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Is There a Role for Bone Grafting in Severely Comminuted Distal Radius Fractures Treated With Locking Plate Fixation?
Dawn Chia, MBBS, MRCS, MMed
Tan Tock Seng Hospital, Singapore

Introduction: The introduction of locking plate technology has increased the range of distal radius fracture types amenable to fixation without the need for bone grafting as suggested by current literature. However, large bony defects in severely comminuted metaphyseal fractures may still compromise the results of locking plate fixation. Similarly, the locking plate may not adequately address small, unstable intra-articular fragments. In our study, we look at the outcomes of bone grafting used in severely comminuted distal radius fractures fixed with locking plates.
Methods: We analyzed prospectively collected data of all patients who underwent surgical fixation of comminuted distal radius fractures with locking plates and bone grafting in our institution. All patients underwent a standardized postoperative rehabilitation program. Wrist motion, grip strength, and radiographic parameters and fracture union were assessed at 3, 6, and 12months. At 12 months, the DASH (Disability of Arm Shoulder Hand) scores were evaluated.
Results: 60 of 450 consecutive patients (13%) who underwent distal radius fracture fixation with volar locking plate systems required autologous bone graft (n=30) or synthetic bone substitutes (n=30). Bone grafting was indicated for maintenance of reduction in the setting of severely comminuted articular fragments or large volar-dorsal metaphyseal defects. No donor site morbidity was encountered. At final follow up, all fractures united with an average volar tilt of 4°, radial inclination of 18.8 °, and articular step or gap of 0.1mm. The outcomes were excellent or good in 75%.
Summary: We recommend the incorporation of bone grafts as a valuable adjunct in maintaining the reduction position of articular fracture fragments, as well as for fractures with combined volar and dorsal metaphyseal comminution.


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