Session III - Combined Meeting with AAST

Repair of Comminuted Distal Radius Fractures: Allogenic versus Autogeneic Transplants

J. Fornaro, MD; R. Zellweger, MD; C. Sommer, MD; O. Trentz, MD, University Hospital Zürich, Zürich, Switzerland

Objective: Distal radius fractures with a large metaphyseal defect often require open reduction and internal fixation combined with defect filling to ensure stability and accurate healing. Autogeneic bone harvested >from the iliac crest is still the gold standard. This study was made to assess the reliability of a new allogeneic transplant as a bone-graft substitute.

Methods: This prospective study included 90 patients with distal unstable radius fractures. The fractures were classified (according to the Comprehensive Classification of Fractures) as: 32, A3-; 20, C2-; and 38, C3-fractures. The fracture-osteosynthesis was done with 2.7-mrn quarter-tube plates and metaphyseal defect filling. The choice between autogeneic and allogeneic bone graft was randomized. Tutoplast® -cancellous-chips were used as an allogeneic transplant. All patients were treated at a level I trauma center by the same group of surgeons. At 3 and 12 months after surgery, several clinical and radiological parameters were assessed. Each patient also completed a questionnaire concerning perception of reintegration into everyday and working life.

Results: By using the allogeneic transplants, operating time could be reduced 24%, and complications derived from bone harvesting were also avoided. These complications were notably frequent in the "iliac crest" group. Overall outcomes were assessed according to the modified system of Gartland and Werley. There were 71% good to-excellent results in the "Tutoplast®" group and 75% good-to-excellent in the "iliac crest" group. Mean time for return to regular work schedule was 15 weeks, and no patient had to change employment as a result of his radius fracture. Radiological parameters were comparable in botb groups and within normal range. Three months after surgery we found the first radiological signs of resorption and remodeling of the allogeneic transplants.

Conclusion: No adverse effects were determined >from the use of the investigated allogeneic transplant. Therefore, this new transplant could be a desirable alternative to the previous gold standard of autogeneic bone grafting from the iliac crest.