Purpose: The purpose of this study is to evaluate the safety of methylmethacrylate cement balloon kypho-plasty (BK) when applied to five or six levels in the same sitting and the incidence and location of cement leakage. Methods: Eighty nine patients (215 vertebral bodies-VBs) with osteoporotic compressive fractures (OCF), and 24 with osteolytic tumors (OT) (72 VBs) were treated with BK. Of patients with OCF, 27 were treated at one level, 26 at two, 21 at three, 7 at four, 6 at five, 2 at six levels. Of OT patients, 3 were treated at one level, 5 at two, 9 at three, 3 at four, and 4 at five. Results: A drop in blood pressure of more than 25mmHg during cement injection was observed in four patients, and was not associated with the number of VB treated. The procedure was aborted in two patients. Otherwise no significant drop in arterial O2 was noted. One patient treated for 5 levels developed fever and tachepnoea for 24 hours after surgery. Arterial O2 and chest x-rays were normal. Pain significantly improved in 95% of patients with OCF and 98% of patients with tumors. In the osteoporotic group, kyphosis correction was achieved in 91% with a mean correction of 7.89°. Cement leakage occurred in 21/215 VBs (9.7%); Epidural: two (0.9%), intraforaminal: 1 (0.5%), intradiscal: 7 (3.2%) while through the anterior or lateral vertebral wall: 11 (5.1%). In the OT group leakage occurred in 6 VBs (8.3%), including 9 (7.0%) through the anterior or lateral wall and one (1.3%) intradiscal. None of the patients had any clinical consequences associated with cement leakage. Conclusions: BK is a safe and effective procedure, even when applied for 5 or 6 levels. End plate fracture or vertebral wall lytic destruction can effectively be managed by eggshell balloon cementoplasty, thus minimizing the incidence of cement leakage. The incidence of cement leakage with KP (9.8%) is far less than that reported with vertebroplasty, (65.5% shown on CT scans)

The ‘cement reaction’ is a recognised cardio-respiratory response to methylmethacrylate bone cement, characterised by hypotension, reduced cardiac output, and on occasion fatal circulatory collapse. It is seen in 0.5-1% of cemented hip arthroplasties during the insertion and pressurisation of cement into the femur, and is believed to be secondary to marrow thromboembolism, the vasodilatory effect of methylmethacrylate, or a combination of the two. A number of steps, within the operating surgeon's control, can be undertaken to reduce the risk of the ‘cement reaction’ occurring. An e-mail based questionnaire was sent to all trainees and consultants in the West of Scotland containing eight questions relating to cementing technique when performing hemiarthroplasty of the hip. The questions related to measures to reduce the potential for ‘cement reaction’, e.g.: whether or not they routinely use a cement restrictor. Seventy-two complete replies were received. For five of the eight measures, the surgeons routinely employed the suggested practices. For the remaining three, the consensus opinion was contrary to the suggested practice for reduction of the risk of ‘cement reaction’. These were with respect to the surgical approach employed, whether or not to attempt to remove all cancellous bone from the proximal femur, and the use, or not, of a venting tube during cement insertion. In all three cases, the difference was statistically significant on chi-squared testing. The cohort of surgeons questioned routinely employ more than half of the methods suggested to reduce the potential for ‘cement reaction’ in hemiarthroplasty of the hip. Further surveys of why they do, or do not, undertake certain practices during cementing would help improve awareness of ‘cement reaction’, and perhaps reduce the incidence of this potentially fatal phenomenon

In properly chosen patients, cementless total knee arthroplasty has achieved success rates equal to cemented designs. The initial variable results of early cementless total knee replacements were a function of design, surgical technique and patient selection. Important design considerations that have enhanced biologic ingrowth include the use of commercially pure titanium with optimal pore size and porosity, and avoidance of porous-coated stems and plugs that cause stress shielding of the bone-implant interface. Factors in surgical technique that enhance bone ingrowth include precise bone cuts that maximise bone-implant contact, and the application of autogenous bone slurry to cut surfaces. Additional factors are restoration of normal alignment, appropriate ligament balance, and the reproduction of the patient's native tibial slope in order to prevent tibial component subsidence. Young and active patients are ideal biological hosts for the use of cementless knee fixation. Their relatively dense cancellous bone and rich blood supply provides for robust purchase for initial fixation and the appropriate milieu for long-term biologic fixation. With increasing life expectancy, this more durable interface is desirable. With avoidance of porous-coated stems and pegs and prevention of fibrous tissue attachment, potential future revisions are more bone-sparing relative to methylmethacrylate fixation. Numerous reports, as well as the authors’ published 10- to 14-year results, demonstrate that cementless fixation in appropriately selected patients provides results comparable to cemented TKA, with the advantage of conserving bone stock and eliminating the potential problems of cement fixation

In properly chosen patients, cementless total knee arthroplasty has achieved success rates equal to cemented designs. The initial variable results of early cementless total knee replacements were a function of design, surgical technique and patient selection. Important design considerations that have enhanced biologic ingrowth include the use of commercially pure titanium with optimal pore size and porosity, and avoidance of porous-coated stems and plugs that cause stress shielding of the bone-implant interface. Factors in surgical technique that enhance bone ingrowth include precise bone cuts that maximize bone-implant contact, and the application of autogenous bone slurry to cut surfaces. Additional factors are restoration of normal alignment, appropriate ligament balance, and the reproduction of the patient's native tibial slope in order to prevent tibial component subsidence. Young and active patients are ideal biological hosts for the use of cementless knee fixation. Their relatively dense cancellous bone and rich blood supply provides for robust purchase for initial fixation and the appropriate milieu for long-term biologic fixation. With increasing life expectancy, this more durable interface is desirable. With avoidance of porous-coated stems and pegs and prevention of fibrous tissue attachment, potential future revisions are more bone-sparing relative to methylmethacrylate fixation. Numerous reports, as well as the authors' published 10- to 14-year results, demonstrate that cementless fixation in appropriately selected patients provides results comparable to cemented TKA, with the advantage of conserving bone stock and eliminating the potential problems of cement fixation

Background. Currently, stailess steel, titanium and carbon-fiber reinforced polyetheretherketone (CF-PEEK) plates are available for the treatment of distal radius fractures. Since the possibility to create a less rigid fixation may represent an advantage in case of ostheoporotic or poor quality bone, the aim of this study is to compare the biomechanical properties of these three materials in terms of bending stiffness with a single static load and after cyclical loading, simulating physiologic wrist motion. Materials and Methods. Three volar plating systems with fixed angle were tested: Zimmer stainless steel volar lateral column (Warsaw, IN); Hand Innovations titanium DVR (Miami, FL); Lima Corporate CF-PEEK DiPHOS-RM (San Daniele Del Friuli, Udine, Italy). For each type of plate tested four right synthetic composite bone radii were used. An unstable, extraarticular fracture was simulated by making an 8 mm gap with a saw starting 12 mm proximal to the articular surface of the radius on the distal radio-ulnar joint side. The osteotomies were made perpendicular to the long axis of the bone to allow for a consistent fracture gap on the dorsal and volar sides of the radius. Plates were implanted using all the distal and proximal fixation holes [Fig. 1]. Each synthetic radius model was potted in methylmethacrylate and tested in a bi-axial servo-hydraulic test frame (MTS Minibionix 858, universal testing machine) for load to failure by advancing a cobalt chrome sphere centered over the articular surface at a constant rate of displacement of 5 mm/min. The sphere was advanced until the construct failed or the dorsal edges of the fracture met. The resultant force was defined as bending stiffness pre fatigue. Three constructs for each plate were then dynamically loaded for 6000 cycles of fatigue at a frequency of 10Hz, with a load value corresponding to the 50% of the previously calculated bending strength. Finally, the constructs were loaded to failure, measuring the bending stiffness post fatigue. Results. All fracture constructs survived all phases of the cyclic loading testing. The mean bending stiffness pre fatigue was higher for the Zimmer plate (155.23±1.91 N/mm), in comparison to Hand Innovations (138.67±4.72 N/mm), and DiPHOS-RM (124.75±3.60 N/mm) [Fig. 2]. After cyclic loading, stiffness increased significantly of a mean 24% for the Zimmer plate (190.42±4.33 N/mm); 33% for the Hand Innovations (186.57±1.71 N/mm); and 18% for the DiPHOS-RM (146.28±1.52 N/mm) [Fig. 2–3]. Conclusions. CF-PEEK plate is less stiff than stainless steel and titanium plates, with an elastic modulus more similar to bone as well as the ability to withstand prolonged fatigue strain. From these preliminary data it might be assumed that the CF-PEEK plates could provide a sufficiently stable osteosynthesis, flexible enough to unload the implant-bone interface, minimising peak stresses at the bone- implant interface, making them particularly suitable for fracture fixation in osteoporotic patients. A proper patient selection (avoiding incompliant or non collaborative) should be performed using CF-PEEK plates to avoid possible implant breakage consequent to a fall or a second trauma on the injuried wrist until the complete fracture healing. For any figures or tables, please contact authors directly (see Info & Metrics tab above).

Purpose: estimate efficiency minimally invasive methods of treatment at patients with tumor lesion of bones. Materials and methods: 145 patients, middle age e 42 years. it has been executed 249 percutaneous vertebroplasty, 15 osteoplasty and 46 radiofrequency thermal ablation Most often minimally invasive methods were carried out to patients with bone metastasis lesion of a breast cancer – 65 (44,8%) and kidneys – 14 (10%) patients. Results: reduction in a painful syndrome on a visual analog scale after operation is noted at 126 (87%) by patients. Positive dynamics Watkins scale at 119 (82%). Improvement of quality of a life on scale Karnofski at 94 (65%) the patient. Complications after vertebroplasty and osteoplasty in the form of methylmethacrylate leak into the surrounding tissues at 19 (18,5%) patients. At one patient after radiofrequency thermal ablation has developed burn skin. There were three pathological bone fractures after radiofrequency thermal ablation. Conclusions: vertebroplasty, osteoplasty and radiofrequency thermal ablation – minimally invasive methods of treatment the patients with tumoral lesion of the bones, allowing in short tim stop a painful syndrome, create adequate stability in a bone segment and improve quality of a life of oncological patients

Pain and kyphosis in vertebral body compression fractures (VBCF) impair quality of life. Conservative treatment has been the proposed solution up to now. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps (IBT) into the vertebral body by a trans-pedicle approach. The purpose of IBT is to restore the original height of the vertebral body while creating a cavity that can be filled with highly viscous methylmethacrylate. We prospectively evaluated the safety and efficacy of kyphoplasty in the treatment of pain related to pathological vertebral body compression fractures resulting from osteoporotic collapse, multiple myeloma, primary malignant tumours (lymphoma) and metastatic cancer. Clinical results show immediate and maintained pain relief in all patients who received this treatment and a more rapid improvement in function. Pain relief may be related to spinal realignment by restoring the weight-bearing on the anterior column and to biological factors such as damage of pain-receptors due to the high temperature of cement polymerisation

Background. Continual implant stability is an important factor for the long-term success of cementless hip replacements. The increasing lifespan of patients causes a higher frequency of osteoporosis which may result in implant loosening due to bone loss. This study aimed to evaluate stability of long living implants in patients with advanced age. Patients and methods. Nine cementless stems made of Titanium-alloy including adjacent bone tissue obtained post mortem were evaluated by radiologic-microradigraphical, histological and morphometrical analysis. The percentage of the surface area covered by bone (BICI=bone implant contact index) was determined. The age of seven women and two men ranged between 81 and 92 years. The time in situ ranged between 10 and 20 years. From the entire length of the femora bearing implants 5 transverse segments were excised, dehydrated, embedded in methylmethacrylate. After the grinding procedure, the sections were evaluated by light microscopy and morphometrical analysis. The autopsy findings were recorded. Atherosclerosis and their related diseases were evident in all cases. Results. The femora of all female patients revealed features of high bony atrophy with concomitant transformation of the corticalis into spongy bone, whereas in male patients minor to moderate atrophic bone changes in the proximal femoral area without implication of the corticalis could be observed. All of the cementless stems made of Titanium-alloy showed osteointegration. The stabilization of the implant resulted in the forceps-like encasement of the edges of the implant within the cortical anchoring and by the development of compensatory bony hypertrophy. The BICI ranged between 35 und 63 percent. Conclusion. Elderly patients provided with cementless hip replacments revealed stable implants in spite of marked bone atrophy and an implantation period up to 20 years. Simultaneously, severe atherosclerosis and their related diseases, which may contribute to bone loss, were evident. The present findings may result from the favoring properties of cementless endoprostheses made of titanium alloy, cortical prosthesis anchoring, and self regulating bone processes. Pharmacologic and therapeutic consequences together with geriatric assessment should be required to preserve functionality and mobility

Purpose: To present a series of 49 patients which underwent single or two staged complete spondylectomy, vertebral body reconstruction and segmental spinal stabilization due to spinal tumors. Materials and Methods: From 1992 to 2002, 49 patients with primary or metastatic spinal tumors were treated. There were 36 females and 13 males with mean age at operation of 53.5 years (19 – 80). The preoperative classification was Frankel E in 17 cases, B – D in 31 cases and A in one case. Five patients had nerve root dysfunction and one, classified as Frankel E, had sphincter inadequacy. The parts of the spine involved were lower cervical in 7 cases, thoracic in 10, thoracolumbar in 15 and lumbar in 17 cases. The operations were two staged in 36 cases and single staged in 13 cases. In the cervical spine, titanium cylinders filled with methylmethacrylate were used. For the rest of the spine, the most commonly used instruments were the Kaneda device, followed by the Miami–MOSS system. Bone graft was used in five benign tumors. Mean follow – up was 62.3 months. Results: One patient died during the anterior procedure and in another it had to be interrupted, whereupon he died one week later. Two patients died due to their underlying pathology in the 6th post–operative month. Complications included wound healing problems in 9 patients and local recurrence in one patient. There were no neurological deteriorations or instrument failures. The majority of patients experienced improvement in their neurological status, reduction of pain or both. Most patients were functionally improved and spinal alignment was maintained in all. Conclusion: Spinal tumor resection and spinal reconstruction provide stability, early weight bearing, symptom remission and neurological improvement

Aims

There is an increasing concern of osteoporotic fractures in the ageing population. Low-magnitude high-frequency vibration (LMHFV) was shown to significantly enhance osteoporotic fracture healing through alteration of osteocyte lacuno-canalicular network (LCN). Dentin matrix protein 1 (DMP1) in osteocytes is known to be responsible for maintaining the LCN and mineralization. This study aimed to investigate the role of osteocyte-specific DMP1 during osteoporotic fracture healing augmented by LMHFV.

Aim: To determine if bonewax will act as a suitable barrier during cementation of bone cavities after curettage of bone tumours. Method: One mix of methylmethacrylate cement was placed on top of a standard piece of bonewax. A steel thermometer probe was used to measure the temperature of the surface of the cement. The temperature was measured above and below the bonewax. Results: The surface temperature of the cement was found to be 57°C both above and below the bonewax. The exothermic reaction occurred after the end of the cement working time, thus the bonewax acted as a physical barrier to protrusion of cement before melting away. Discussion: Bone tumours such as GCT may cause cortical destruction. Standard treatment for many such benign tumours is curettage and cementation. 1. This is simplest when there is no cortical defect, other than the cortical window which is created by the surgeon who then curettes the tumour and performs any adjuvant therapy that is indicated. The cavity is then filled with cement, which is applied while still workable and runny to allow complete fill of the cavity. Pressurisation is the norm to interdigitate cement into bone to produce thermal necrosis of residual tumour cells. Problems occur when a cortical defect exists as this will allow the escape of cement into the joint or soft tissues with a detrimental thermal effect on cartilage or soft tissues. 2. ,. 3. The surface temperature found in this study is consistent with others. 4. A cortical defect will deny effective pressurisation, interdigitation and thermal necrosis of tumour cells. We have used bonewax in such surgery and found it is an effective barrier to cement protrusion during cementation of an incomplete cavity and allows effective pressurisation and interdigitation of cement whilst preventing potentially harmful escape of cement and direct contact with cartilage or soft tissues and thus reduces the risk of immediate thermal necrosis and of later third body joint wear. 1. , or soft tissue irritation. Furthermore the bonewax disappears and is non-toxic

Purpose: The objective of this study is to investigate the effects of the Reamer-Irrigator-Aspirator (RIA) on fat embolism outcome, as compared to the standard AO reamer, utilizing physiologic parameters as outcome measures. Methods: All animal procedures were approved by the Animal Care Committee. Fifteen animal experiments were completed. Following anesthesia, each pig was intubated and ventilated. Initial blood samples were analyzed for proper ventilation and acceptable baseline conditions (PaCO2 between 35–40 mm Hg). One third of the pig’s blood volume was withdrawn to simulate hemorrhagic shock. Each animal was kept in a state of hypovolemia for an hour before transfusion and resuscitation. Each pig underwent alternate assignment into either the RIA or AO group. The distal femur was exposed and reamed in a retrograde fashion, followed by cement pressurization with methylmethacrylate. Physiologic measurements included mean arterial pressure (MAP), pulmonary arterial pressure (PAP), partial pressure of arterial oxygen (PaO2), and cardiac output. Upon completion, the animals were euthanized. The data was analyzed using the SPSS statistical program. Results: One animal in the AO group expired after cement pressurization associated with profound hypotension, pulmonary hypertension and eventual cardiac arrest. There was a statistically significant difference for PaO2 (P = 0.004), cardiac output (P = 0.002), and PAP (P = 0.005) between the AO and RIA groups. That is, by the completion of the experiment the RIA group had higher PaO2, lower PAP, and higher cardiac output measurements as compared to the AO group. There was no statistical significance between the two groups with respect to MAP (P = 0.468). Conclusions: Using established physiologic parameters, there appears to be a difference between the standard AO reamer and the RIA in terms of fat embolism outcome. The RIA showed a more favorable outcome with respect to PAP, PaO2, and cardiac output. With its simultaneous irrigation and aspiration, the RIA may result in less intramedullary fat displacement into the systemic circulation

Deep periprostheses infection is a devastating complication that occurred in 8 to 20% of patients treated by en bloc resection and prosthetic reconstruction for bone sarcomas. The systemic safety of high dose vancomycin loaded spacer has been investigated but rarely the elution of vancomycin in vivo. The aim of the study is to evaluate the elution of vancomycin into the site of the excision arthroplasty to see if effective bactericidal activity can be obtained. Patients and Methods: From 2006 to 2008, 16 consecutive patients were managed by prosthetic exchange procedure using high dose vancomycin loaded cement. Patients were males :7, females :9. Average of age at the time of surgery was 22 years. Antibiotic-loaded methylmethacrylate cement beads were prepared by adding 4 g of vancomycin powder to a 40 g pack of Palacos R cement in the operative place immediately before the operation. We used 4 G vancomycin per batch of 40 G cement and generally used 2 to 4 batches of cement in one spacer depending of the size and length of resection. The average dose of vancomycin was 7.5 G (4–14.5). The wounds were closed with absorbable mono-filaments sutures over one suction drain. Intravenous antibiotics excluding vancomycin were given for 6 to 24 weeks. Patients biological values and the concentrations of vancomycin in the blood and in the aliquots of suction drainage were checked daily until removal of drain. Vancomycin was measured by fluorescent polarization immunoassay on the AxSYM analyzer (Abbott). Results: the serum concentration of vancomycin remained in all patients under 2 μg/ml confirming the systemic safety of the method. Local concentration of vancomycin depended of the dose of vancomycin used and decreased quickly during the first week: half life :2.25 days. For a dose of 10 G vancomycin, the average concentration in the liquid from the drain was :. d1 :725μg/ml. d2 :510 μg/ml. d3 :346 μg/ml. on day 10, its remained over 35μg/ml vancomycin in the aliquot of the drain. These results should be compared to the bactericidal concentration of vancomycin for staphylococcus aureus:10 to 20 μg/ml for usual organisms, 20 to 40 for resistant organisms. We had no reported cases of allergy, toxicity or intolerance. Conclusion : high dose vancomycin spacers result in very low serum concentration without risk of systemic toxicity. In the operative wound, very high concentration are obtained, 10 to 20 fold bactericidal concentration for staphylococcus aureus. Additional studies are needed, with longer follow-up to evaluate the clinical efficacy of this method

The circulatory effects of multilevel balloon kyphoplasty (BK) are not adequately addressed, neither the effectiveness of egg shell cementoplasty in preventing anticipated cement leakage in difficult cases. The purpose of this study was to evaluate. the effect of multilevel BK to blood pressure and arterial blood gasses;. the incidence of methylmethacrylate cement leakage using routine postoperative computer tomography scan and. the effectiveness of egg shell cementoplasty to prevent cement leaks. Materials and methods: This is a prospective study of 89 patients (215 vertebral bodies-VBs) with osteoporotic compressive fractures (OCF), and 27 with osteolytic tumors (OT) (88 VBs). The mean age was 67.6 years. 27 patients with OCF were treated at one level, 26 at two, 21 at three, 7 at four, 6 at five, and 2 at six levels at the same sitting. Three patients with OT were treated at one level, 6 at two, 9 at three, 3 at four, 4 at five, and 2 at seven. Egg shell balloon cementoplasty to prevent cement leakage was performed in 10 patients with severe endplate fracture or vertebral wall lytic destruction. Arterial blood pressure and oxygen saturation were monitored during surgery. Arterial blood gases were measured before and 3 min after cement injection. Cement leakage was assessed by the postoperative x rays and computer tomography scans. Results: A drop in blood pressure of more than 25mmHg during cement injection was observed in 6 patients, and was not associated with the number of VB treated. Blood pressure was dropped more than 40mm in 2 patients and the procedure was aborted after completing 1 level in the first and 2 levels in the second. Drop in arterial O2 saturation was noted in 4 patients. One patient treated for 5 levels developed fever and tachepnoea for 24 hours after surgery. Arterial O2 and chest x-rays were normal. Cement leakage was found in 9.7% (21/215) of VBs treated for OCF. Its incidence per location was: epidural, 0.9% (2 VBs); intraforaminal, 0.5% (1 VB); intradiscal, 3.2% (7 VBs); and through anterior or lateral walls, 5.1% (11 VBs). In the OT group cement leakage was found in 10.2% (9/88) of the treated VBs. Its location included 8 (9%) through the anterior or lateral walls and one (1.1%) intradiscal. Cement leakage had no clinical consequences. No cement leakage was observed in cases treated with egg shell balloon cementoplasty. Conclusions: BK is a safe procedure when applied for multiple levels in the same sitting, and its rare circulatory effects are not related to the number of levels treated. The incidence of cement leakage in this study was 10%, which is far less than that reported with vertebroplasty using routine postoperative CT scan. Egg shell balloon cementoplasty can effectively minimize cement leakage in cases with fractured endplate or lytic destruction of VB walls

Purpose: Fractures o the distal radius remain a problem difficult to resolve. A post-operative displacement is observed in about half the cases. The displacement is generally a secondary shortening with mis- or unrecognized metaphyseal comminution. In the United State, autologous bone graft is widely used, which, like bone substitutes also used in France, allows appropriate filling of the metaphyseal comminution which always remains open after pin withdrawal. We present a prospective series of 30 patients with a fracture of the distal radius treated by pin or plate fixation in combination with Norian to fill the substance loss subsequent to metaphyseal comminution. Material and methods: Thirty patients were treated between November 1998 and March 1999 for fracture of the distal radius with posterior displacement. The inclusion criterion was comminution > 2 according to the Laulan classification. All were treated by osteosynthesis with plate or pin fixation and insertion of Norian. There were 26 women and 4 men. Twenty-two patients had an articular fracture. Plate fixation was used in ten patients and pin fixation in 19. The fracture involved the dominant side in 21 cases. The fracture was closed in all cases. Norian was injected after osteosynthesis following the recommendations of the manufacturer (impaction of the cavity rims created by the comminution, no motion for 10 min after injection). All patients were reviewed at 1, 3 and 6 months and at last follow-up. The flexion-extension and pronation-supination amplitudes were measured, as was the muscle force. Results: All patients were reviewed with a minimum follow-up of at least 2 years. Mean age was 65 years (545–82). All fractures had consolidated. There were three defective calluses in patients aged over 80 years with osteoporosis; the clinical outcome was better than the radiological image. Three patients developed reflex dystrophy. Mean amplitudes were: flexion 43.6°, extension 52.3°, pronation 63°, supination 70°. The mean wrist force was 52 kpa. No complications related to Norian were observed. Two biopsies were made and showed, in one case at six months, early signs of osteointegration. The product disappeared progressively after 2 years but not in all patients. The immediate postoperative ulnar variance was unchanged at last follow-up. In seven patients the ulnar variance was modified with impaction of the fracture line but with no effect on pronation-supination. Discussion: Metaphyseal comminution after fracture of the distal radius is a classical observation. It may be located posteriorly or anteriorly and leads to secondary impaction before or after pin withdrawal. To avoid this problem, and the inversion of the ulnar variance, the bone defect must be filed at the initial surgical procedure. Solutions include bone grafts (autograft, allograft, xenograft) and injection of methylmethacrylate. Bone substitutes can now be used to fill the gap without the theoretical or real risk of bacterial contamination. The first studies in animal models were published in 1995. Kopylov and Jupiter demonstrated the contribution of Norian for fractures of the lower end of the radius to avoid impaction and improve pronation-supination. Conclusion: Metaphyseal comminution of fractures of the distal radius is a real problem. If the gap is not filled during the initial surgical treatment, impaction with inversion of the ulnar variance can lead to pronation-supination insufficiency. Norian SRS can be used to fill the bone defect producing mechanical results as good as or better than compression cancellous grafts. The produce is resorbed slowly and is easy to use. Its high cost is undoubtedly an inconvenience limiting its use to “young” patients with fractures of the distal radius. After 70 years, the absence of a strong correlation between the radiological and clinical result suggests a less “aggressive” therapeutic approach

Objectives

An experimental rabbit model was used to test the null hypothesis, that there is no difference in new bone formation around uncoated titanium discs compared with coated titanium discs when implanted into the muscles of rabbits.