Abstract
Background: There is a large assortment of modalities for the surgical treatment/management of distal radius fractures (DRFs), where the most widely used is the fixed-angle volar plating (VLP) system, which, sometimes, is referred to as the “surgical modality of choice”. While outcomes with each modality are usually good to excellent, each has its share of shortcomings and complications. Thus, there is scope for improvements to existing modalities and/or introduction of new ones. Study Purpose: We introduce a novel modality, namely, the prototype of an intramedullary injectable bioresorbable polymer-bioresorbable balloon osteosynthesis (IPBO) system, and investigated its plausibility. Experimental Procedures: The biomechanical performance of a construct comprising a synthetic distal radius (fourth-generation Sawbones?) on which a simulated fracture was created (4-mm wide osteotomy positioned 25 mm from the most distal end of the radius) and fixated with a placement of the IPBO system (SIPBO Construct) was compared to that when the fixation was with an approved Ti-6Al-4V alloy VLP system (SVLP Construct), under a clinically-relevant compressive loading protocol. Performance involved determination of quantitative parameters of the construct (initial longitudinal stiffness (ICLS), final longitudinal stiffness (FCLS), and load-to-failure (Pf)) and observation and recording of features of the construct at the fracture point. We also determined the quantitative parameters for the intact synthetic distal radius (control). Results: For each of the quantitative parameters, the range of values for SIPBO Construct was within that for SVLP Construct, suggesting that the IPBO System is a plausible modality. Also, for SIPBO Construct, failure occurred within the polymer zone, whereas, for SVLP Construct, some failure features were fracture of the cortical wall and of the dorsal proximal fragments. Conclusion: The findings suggest that the IPBO system is plausible. As such, it merits further study; for example, determination of the influence of fracture gap fill ratio (defined as the proportion of the fracture gap that is filled by the expanding balloon as the polymer is injected into the balloon) on a large collection of quantitative biomechanical parameters.
Highlights
Distal radius fractures (DRFs) are, undoubtedly, one of the most common fractures of the upper extremity but, of the whole skeletal system; for example, in the United States, they account for −20% of cases presented at emergency medicine departments [1]
ICLS of SIPBO Construct was within the range of that of SVLP Construct, with the same trend found for FCLS and for Pf (Table 1)
Each of the SIPBO constructs failed, with the location of failure being in the polymer, which is attributed to insufficient polymer expansion within the fracture gap (Figures 5(a)-(c))
Summary
Distal radius fractures (DRFs) are, undoubtedly, one of the most common fractures of the upper extremity but, of the whole skeletal system; for example, in the United States, they account for −20% of cases presented at emergency medicine departments [1]. There is a large volume of literature on clinical performance (functional scores and radiological outcomes) of many modalities, either on their own or in comparison with one or more of others [13]-[19] This has led to identification and discussion of shortcomings and complications of many modalities [17]. There is scope for modifications to current modalities and/or introduction of new ones In this regard, we have a developed the prototype of a novel modality that utilizes an injectable bioresorbable polymer balloon and intramedullary placement; that is, a prototype of an intramedullary injectable bioresorbable polymer-bioresorbable balloon osteosynthesis (IPBO) system. There is a large assortment of modalities for the surgical treatment/management of distal radius fractures (DRFs), where the most widely used is the fixed-angle volar plating (VLP) system, which, sometimes, is referred to as the “surgical modality of choice”. For SIPBO Construct, failure occurred within the polymer zone, whereas, for SVLP Con-
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