Hemiarthroplasty for Complex Distal Radius Fractures in Elderly Patients

Abstract

Background In elderly patients, distal radius fractures frequently occur in osteoporotic bone and may be nonreconstructable. It is our hypothesis that a hemiarthroplasty replacment of the articular surface can provide satisfactory results in terms of range of motion, pain, and function for immediate salvage of a fracture that is not amenable to internal fixation.

Methods Between July 2009 and January 2012, eight elderly patients were treated with insertion of a Sophia distal radius implant (Biotech, Paris, France). Inclusion criteria consisted of an isolated AO type C2 distal radius fracture in patients over 70 years old. All patients were reviewed by an independent surgeon.

Results The mean follow-up was 25 months (range, 17–36 months). Mean wrist range of motion (ROM) was 45° (40–50°) of flexion, 44° (40–50°) of extension, and a mean pronation-supination arc of 160°. Mean grip force was 18 kgf. The mean QuickDASH (Disabilities of the Arm, Shoulder and Hand) was 18.2/100 (6.82–29.55), and the mean visual analog scale (VAS) was 2.33 (0–4). X-ray images did not demonstrate implant loosening or ulnar translation of the carpus.

Conclusions The Sophia hemiarthroplasty provided rapid recovery of independence in elderly patients with a nonreconstructable comminuted distal radius fracture.

Keywords

distal radius fractures - prosthesis - epiphyseal comminution

• References

• 1 Rozental TD, Makhni EC, Day CS, Bouxsein ML. Improving evaluation and treatment for osteoporosis following distal radial fractures. A prospective randomized intervention. J Bone Joint Surg Am 2008; 90 (5) 953-961
• 2 Glickel SZ, Catalano LW, Raia FJ, Barron OA, Grabow R, Chia B. Long-term outcomes of closed reduction and percutaneous pinning for the treatment of distal radius fractures. J Hand Surg Am 2008; 33 (10) 1700-1705
• 3 Zenke Y, Sakai A, Oshige T, Moritani S, Nakamura T. The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius. J Bone Joint Surg Br 2009; 91 (1) 102-107
• 4 Richard MJ, Katolik LI, Hanel DP, Wartinbee DA, Ruch DS. Distraction plating for the treatment of highly comminuted distal radius fractures in elderly patients. J Hand Surg Am 2012; 37 (5) 948-956
• 5 Saffar P, Mazodier F, Werther JR. Fractures in the elderly patient: is it necessary to operate on patients over 75 years old?. [in French] Rev Chir Orthop Repar Appar Mot 2001; 87: 130-132
• 6 Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am 2007; 89 (9) 2051-2062
• 7 Charissoux J-L, Mabit C, Fourastier J , et al. Comminuted intra-articular fractures of the distal humerus in elderly patients [in French]. Rev Chir Orthop Repar Appar Mot 2008; 94 (4, Suppl): S36-S62
• 8 Roux JL. Replacement and resurfacing prosthesis of the distal radius: a new therapeutic concept [in French]. Chir Main 2009; 28 (1) 10-17
• 9 Herzberg G, Dumontier C. Symposium: fresh fractures of the distal radius in the adult [in French]. Rev Chir Orthop Repar Appar Mot 2000; 86 (Suppl. 01) 1585-1588
• 10 Dubert T, Voche P, Dumontier C, Dinh A. The DASH questionnaire. French adaptation of an international evaluation tool [in French]. Chir Main 2001; 20 (4) 294-302
• 11 Gehrmann SV, Windolf J, Kaufmann RA. Distal radius fracture management in elderly patients: a literature review. J Hand Surg Am 2008; 33 (3) 421-429
• 12 Schneppendahl J, Windolf J, Kaufmann RA. Distal radius fractures: current concepts. J Hand Surg Am 2012; 37 (8) 1718-1725
• 13 Hanel DP, Lu TS, Weil WM. Bridge plating of distal radius fractures: the Harborview method. Clin Orthop Relat Res 2006; 445 (445) 91-99
• 14 Ginn TA, Ruch DS, Yang CC, Hanel DP. Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution. Surgical technique. J Bone Joint Surg Am 2006; 88 (Suppl 1 Pt 1): 29-36