Abstract
BackgroundThe invention of the locking plate technology leads to alterations of treatment strategies at metaphyseal fracture sites with the concept of spontaneous remodeling of trabecular bone voids. Whereas trabecular regeneration has been proven in experimental animal studies, no histologic data exist on human fracture healing with special emphasis on bone voids.MethodsIn order to qualify the trabecular bone remodeling capacity in vivo, bone specimens from the metaphyseal bone void were analyzed 14 months after trauma using quantitative histomorphometry. Twenty-five patients with an unstable dorsally displaced distal radius fracture were fixed with a palmar locking plate without additional bone graft or substitute. At implant removal, specimens from the previous compression void were harvested with a trephine in a volar-dorsal direction. In 16 patients, histomorphometric analysis could be performed, comparing the dorsal trabecular network with the volar, non-compressed ultrastructure.ResultsSignificant differences for bone volume/total volume (BV/TV), trabecular number (TbN) and trabecular separation (TbSp), but not for trabecular thickness (TbTh) and osteoid volume/total volume (OV/TV), were detected. Neither patient age, defect size nor gender had a significant influence on bone remodeling.ConclusionsThe results of this study indicate that trabecular bone remodeling does not lead to pre-trauma bone quality in metaphyseal bone compression voids following reduction and application of a locking plate.
Highlights
The invention of the locking plate technology leads to alterations of treatment strategies at metaphyseal fracture sites with the concept of spontaneous remodeling of trabecular bone voids
A particular challenge is the treatment of metaphyseal bone defects, which occur after the stabilization and anatomical reconstruction of compression fractures, e.g. at the distal radius, with internal or external implants
Significant differences between the two regions of interest were detected for the microarchitectural parameters bone volume/total volume (BV/TV), trabecular number (TbN) and trabecular separation (TbSp), indicating that the bone quality in the dorsal defect zone had not recovered to pre-trauma values of the volar aspect
Summary
The invention of the locking plate technology leads to alterations of treatment strategies at metaphyseal fracture sites with the concept of spontaneous remodeling of trabecular bone voids. A particular challenge is the treatment of metaphyseal bone defects, which occur after the stabilization and anatomical reconstruction of compression fractures, e.g. at the distal radius, with internal or external implants. Bone grafts have been proven to enhance the stability of the construct and to accelerate bone healing [3,4]. These techniques have been applied with good outcomes reported for both upper and lower
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