Article
Unidirectional porous beta-tricalcium phosphate: a new bone filling substitute for treatment of distal radius fracture in the elderly population
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Authors
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Keiichi Muramatsu
- Dept. Orthopedic Surgery, Nagato General Hospital, Yamaguchi University, Ube, Japan
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Ryuta Iwanaga
- Yamaguchi University, Ube, Japan
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: The distal radius is the most common fracture site in the upper extremity, especially in elderly patients. Dorsally displaced fractures are often treated by open reduction and internal fixation using the volar approach. The bony defect can be filled with bone graft substitute in order to increase the mechanical strength of the subchondral bone. A new beta-tricalcium phosphate with unidirectional pore structure (UDPTCP), Affinos® (Kurray, Okayama, Japan), has been in clinical use since 2015. To date, there have been only a few clinical studies using this material. We report here the first clinical study for distal radial fracture in the elderly population treated with UDPTCP.
Methods: Consecutive patients aged 65 years or older with dorsally displaced unstable fracture of the distal radius (n=36) were treated operatively in our department. Following reduction of the fracture site, a 7 mm size cube of UDPTCP was placed in the gap of the bony defect and the fracture stabilized with mono-axial or poly-axial type locking plates and screws. The evaluation of all cases was based on clinical examination at the final follow up as well as serial radiography. Resorption and remodeling of UDPTCP were assessed radiologically by measuring the area of filled UDPTCP and the density at their center.
Results: The clinical outcome in all cases was excellent. No serious complications were observed in the post-operative period. Significant correction loss of radial alignment was seen in patients stabilized with poly-axial locking plate. The area of filled UDPTCP and the density at their center was significantly reduced at 2 months after surgery. These results indicate that resorption and remodeling of UDPTCP starts peripherally and centrally at the same time. The resorption of UDPTCP and the formation of new bone were well balanced in our patient cohort.
Conclusion: Block UDPTCP is a safe and convenient material for the treatment of distal radius fracture and is replaced within a suitable time period after grafting into the fracture site. Additional stability can be expected by using block UDPTCP as a bone filler. UDPTCP and stable internal fixation is therefore a reliable strategy for restoring and preserving anatomical position, especially in the elderly population.
