title: Distal radius osteotomy in the elderly patient using angular stable implants and Norian bone cement.
abstract: OBJECTIVE
  To report our results after testing the combination of two technologies--angular-stable locking screw implants and Norian SRS cement--in corrective osteotomies of the distal radius in the elderly. This technique eliminates donor site bone-graft morbidity and expands the indications of corrective osteotomies to older patients with osteoporotic bone.
  
  
  METHODS
  Our retrospective series include 6 patients (5 women and 1 man) with an average age of 60 years. Three patients had corrections through a dorsal approach, 1 through a volar approach, and 2 through a combined approach. Two corrections included an intraarticular osteotomy. We used 2.4-mm volar T plates in patients approached volarly and 2.4-mm L and T plates for those approached dorsally; the osseous defect was filled with bone cement (Norian SRS). Range of motion and grip strength were measured at 16 months average follow-up. Standard wrist radiographs were taken to evaluate alignment and determine improvement. At final follow-up, patients completed the Modified Mayo Wrist score, the Modified Gartland and Werley score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.
  
  
  RESULTS
  There were no perioperative complications. All corrective osteotomies healed. One patient required a Darrach procedure at 6 months. The average wrist and forearm motion was 77% of the opposite side and grip strength 88% of the opposite side. The average total correction in the sagittal plane was 22 degrees with all patients returning to neutral or better alignment. The average ulnar variance improvement was 2 mm. Average postoperative DASH was 28 points; average Modified Mayo Wrist score was 68; and the Modified Gartland and Werley score averaged 9 points.
  
  
  CONCLUSIONS
  We believe that corrective osteotomy of the distal radius in the elderly using angular stable implants and Norian calcium phosphate cement is a safe and predictable surgical technique, even in patients with underlying osteoporosis. It eliminates donor site morbidity, and patient-rated outcome measures demonstrated acceptable daily living function return.
authors.affiliation: Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA. slozanocalderon@partners.org
authors.forename: Santiago
authors.initials: S
authors.lastname: Lozano-Calderón
authors.forename: Michael
authors.initials: M
authors.lastname: Moore
authors.forename: Matthew
authors.initials: M
authors.lastname: Liebman
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Jupiter
mesh_terms: D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use*; D001860:Bone Plates; D002130:Calcium Phosphates / Q000627:therapeutic use*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D017759:Fractures, Malunited / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011884:Radius / Q000601:surgery*; D011885:Radius Fractures / Q000601:surgery; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome