Cement pinning of osteoporotic distal radius fractures with an injectable calcium phosphate bone substitute: report of 6 cases

Abstract

The treatment of osteoporotic distal radius fractures is frequently complicated by secondary displacements, mainly because of the posterior comminution. This work studies the advantages of injectable calcium phosphate cement, applied in addition to osteosynthesis with intrafocal pins. Our series comprises six osteoporotic patients with an average age of 77.5 years, showing a fracture of the distal radius osteosynthesized with pins. Cement has then been injected via the radial styloid. The result has been evaluated at an average interval of 14.7 months. The pain has been measured on an analogue visual scale and overall function by the DASH score. Mobility and gripping strength have been compared with the controlateral side. Radiographies have shown the presence of cement leakages, studied the resorption rate and measured secondary displacement. On the clinical level, the pain at the last examination was estimated at an average of 0.66 and total function at 30.28. Compared to the controlateral side, flexion-extension mobility was on average 95.3%, prono-supination 99%, and gripping strength 80.25%. There have been complaints of two resolutive reflex sympathetic dystrophy. Radiologically, the cement has distributed itself along the path of the trocar, in average quantities of 2 ml. Three anterior leaks of cement have been noticed, resorbed within a few months. The radio-ulnar index has lost on average 1.7 mm but the inclination of the radial glene has remained stable. At the last examination, resorption of the intra-osseous cement was partial three times and subtotal three times. Despite the paucity of the sample, it appears that adding calcium phosphate cement does not reduce secondary displacements. The asymptomatic extra-osseous leakages of cement disappeared on average in 6 months. The intra-osseous cement’s resorption rate was slower. Despite the partial results, calcium phosphate cements retain a place in the treatment of distal radius fractures, provided that they remain injectable and address unstable fractures in porotic bone. Cimentobrochage des fractures du radius distal osteoporotique avec un substitut osseux phosphocalcique injectable: a propos d’une serie preliminaire de 6 cas