Document Detail


Distal radius osteotomy in the elderly patient using angular stable implants and Norian bone cement.
MedLine Citation:
PMID:  17826549     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To report our results after testing the combination of two technologies--angular-stable locking screw implants and Norian SRS cement--in corrective osteotomies of the distal radius in the elderly. This technique eliminates donor site bone-graft morbidity and expands the indications of corrective osteotomies to older patients with osteoporotic bone. METHODS: Our retrospective series include 6 patients (5 women and 1 man) with an average age of 60 years. Three patients had corrections through a dorsal approach, 1 through a volar approach, and 2 through a combined approach. Two corrections included an intraarticular osteotomy. We used 2.4-mm volar T plates in patients approached volarly and 2.4-mm L and T plates for those approached dorsally; the osseous defect was filled with bone cement (Norian SRS). Range of motion and grip strength were measured at 16 months average follow-up. Standard wrist radiographs were taken to evaluate alignment and determine improvement. At final follow-up, patients completed the Modified Mayo Wrist score, the Modified Gartland and Werley score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS: There were no perioperative complications. All corrective osteotomies healed. One patient required a Darrach procedure at 6 months. The average wrist and forearm motion was 77% of the opposite side and grip strength 88% of the opposite side. The average total correction in the sagittal plane was 22 degrees with all patients returning to neutral or better alignment. The average ulnar variance improvement was 2 mm. Average postoperative DASH was 28 points; average Modified Mayo Wrist score was 68; and the Modified Gartland and Werley score averaged 9 points. CONCLUSIONS: We believe that corrective osteotomy of the distal radius in the elderly using angular stable implants and Norian calcium phosphate cement is a safe and predictable surgical technique, even in patients with underlying osteoporosis. It eliminates donor site morbidity, and patient-rated outcome measures demonstrated acceptable daily living function return.
Authors:
Santiago Lozano-Calderón; Michael Moore; Matthew Liebman; Jesse B Jupiter
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of hand surgery     Volume:  32     ISSN:  0363-5023     ISO Abbreviation:  J Hand Surg Am     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-09-10     Completed Date:  2007-12-14     Revised Date:  2009-06-08    
Medline Journal Info:
Nlm Unique ID:  7609631     Medline TA:  J Hand Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  976-83     Citation Subset:  IM    
Affiliation:
Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA. slozanocalderon@partners.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Bone Cements / therapeutic use*
Bone Plates*
Calcium Phosphates / therapeutic use*
Disability Evaluation
Female
Follow-Up Studies
Fractures, Malunited / surgery*
Hand Strength
Humans
Male
Middle Aged
Osteotomy / methods*
Radius / surgery*
Radius Fractures / surgery
Range of Motion, Articular
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Bone Cements; 0/Calcium Phosphates

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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