Evaluating the necessity of bone augmentation for distal radius fracture fixed with a volar locking plate: a retrospective study

Abstract

Background: Multiple approaches for fixation of distal radius fractures exist; nonetheless, there is no consensus on the optimal treatment for these injuries. Although using volar locking plates has become increasingly common as a surgical intervention, the usefulness of bone augmentation remains debatable. Therefore, this study aimed to evaluate the necessity of bone augmentation for distal radius fractures fixed with a volar locking plate. Methods: This retrospective study enrolled patients with a single distal radius fracture treated with a volar locking plate between January 2014 and December 2016. Overall, 105 fractures were included and divided into two groups (non-bone augmentation: group 1, n = 88; bone augmentation: group 2, n = 17). Images were reviewed, and dorsal cortex collapse, volar tilting, and radial height and inclination were measured immediately after surgery and at the 6-month follow-up. Results: Both groups exhibited significant differences in dorsal collapse (p < 0.001 and p = 0.001, respectively) and radial height shortening (p < 0.001 and p = 0.039, respectively); volar tilting and radial inclination did not differ significantly. There was no difference in the degree of dorsal collapse (p = 0.715) and radial height shortening (p = 0.651) between the two groups. Of the 105 fractures, 54 were identified as comminuted type according to the AO classification (A3, C2, and C3), and similar radiographic outcomes were noted. Conclusions: Volar locking plates for the treatment of distal radius fractures with or without bone augmentation do not affect the radiographic outcomes. In comminuted fractures, additional bone augmentation is unnecessary if intraoperative anatomical reduction and fixation are performed when possible.

Current Management and Volar Locking Plate Fixation with Bone Cement Augmentation for Elderly Distal Radius Fractures—An Updated Narrative Review

“…In this section, we reviewed the available literature regarding the use of VLPF with BCA for DRFs, especially in the elderly. According to our survey, there have been merely six related studies to date, including one RCT [24], three retrospective studies [25,26,85], and two biomechanical studies [27,28] (Table 2). We summarized their main findings with our appraisals in the following sections.…”

“…Furthermore, a retrospective comparative study by Chang et al evaluated the necessity of BCA for DRFs fixed with VLPF [26]. Overall, 105 fractures were included and divided into the non-BCA group (n = 88) and the BCA group (n = 17).…”

“…There have been few studies investigating this combination modality. One small-scale randomized-controlled trial (RCT) and two retrospective comparative studies found that BCA on VLPF offers no additional benefits in comparison with VLPF alone [24][25][26], yet two biomechanical studies reported improvement in biomechanical properties from augmented VLPF [27,28].…”

Predictive Value of Dual-Energy CT-Derived Metrics for the Use of Bone Substitutes in Distal Radius Fracture Surgery

“…With the introduction of volar locking plates, the surgical intervention rate for DRFs has increased. A volar locking plate combined with bone augmentation for osteoporotic bone fractures provides better biomechanical fixation [3]. Typically, the decision to use bone substitutes for bone defects is made during surgery based on the texture of the bone.…”

Clinical Outcomes of a Novel Unidirectional Porous β-Tricalcium Phosphate Filling in Distal Radius Fracture with Volar Locking Plate Fixation: Secondary Publication of the Japanese Version

“…In the case of distal radius fractures under the condition of osteoporotic or comminuted fractures, filling the bone defect with artificial bone is reported to maintain the correct position and promote bone fusion [4].…”