The use of tricorticocancellous bone graft in severely comminuted intra-articular fractures of the distal radius.
OBJECTIVE
We report the results of a retrospective study of the use of tricorticocancellous iliac crest bone graft in 12 patients with acute AO type C3.2 or type C3.3 fractures of the distal radius who were followed up for at least 1 year.


METHODS
Twelve of 17 patients treated with the protocol were available for follow-up evaluation. All fractures were treated with open reduction and combined internal and external fixation. Five fractures were plated dorsally, 1 volarly, and 5 volarly and dorsally.


RESULTS
Five patients had AO type C3.2 fractures and 7 had AO type C3.3 fractures. Nine of 10 radiographic parameters that were restored to near-normal values during the surgery were maintained at near-normal levels at the final follow-up evaluation at a mean of 28 months after surgery. Nine fractures had less than 2 mm of articular step-off of the distal radius and 8 had less than 3 mm of total articular incongruity (gap plus step-off). In 10 patients the radial length was restored to at least 10 mm. The mean arc of flexion-extension was 67% and the mean grip strength was 57% of that of the uninjured side. According to the Gartland and Werley demerit-point system 5 of the patients had good or excellent results. According to the modified Green and O'Brien clinical rating system 2 patients had good or excellent results. Poor results for 2 patients according to the demerit-point system and for 6 patients according to the Green and O'Brien clinical rating system were associated with severe ipsilateral soft-tissue and osseous injuries of the wrist, forearm, and arm. The total articular incongruity had a moderately strong correlation with the outcome as assessed by the demerit-point system.


CONCLUSIONS
Tricorticocancellous bone grafting in conjunction with combined internal and external fixation is a satisfactory treatment that can lead to a high rate of return to work and sports, a high level of patient satisfaction, and a low rate of complications.


METHODS
Therapeutic, Level IV.
Rogachefsky
Richard A
RA
Division of Hand Surgery, Department of Orthopaedics and Rehabilitation, University of Miami School of Medicine, Miami, FL, USA. rtbrogachefsky@aol.com
Ouellette
Elizabeth Anne
EA
Sun
Steven
S
Applegate
Brooks
B
D000328:Adult; D000368:Aged; D001168:Arthritis / Q000000981:diagnostic imaging; D001860:Bone Plates; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome