Treatment of comminuted distal radius fractures with in situ autologous cancellous bone graft using intrafocal technique through the extended flexor carpi radialis approach

Abstract

Objective To explore the clinical effect of fracture reduction, autologous cancellous bone graft and palmar double-tiered subchondral locking support plate fixation through the extended flexor carpi radialis approach for treatment of comminuted distal radius fractures. Methods From October 2015 to August 2016, a total of 18 cases of comminuted distal radius fractures (AO type C3)were treated. The extended flexor carpi radialis approach were applied by transection of radialis septum and brachioradialis tendon insertion. Proximal end of radius fractures were dissected subperiosteally and pronated to expand the exposure range. Proper reduction and autogenous cancellous bone graft harvested from the proximal radius were achieved by using the intrafocal technique. The fractures were fixed by a volar double-tiered subchondral support locking plate. The clinical effect was analyzed according to the amount of autologous cancellous bone, postoperative wrist activity, postoperative radiographic parameters and Gartland-Werley wrist score. Results The amount of autologous cancellous bone was 1.2 to 3.1 cm3, with an average of 2.3 cm3. All the patients were follow-up for 9 to 19 months, with an average of 12.4 months. All the fractures were healed. No extensor tendon and median nerve injury symptoms occurred. At 9 months after the operation, the activity of affected wrist was (51.24 + 4.72) ° on flexion, (48.86±6.32)° on extension, (15.58±3.72)°on radial deviation, (24.67±5.82)° on ulnar deviation, (76.34±11.54)° on pronation and (74.58±10.56)° on supination. According to the Gartland-Werley wrist score, the results were excellent in 7 cases, good in 8 cases, fair in 2 cases and poor in 1 case. The results of imaging examination showed that the ulnar deviation angle was 13.1° to 24.6° with an average of 23.8°, the volar tilt angle was 10.3° to 14.3° with an average of 13.2°, the radial height was 9.3 to 14.8 mm with an average of 13.1 mm. Conclusion The sufficient volar exposure by the extended flexor carpi radialis approach can facilitate the fracture reduction under direct vision and subchondral support with autogenous cancellous bone graft harvested from the proximal fragment using the intrafocal technique. And stable fixation of the dorsal, volar and central fragments with double-tiered subchondral support plate can also facilitate the functional restoration in the treatment of comminuted distal radius fractures. Key words: Radius fractures; Bone transplantation; Extended flexor carpi radialis approach; Intrafocal technique; Double-tiered subchondral support