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J Wrist Surg
DOI: 10.1055/s-0044-1787539
Survey or Meta-Analysis

The Role of Bone Grafting in Corrective Osteotomy of Distal Radius Malunions

Ryan Paul
1   Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
2   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
,
Jonathan Persitz    *
1   Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
2   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
,
Shawn Khan
2   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
,
Michael MacDougall
2   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
,
Andrea Chan
1   Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
2   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
› Institutsangaben Funding None.
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Abstract

Background It remains unclear whether bone grafting is required during corrective osteotomy of the distal radius. The goal of this systematic review is to determine the union, revision, and complication rates of bone grafting techniques associated with extra-articular corrective osteotomy for dorsally malunited distal radius fractures treated with volar plating.

Questions Is bone grafting in distal radius corrective osteotomy associated with increased rates of bone union and reduced rates of revision surgery and complications?

Methods A comprehensive search of the MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature databases was completed for studies reporting clinical outcomes of extra-articular corrective osteotomy for dorsally malunited distal radius fractures treated with volar plating.

Results A total of 13 studies, with 14 intervention arms and 236 patients, were included. Bone grafting techniques consisted of autograft (6 studies, n = 93), synthetic bone grafts (2 studies, n = 38), allograft (1 study, n = 14), or no grafting (5 studies, n = 91). The overall union rate was 97%, and the mean time-to-union was 12.0 weeks. Larger corrections of dorsal tilt and ulnar variance were performed in the autograft and allograft groups. Complication and revision rates were highest in the synthetic group, 45 and 26.3% respectively.

Conclusion Grafting in extra-articular corrective osteotomy for dorsally angulated distal radius malunions treated with volar plating is not associated with an improved union rate in the literature. However, larger corrections were achieved in both the autograft and allograft groups compared to the no-graft and synthetic groups, resulting in similar union rates. Synthetic bone grafting was associated with the highest complication and revision rates. Future comparative prospective trials and proper documentation of whether cortical contact was present or absent are required to assess whether bone grafting warrants consideration in more advanced deformities.

Level of Evidence IV.

Keywords

radius - malunion - osteotomy - graft - union

Declaration of Competing Interest

Nothing to declare.


* RP and JP equally contributed to this manuscript as 1st authors.




Publikationsverlauf

Eingereicht: 17. November 2023

Angenommen: 16. Mai 2024

Artikel online veröffentlicht:
04. Juni 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Bushnell BD, Bynum DK. Malunion of the distal radius. J Am Acad Orthop Surg 2007; 15 (01) 27-40
    CrossrefPubMedGoogle Scholar
  • 2 Haase SC, Chung KC. Management of malunions of the distal radius. Hand Clin 2012; 28 (02) 207-216
    CrossrefPubMedGoogle Scholar
  • 3 Peterson B, Gajendran V, Szabo RM. Corrective osteotomy for deformity of the distal radius using a volar locking plate. Hand (N Y) 2008; 3 (01) 61-68
    CrossrefPubMedGoogle Scholar
  • 4 Henry M. Immediate mobilisation following corrective osteotomy of distal radius malunions with cancellous graft and volar fixed angle plates. J Hand Surg Eur Vol 2007; 32 (01) 88-92
    CrossrefPubMedGoogle Scholar
  • 5 Ozer K, Chung KC. The use of bone grafts and substitutes in the treatment of distal radius fractures. Hand Clin 2012; 28 (02) 217-223
    CrossrefPubMedGoogle Scholar
  • 6 Bhatia N, Gupta A, Dabas V, Kataria A, Goel A, Yadav A. Z-corrective osteotomy in malunited extra-articular fractures of distal radius. J Hand Surg Am 2022; 47 (06) 585.e1-585.e10
    CrossrefPubMedGoogle Scholar
  • 7 Tiren D, Vos DI. Correction osteotomy of distal radius malunion stabilised with dorsal locking plates without grafting. Strateg Trauma Limb Reconstr 2014; 9 (01) 53-58
    CrossrefPubMedGoogle Scholar
  • 8 Younger EM, Chapman MW. Morbidity at bone graft donor sites. J Orthop Trauma 1989; 3 (03) 192-195
    CrossrefPubMedGoogle Scholar
  • 9 Kim DH, Rhim R, Li L. et al. Prospective study of iliac crest bone graft harvest site pain and morbidity. Spine J 2009; 9 (11) 886-892
    CrossrefPubMedGoogle Scholar
  • 10 Zamborsky R, Svec A, Bohac M, Kilian M, Kokavec M. Infection in bone allograft transplants. Exp Clin Transplant 2016; 14 (05) 484-490
    PubMedGoogle Scholar
  • 11 Giannoudis PV, Dinopoulos H, Tsiridis E. Bone substitutes: an update. Injury 2005; 36 (3, suppl 3): S20-S27
    CrossrefPubMedGoogle Scholar
  • 12 Jepegnanam TS, von Schroeder HP. Rapid resorption of calcium sulfate and hardware failure following corrective radius osteotomy: 2 case reports. J Hand Surg Am 2012; 37 (03) 477-480
    CrossrefPubMedGoogle Scholar
  • 13 Ekrol I, Hajducka C, Court-Brown C, McQueen MM. A comparison of RhBMP-7 (OP-1) and autogenous graft for metaphyseal defects after osteotomy of the distal radius. Injury 2008; 39 (Suppl. 02) S73-S82
    CrossrefPubMedGoogle Scholar
  • 14 Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73 (09) 712-716
    CrossrefPubMedGoogle Scholar
  • 15 Abramo A, Tagil M, Geijer M, Kopylov P. Osteotomy of dorsally displaced malunited fractures of the distal radius: no loss of radiographic correction during healing with a minimally invasive fixation technique and an injectable bone substitute. Acta Orthop 2008; 79 (02) 262-268
    CrossrefPubMedGoogle Scholar
  • 16 Scheer JH, Adolfsson LE. Non-union in 3 of 15 osteotomies of the distal radius without bone graft. Acta Orthop 2015; 86 (03) 316-320
    CrossrefPubMedGoogle Scholar
  • 17 de Oliveira RK, Binz MAR, Ferreira MT, Ruschel PH, Serrano PD, Praetzel RP. Osteotomy of the distal radius using a fixed-angle volar plate. Rev Bras Ortop 2015; 47 (02) 173-185
    PubMedGoogle Scholar
  • 18 Kiliç A, Kabukçuoğlu YS, Gül M, Sökücü S, Ozdoğan U. Fixed-angle volar plates in corrective osteotomies of malunions of dorsally angulated distal radius fractures. Acta Orthop Traumatol Turc 2011; 45 (05) 297-303
    PubMedGoogle Scholar
  • 19 Miyake J, Murase T, Moritomo H, Sugamoto K, Yoshikawa H. Distal radius osteotomy with volar locking plates based on computer simulation. Clin Orthop Relat Res 2011; 469 (06) 1766-1773
    CrossrefPubMedGoogle Scholar
  • 20 Pecache MB, Calleja HM. Corrective osteotomy of distal radius malunion using a rectangular-shaped iliac bone graft and volar plating. Tech Hand Up Extrem Surg 2020; 25 (03) 130-135
    CrossrefPubMedGoogle Scholar
  • 21 Rothenfluh E, Schweizer A, Nagy L. Opening wedge osteotomy for distal radius malunion: dorsal or palmar approach?. J Wrist Surg 2013; 2 (01) 49-54
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 22 Ozer K, Kiliç A, Sabel A, Ipaktchi K. The role of bone allografts in the treatment of angular malunions of the distal radius. J Hand Surg Am 2011; 36 (11) 1804-1809
    CrossrefPubMedGoogle Scholar
  • 23 Robinson LP, Usmani RH, Fehrenbacher V, Protzer L. Simplifying the volar distraction osteotomy for distal radius malunion repair. J Wrist Surg 2021; 11 (02) 185-190
    PubMedGoogle Scholar
  • 24 Mahmoud M, El Shafie S, Kamal M. Correction of dorsally-malunited extra-articular distal radial fractures using volar locked plates without bone grafting. J Bone Joint Surg Br 2012; 94 (08) 1090-1096
    CrossrefPubMedGoogle Scholar
  • 25 Opel S, Konan S, Sorene E. Corrective distal radius osteotomy following fracture malunion using a fixed-angle volar locking plate. J Hand Surg Eur Vol 2014; 39 (04) 431-435
    CrossrefPubMedGoogle Scholar
  • 26 Tarallo L, Mugnai R, Adani R, Catani F. Malunited extra-articular distal radius fractures: corrective osteotomies using volar locking plate. J Orthop Traumatol 2014; 15 (04) 285-290
    CrossrefPubMedGoogle Scholar
  • 27 Wieland AWJ, Dekkers GHG, Brink PRG. Open wedge osteotomy for malunited extraarticular distal radius fractures with plate osteosynthesis without bone grafting. Eur J Trauma 2005; 31 (02) 148-153
    CrossrefPubMedGoogle Scholar
  • 28 Lee JH, Kim GH, Park MJ. Clinical outcomes of open-wedge corrective osteotomy using autogenous or allogenic bone grafts for malunited distal radius: a novel parameter for measuring the rate of bone union. Acta Orthop Traumatol Turc 2022; 56 (03) 199-204
    CrossrefPubMedGoogle Scholar
  • 29 Friesenbichler J, Maurer-Ertl W, Sadoghi P, Pirker-Fruehauf U, Bodo K, Leithner A. Adverse reactions of artificial bone graft substitutes: lessons learned from using tricalcium phosphate geneX®. Clin Orthop Relat Res 2014; 472 (03) 976-982
    CrossrefPubMedGoogle Scholar
  • 30 Robinson D, Alk D, Sandbank J, Farber R, Halperin N. Inflammatory reactions associated with a calcium sulfate bone substitute. Ann Transplant 1999; 4 (3-4): 91-97
    PubMedGoogle Scholar
  • 31 Kelly CM, Wilkins RM, Gitelis S, Hartjen C, Watson JT, Kim PT. The use of a surgical grade calcium sulfate as a bone graft substitute: results of a multicenter trial. Clin Orthop Relat Res 2001; (382) 42-50
    CrossrefPubMedGoogle Scholar