Outcomes of Autologous and Synthetic Bone Grafts in Locking Plate Fixation of Comminuted Distal Radius Fractures

TL;DR

This study compares autologous and synthetic bone grafts in treating severe wrist fractures and finds no significant difference in long-term outcomes.

Contribution

The study provides evidence that both autologous and synthetic bone grafts yield similar long-term outcomes in complex wrist fracture cases.

Findings

All fractures united successfully with average volar tilt of 4° and radial inclination of 18.8°.

No significant difference was found between autologous and synthetic grafts in clinical or radiological outcomes.

Bone grafts aid in managing severe metaphyseal comminution and articular fragment reduction.

Abstract

Background

The introduction of locking plate technology has improved the feasibility of distal radius fracture fixation without the need for bone grafting, yet challenges persist in cases of severely comminuted fractures and small, unstable intra-articular fragments. This study aimed to assess the outcomes of bone grafting in severely comminuted distal radius fractures treated with locking plates.

Methods

We performed a retrospective analysis involving 450 patients who underwent distal radius fracture fixations. We evaluated wrist motion, grip strength, and radiographic parameters, including radial inclination, radial tilt, ulnar variance, articular step, and fracture union at standardized intervals. In addition, at the 12- and 24-month marks, we assessed the disabilities of the arm, shoulder, and hand (DASH) questionnaire score.

Results

Out of the 450 patients who underwent distal radius fracture fixation using volar locking plate systems, 59 individuals (13%) required either autologous bone graft (n = 24) or synthetic bone substitutes (n = 35). In the final follow-up, all fractures had successfully united, displaying an average volar tilt of 4°, radial inclination of 18.8°, and an articular step or gap of 0.1 mm.

Conclusion

There was no significant difference between the use of autologous or synthetic bone grafts on clinical or radiological outcomes in the long term. Bone grafts are useful in severe metaphyseal comminution and aid in the reduction of articular fragments and bi-cortical comminution.

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