[Fractures of the distal radius treated by osteosynthesis and injectable bone substitute: a prospective study of 39 patients].
OBJECTIVE
Comminution is often neglected in patients presenting fractures of the distal radius. Use of injectable bone substitutes can fill the gap left by comminution, avoiding radial shortening and loss of prono-supination.


METHODS
Forty-eight patients with a distal fracture of the radius were treated by osteosynthesis and injectable cement between 1998 and 2001. These patients were reviewed at mean follow-up of 46 months (36-56). Dorsal displacement was present in all cases and the AO classification was A (n=26), B (n=15), C (n=7). Fixation was achieved with pins (n=32), posterior plate (n=14), and external fixator (n=2) before injection of the bone substitute. Outcome was evaluated with the Herzberg score, the Gartland and Werley score and DASH by an independent operator.


RESULTS
Four patients were lost to follow-up and five who developed a deformed callus after the initial osteosynthesis were excluded from the analysis. The Herzberg functional score reached 84 (range 54-100) and the Gartland and Werley radioclinical score was 4.6 (0-11) with 89% excellent and good outcomes. DASH was 23.6 (5.8-62.7). Ulnar variance was unchanged or changed less than 2 mm between the immediate postoperative period and last follow-up in 88% of patients. There was one carpal tunnel syndrome related to anterior cement leakage. Three biopsies were performed and revealed a "humid sand" aspect six months after injection as well as presence of osteoblasts within the bone substitute. There was no or very little resorption.


CONCLUSIONS
Several authors have demonstrated the biomechanical and functional effects of filling the comminution gap to avoid radial shortening. The first reported cases, then later prospective series, favored the use of injectable cements for patients with comminution. Cement used in our patients allowed preservation enables preservation of normal ulnar variance in addition to filling the gap. Like any bone substitute, it is an attractive alternative to other filling methods (ceramic graft) offering two advantages: adaptation to the bone defect and primary stability. This easy-to-use cement is resorbed slowly. Because of high cost, it may be reserved for patients with important functional needs.
Obert
L
L
Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique Reconstructrice et Assistance Main, CHU J. Minjoz, boulevard Fleming, 25030 Besançon. laurentobert@yahoo.fr
Leclerc
G
G
Lepage
D
D
Forterre
O
O
Tropet
Y
Y
Garbuio
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D002130:Calcium Phosphates; D005592:Fracture Fixation; D006801:Humans; D007267:Injections; D008875:Middle Aged; D011446:Prospective Studies; D011885:Radius Fractures / Q000628:therapy*
D001843:Bone Cements; D002130:Calcium Phosphates; C496047:Norian SRS Cement