Injectable Calcium Phosphate Bone Substitute In Distal Radial Fractures

Abstract: Fractures of the distal end of the radius are common and occur in many different forms. The long-term results after conservative treatment of fracture of the distal end of the radius in younger adults with special reference to degenerative changes and function are investigated in 76 patients (Paper I). After 30 years, 81% of the patients made no difference between the fractured and the non- fractured side. The malunion was obvious with increased dorsal, radial and axial compression. Degenerative changes in radio-carpal and distal radio-ulnar joints were found in higher proportion in the injured wrist and especially in intraarticular fractures compared to the non-injured side. Incongruity of the fracture and radial shortening were in relation with degenerative changes. Patients with degenerative changes in the radio-carpal joints had significantly more complaints. There is a need for an easy and reliable method for distal radial fracture fixation which addresses the problem of compression of cancellous bone. The feasibility of an injectable bone cement, Norian SRS, was evaluated in Paper II. In comparison to external fixation, the patients, treated with Norian SRS, showed earlier recovery of grip strength and mobility. However the fractures were not perfectly stabilized and a mild loss of fracture reduction over time could be observed in both groups, but was larger in patients treated with Norian SRS (Paper III). This instability of the fracture treated with Norian SRS was confirmed by stereometric analysis (RSA) and the need of some other type of fixation in addition to bone substitute emphasized (Paper IV). In an animal study, we found that the instability of the fracture, treated with Norian SRS, is not in relation with the time point for surgery, thus delayed surgery does not reduce the interface strength between the surface of a bone fracture and an injectable hydroxyapatite (Paper V). The need of fracture fixation with Norian SRS, in association with early mobilization was evaluated in Paper VI. We found that, in most cases, surgery can be avoided in the treatment of redislocated distal radial fractures in low demand-patients.

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