842.

7. McBirnie J, Court-Brown CM, McQueen MM. Early open reduction and bone grafting for unstable fractures of the distal radius. J Bone Joint Surg Br. 1995; 77:571–575.

8. Wolfe SW, Pike L, Slade JF 3rd, Katz LD. Augmentation of distal radius fracture fixation with coralline hydroxyapatite bone graft substitute. J Hand Surg Am. 1999; 24:816–827.

9. Goldfarb CA, Yin Y, Gilula LA, Fisher AJ, Boyer MI. Wrist fractures: what the clinician wants to know. Radiology. 2001; 219:11–28.

10. Sarmiento A, Zagorski JB, Sinclair WF. Functional bracing of Colles' fractures: a prospective study of immobilization in supination vs. pronation. Clin Orthop Relat Res. 1980; (146):175–183.

11. Mah ET, Atkinson RN. Percutaneous Kirschner wire stabilisation following closed reduction of Colles' fractures. J Hand Surg Br. 1992; 17:55–62.

12. Zhang SX, Gu FR, Peng YL, et al. External fixation and bone grafting for collapsed and comminuted distal radius fracture. Chin J Traumatol. 2005; 8:156–159. 164

13. Kofoed H. Comminuted displaced Colles' fractures. Treatment with intramedullary methylmethacrylate stabilisation. Acta Orthop Scand. 1983; 54:307–311.

14. Arora J, Malik AC. External fixation in comminuted, displaced intra-articular fractures of the distal radius: is it sufficient? Arch Orthop Trauma Surg. 2005; 125:536–540.

15. Mudgal CS, Jupiter JB. Plate fixation of osteoporotic fractures of the distal radius. J Orthop Trauma. 2008; 22:S106–S115.

16. Na KT, Song SW, Lee YM, Kang BM. Dorsal plate fixation for dorsally displaced distal radius fractures. J Korean Soc Surg Hand. 2014; 19:44–51.

17. Orbay JL. The treatment of unstable distal radius fractures with volar fixation. Hand Surg. 2000; 5:103–112.

18. Lozano-Calderón SA, Souer S, Mudgal C, Jupiter JB, Ring D. Wrist mobilization following volar plate fixation of fractures of the distal part of the radius. J Bone Joint Surg Am. 2008; 90:1297–1304.

19. Murakami K, Abe Y, Takahashi K. Surgical treatment of unstable distal radius fractures with volar locking plates. J Orthop Sci. 2007; 12:134–140.

20. Kim SJ, Cho CH. 2.4 mm volar locking compression plate for treatment of unstable distal radius fractures. J Korean Fract Soc. 2011; 24:151–155.

21. Kim JK, Koh YD, Kook SH. Effect of calcium phosphate bone cement augmentation on volar plate fixation of unstable distal radial fractures in the elderly. J Bone Joint Surg Am. 2011; 93:609–614.

22. Rhee SH, Kim J, Lee YH, Gong HS, Lee HJ, Baek GH. Factors affecting late displacement following volar locking plate fixation for distal radial fractures in elderly female patients. Bone Joint J. 2013; 95:396–400.

23. Foo TL, Gan AW, Soh T, Chew WY. Mechanical failure of the distal radius volar locking plate. J Orthop Surg (Hong Kong). 2013; 21:332–336.

24. Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma. 2007; 21:316–322.

25. Kainz H, Dall'Ara E, Antoni A, Redl H, Zysset P, Weninger P. Calcium phosphate cement augmentation after volar locking plating of distal radius fracture significantly increases stability. Eur J Orthop Surg Traumatol. 2014; 24:869–875.

26. Büyükkurt CD, Bülbül M, Ayanoğlu S, Esenyel CZ, Oztürk K, Gürbüz H. The effects of osteoporosis on functional outcome in patients with distal radius fracture treated with plate osteosynthesis. Acta Orthop Traumatol Turc. 2012; 46:89–95.

27. Goto A, Murase T, Oka K, Yoshikawa H. Use of the volar fixed angle plate for comminuted distal radius fractures and augmentation with a hydroxyapatite bone graft substitute. Hand Surg. 2011; 16:29–37.

28. Geissler WB, Fernandez DL. Percutaneous and limited open reduction of the articular surface of the distal radius. J Orthop Trauma. 1991; 5:255–264.

29. Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA. Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res. 1996; (329):300–309.

30. Mjöberg B, Pettersson H, Rosenqvist R, Rydholm A. Bone cement, thermal injury and the radiolucent zone. Acta Orthop Scand. 1984; 55:597–600.

31. Zimmermann R, Gabl M, Lutz M, Angermann P, Gschwentner M, Pechlaner S. Injectable calcium phosphate bone cement Norian SRS for the treatment of intra-articular compression fractures of the distal radius in osteoporotic women. Arch Orthop Trauma Surg. 2003; 123:22–27.

32. Enneking WF, Mindell ER. Observations on massive retrieved human allografts. J Bone Joint Surg Am. 1991; 73:1123–1142.

33. Kim JY, Kang HJ, Yi Y. Multiple flexor tendon injuries after volar plate fixation for distal radius fracture: two cases report. J Korean Soc Surg Hand. 2012; 17:47–51.

TOOLS

Similar articles