OTA 2006 Posters

Scientific Poster #141 Upper Extremity

Distal Radius Osteotomy in the Older Age Patient using Angular Stable Implants and Norian Bone Cement
Matthew Liebman, MD; Santiago A. Lozano-Calderón, MD;
Jesse B. Jupiter, MD (a-AO Foundation);
(all authors - e-Wyeth Co, Amgen Co)
Massachusetts General Hospital ­ Harvard Medical School,
Boston, Massachusetts, USA

Introduction:­Corrective osteotomy of malunited distal radius fractures is a well-recognized and effective surgical procedure. However, it has potential technical challenges, especially with the fixation of osteopenic bone and iliac crest donor site morbidity. Two advances in technology have facilitated this procedure, both eliminating the donor site morbidity and expanding its application to osteoporotic bone. The first is the development of angular stable locked implants and the second is bone cements that are exothermic, close to the actual composition of human bone, resistant to compressive loads, and capable of filling the 3-dimensional defect treated by the osteotomy after stable internal fixation has been applied.

Materials/Methods: Our series includes 11 patients, 7 female and 4 male with an average age of 55 years, treated with this approach. Seven patients had corrections through a dorsal approach and 4 through a volar approach. Two corrections included an intra-articular osteotomy. All patients received as implants angular stable plates (2.4-mm volar T-plates for patients approached volarly and 2.4-mm L and T-plates for those approached dorsally); the osseous defect was filled with bone cement (Norian,). Patients were followed up 12 months on average. During this evaluation, range of motion and grip strength were measured. Standard radiographs of the wrist were taken to evaluate alignment and determine improvement after surgical correction. At follow-up evaluation, patients filled out the Modified Mayo Wrist score, the Modified Garland and Werley score, and the DASH questionnaire.

Results: There were no perioperative complications. All corrective osteotomies healed. One patient required a Darrach procedure at 6 months. At an average follow-up of 12 months, the average wrist and forearm motion was 70% of the opposite side and grip strength 82% of opposite side. There was no loss of reduction at late follow-up. The average correction in the sagittal plane was 17° with all patients returning to neutral or better alignment. The average ulnar variance improvement was 2.4 mm. Average postoperative DASH score was 25 points; average Modified Mayo Wrist Score, 67; and the Modified Garland and Werley score averaged 9 points.

Conclusion: We believe this operative technique to be safe and predictable, even with underlying osteoporosis, and it eliminates donor site morbidity. Patient-rated outcome measures demonstrated acceptable return to functions of daily living.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.