DRILLING, CEMENTING, PINNING OF THE OSTEOPOROTIC DISTAL RADIUS: A SERIES OF 17 CASES

Abstract

Purpose of the study: The role of injectable phosphocalcium cements for the treatment of fractures of the osteoporotic distal radius is poorly defined. Simple adjunction of a phosphocalcium cement to infrafocl pinning has not proven its efficacy. To improve this percutaneous technique, the purpose of this work was to study the contribution of prior metaphysodiaphyseal preparation by drilling to increase the quantity of cement injected and to improve is distribution on either side of the fracture line, with the hope of limiting the progressive degradation of the radioulnar index.

Material and methods: Sixteen patients aged 76.5 years on average (range 65–92 years) were treated starting in 2004 for fractures of the distal radius with posterior displacement and very porotic bone. After orthopedic reduction with external manoeuvres, three n°18 pins were introduced into the fracture focus percutaneously. After pin insertion, a fourth stab incision was made at the apex of the radial styloid process for insertion of a n°11 trocar which was advanced to the medial cortex without perforating it. The trocar was then removed to allow insertion of a curved pin for the purpose of drilling out the remaining bony network to the distal part of the shaft through to the subchondral bone. 20 mg Cementek LV® was then injected under fluoroscopic control. The postoperative protocol was as usual with an orthesis for six weeks and pin removal at six weeks.

Results: Mean follow-up was nine months. There were five complications which resolved (reflex dystrophy). On average, 4.6 ml was injected. There were eight cases of cement leakage which was «milked out» as much as possible via the skin incision. Leaks resorbed in a few months and did not have any clinical impact. At follow-up, clinical outcome (pain, strength, mobility, DASH), and radiological indices were satisfactory. Loss of the distal radioulnar index was 1 mm on average.

Discussion: This technique for drilling, cementing, pinning, appears to limit secondary displacements of distal radial fractures with osteoporotic bone. Cement leakage is not sufficient to contraindicate this method since all observed leaks resorbed spontaneously with no sequelae. Longer follow-up will be necessary to confirm these encouraging results.