The authors report a prospective, randomize trial comparing hydroxyapatite cement with Kirschner wire fixation in the treatment of acute distal radius fractures. Eighteen female patients over the age of 60 years with Melone type 1 or type 11a fractures were included in the study. Randomization occurred intra-operatively after performing a closed reduction maneuver. In one group of 9 patients, the fracture was stabilized with 2 to 3 Kirschner wires. In the other group of 9 patients, the fracture was exposed dorsally and filled with hydroxyapatite cement (Orthofix Bonesource, Osteogenics Inc., Richardson, TX). The treated wrists in both groups of patients were immobilized for 4 weeks in a short arm cast; the Kirschner wires in the first group were removed 6 weeks post-operatively. The authors noted a loss of reduction in the hydroxyapatite treated group of patients within 1 week of surgery (i.e., increased dorsal angulation). They concluded that hydoxyapatite bone cement should be used only in combination with skeletal fixation when distal radius fractures are managed surgically.
Loss of dorsal support due to impaction of cancellous bone at the fracture site contributes to distal radius fracture instability. A variety of bone mineral substitutes have been developed to replace and/or augment autogenous bone grafting sources. Orthofix Bonesource and Norian Skeletal Repair System (Norian Corp, Cupertino, CA) are two such materials under investigation. Experimental and now clinical studies support the need for supplemental K-wire fixation when using these materials. The cements have no adhesive properties and cannot control the distal fragments alone. Furthermore, it remains unclear which fracture types and which patients (e.g. those with ostoporosis) are best treated with these methods. Newer cement delivery systems currently being developed may expand this indication.
J Hand Surg