A Posttraumatic Distal Radius Allograft: 10 Years Follow-Up

Abstract

Background Wrist osteoarthritis is a common disease often resulting from malunited fractures of the distal radius. The primary treatment purpose is to provide pain relief, while maintaining strength and mobility whenever possible. In a patient presenting a posttraumatic degeneration of the wrist, deciding which surgical technique, which joints to sacrifice and which to preserve is crucial to optimizing the outcome.

Case Description We describe a 10-year follow-up of an osteoarticular allograft of the distal radius proposed to treat an isolated distal radius posttraumatic degeneration. The patient was young and active. No or slight articular degeneration of the carpal rows was present. The surgical technique was based on a periarticular step-cut that allowed the preservation of the dorsal capsule and the maximum contact between the bone and the allograft.

Literature Review In the literature, the allograft of the radius is described as a solution to an oncologic problem. Considering a posttraumatic scenario other techniques are usually performed. However, compared with artificial interbody fusion devices and prosthetic implants, structural bone allograft retains an advantage in biologic performance. It has osteoconductive properties and is similar to native tissues providing a progressive incorporation by the host.

Clinical Relevance This surgical technique provide a metaphyseal step-cut able to ensure a secure stabilization and a wide contact surface between the allograft and the native bone. Integration of the allograft with good functional and radiological outcome seen after 10 years supports this technique.

Keywords

distal radius allograft - wrist arthritis - distal radius degeneration - distal radius fracture - radioscapholunate

• References

• 1 Cavaliere CM, Chung KC. A systematic review of total wrist arthroplasty compared with total wrist arthrodesis for rheumatoid arthritis. Plast Reconstr Surg 2008; 122 (03) 813-825
• 2 Culp RW, Bachoura A, Gelman SE, Jacoby SM. Proximal row carpectomy combined with wrist hemiarthroplasty. J Wrist Surg 2012; 1 (01) 39-46
• 3 Rothe M, Rudolf KD, Partecke BD. Long-term results following denervation of the wrist in patients with stages II and III SLAC-/SNAC-wrist [in German]. Handchir Mikrochir Plast Chir 2006; 38 (04) 261-266
• 4 Bianchi G, Donati D, Staals EL, Mercuri M. Osteoarticular allograft reconstruction of the distal radius after bone tumour resection. J Hand Surg [Br] 2005; 30 (04) 369-373
• 5 Obert L, Lepage D, Ferrier M, Tropet Y. Rib cartilage graft for posttraumatic or degenerative arthritis at wrist level: 10-year results. J Wrist Surg 2013; 2 (03) 234-238
• 6 Kocher MS, Gebhardt MC, Mankin HJ. Reconstruction of the distal aspect of the radius with use of an osteoarticular allograft after excision of a skeletal tumor. J Bone Joint Surg Am 1998; 80 (03) 407-419
• 7 Gross AE, Shasha N, Aubin P. Long-term followup of the use of fresh osteochondral allografts for posttraumatic knee defects. Clin Orthop Relat Res 2005; (435) 79-87
• 8 Bus MP, Dijkstra PD, van de Sande MA. , et al. Intercalary allograft reconstructions following resection of primary bone tumors: a nationwide multicenter study. J Bone Joint Surg Am 2014; 96 (04) e26 . Doi: 10.2106/JBJS.M.00655
• 9 Wheeler DL, Enneking WF. Allograft bone decreases in strength in vivo over time. Clin Orthop Relat Res 2005; (435) 36-42
• 10 Stevenson S, Shaffer JW, Goldberg VM. The humoral response to vascular and nonvascular allografts of bone. Clin Orthop Relat Res 1996; (326) 86-95
• 11 Cascio BM, Thomas KA, Wilson SC. A mechanical comparison and review of transverse, step-cut, and sigmoid osteotomies. Clin Orthop Relat Res 2003; (411) 296-304