Verwendung von nanokristallinem Hydroxyapatit (Ostim®) bei der Versorgung von Radiusfrakturen

Zusammenfassung

Ziel der Untersuchung: Bei Radiusfraktur mit metaphysärer Trümmerzone und Gelenkbeteiligung wird der Einsatz von innovativem Knochenersatzmaterial geprüft. Basismethodik: 11 C 2-, 11 C 3-, 3 A 3-Radiusfrakturen werden mit winkelstabiler palmarer Plattenosteosynthese sowie mit einer Defektauffüllung aus nanokristallinem Hydroxyapatit versorgt. Untersuchungen erfolgen präoperativ, postoperativ nach 4 und 12 Wochen und nach 9–12 Monaten. Ergebnisse: 10,5 ± 1,4 Monate postoperativ bestehen ein dorsopalmarer Neigungswinkel von 8,7 ± 1,8° und ein radioulnarer Neigungswinkel von 18,8 ± 2,9° bei durchschnittlichem Ulnavorschub von 0,6 ± 1,8 mm. Nach der Gartland / Werley-Bewertung werden 10 Behandlungsergebnisse mit „sehr gut”, 12 mit „gut” und 3 mit „mäßig” bewertet. Schlussfolgerung: Mit einer Kombination aus winkelstabiler Plattenosteosynthese und nanokristalliner Hydroxyapatitauffüllung im metaphysären Defektbereich zur Versorgung von A 3-, C 2- und C 3-Radiusfrakturen sind radiologisch und klinisch gute Ergebnisse erzielbar.

Abstract

Aim of the Study: In this study, innovative bone replacement material was tested after complicated metaphyseal radius fractures with the affected joints. Material and Methods: In all, 11 C 2, 11 C 3 and 3 A 3 radius fractures were treated by surgery combining an angularly stable palmar plate osteosynthesis with defect filling using nanocrystalline hydroxyapatite. Examinations were conducted preoperatively and postoperatively after 4 weeks, 12 weeks and 9–12 months. Results: After 10.5 ± 1.4 months, inclination angles of 8.7 ± 1.8° (dorsopalmar) and 18.8 ± 2.9° (radioulnar) were measured at the treated fractures, the ulnar drift was 0.6 ± 1.8 mm. According to the Gartland / Werley scale, 10 therapeutic results were considered „excellent”, 12 „good” and 3 „fair”. Conclusion: An angularly stable plate osteosynthesis with metaphyseal defect filling using nanocrystalline hydroxyapatite for the treatment of A 3, C 2 and C 3 radius fractures showed satisfactory radiological and clinical results.

Schlüsselwörter

Radiusfraktur - metaphysärer Defekt - Hydroxyapatit - nanokristallin

Key words

radius fracture - methaphyseal defect - hydroxyapatite - nanocrystalline

Literatur

• 1 Anzarut A, Johnson J A, Rowe B H et al. Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures.  J Hand Surg [Am]. 2004;  29 1121-1127
• 2 Arrington E D, Smith W J, Chambers H G et al. Complications of iliac crest bone graft harvesting.  Clin Orthop Relat Res. 1996;  (329) 300-309
• 3 Balasundaram G, Sato M, Webster T J. Using hydroxyapatite nanoparticles and decreased crystallinity to promote osteoblast adhesion similar to functionalizing with RGD.  Biomaterials. 2006;  27 2798-2805
• 4 Batra S, McMurtrie A, Batra M et al. Distal radius fracture management in the emergency departments in UK: are we doing enough?.  Int J Clin Pract. 2007;  61 1131-1136
• 5 Bezrukov V M, Grigor'iants L A, Zuev V P et al. [The surgical treatment of jaw cysts using hydroxyapatite with an ultrahigh degree of dispersity].  Stomatologiia (Mosk). 1998;  77 31-35
• 6 Biyani A, Simison A J, Klenerman L. Fractures of the distal radius and ulna.  J Hand Surg [Br]. 1995;  20 357-364
• 7 Briem D, Linhart W, Lehmann W et al. [Long-term outcomes after using porous hydroxyapatite ceramics (Endobon) for surgical management of fractures of the head of the tibia].  Unfallchirurg. 2002;  105 128-133
• 8 Carter P R, Frederick H A, Laseter G F. Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: a multicenter study of 73 fractures.  J Hand Surg [Am]. 1998;  23 300-307
• 9 Cassidy C, Jupiter J B, Cohen M et al. Norian SRS cement compared with conventional fixation in distal radial fractures. A randomized study.  J Bone Joint Surg [Am]. 2003;  85 2127-2137
• 10 Chung K C, Watt A J, Kotsis S V et al. Treatment of unstable distal radial fractures with the volar locking plating system.  J Bone Joint Surg [Am]. 2006;  88 2687-2694
• 11 Constantz B R, Ison I C, Fulmer M T et al. Skeletal repair by in situ formation of the mineral phase of bone.  Science. 1995;  267 1796-1799
• 12 Doi K, Hattori Y, Otsuka K et al. Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation.  J Bone Joint Surg [Am]. 1999;  81 1093-1110
• 13 Felderhoff J, Wiemer P, Dronsella J et al. [The operative therapy of distal unstable radius fractures with dorsal and palmar plates. A retrospective study with respect to the DASH-score system].  Orthopade. 1999;  28 853-863
• 14 Fernandez D L. Should anatomic reduction be pursued in distal radial fractures?.  J Hand Surg [Br]. 2000;  25 523-527
• 15 Gartland Jr J J, Werley C W. Evaluation of healed Colles' fractures.  J Bone Joint Surg [Am]. 1951;  33 895-907
• 16 Gierse H, Donath K. Reactions and complications after the implantation of Endobon including morphological examination of explants.  Arch Orthop Trauma Surg. 1999;  119 349-355
• 17 Goulet J A, Senunas L E, DeSilva G L et al. Autogenous iliac crest bone graft. Complications and functional assessment.  Clin Orthop Relat Res. 1997;  76-81
• 18 Grigor'ian A S, Grigor'iants L A, Podoinikova M N. [A comparative analysis of the efficacy of different types of filling materials in the surgical elimination of tooth perforations (experimental morphological research)].  Stomatologiia (Mosk). 2000;  79 9-12
• 19 Huber F X, Belyaev O, Hillmeier J et al. First histological observations on the incorporation of a novel nanocrystalline hydroxyapatite paste OSTIM in human cancellous bone.  BMC Musculoskelet Disord. 2006;  7 50
• 20 Knirk J L, Jupiter J B. Intra-articular fractures of the distal end of the radius in young adults.  J Bone Joint Surg [Am]. 1986;  68 647-659
• 21 Krimmer H, Pessenlehner C, Hasselbacher K et al. [Palmar fixed angle plating systems for instable distal radius fractures].  Unfallchirurg. 2004;  107 460-467
• 22 Ladd A L, Pliam N B. The role of bone graft and alternatives in unstable distal radius fracture treatment.  Orthop Clin North Am. 2001;  32 337-351, ix
• 23 Leroux T, Perez-Ordonez B, von Schroeder H P. Osteolysis after the use of a silicon-stabilized tricalcium phosphate-based bone substitute in a radius fracture: a case report.  J Hand Surg [Am]. 2007;  32 497-500
• 24 Linhart W, Briem D, Schmitz N D et al. [Treatment of metaphyseal bone defects after fractures of the distal radius. Medium-term results using a calcium-phosphate cement (BIOBON)].  Unfallchirurg. 2003;  106 618-624
• 25 Mudgal C S, Jupiter J B. Plate and screw design in fractures of the hand and wrist.  Clin Orthop Relat Res. 2006;  445 68-80
• 26 O'Connor D, Mullett H, Doyle M et al. Minimally displaced Colles' fractures: a prospective randomized trial of treatment with a wrist splint or a plaster cast.  J Hand Surg [Br]. 2003;  28 50-53
• 27 Orbay J L, Touhami A. Current concepts in volar fixed-angle fixation of unstable distal radius fractures.  Clin Orthop Relat Res. 2006;  445 58-67
• 28 Paksima N, Panchal A, Posner M A et al. A meta-analysis of the literature on distal radius fractures: review of 615 articles.  Bull Hosp Jt Dis. 2004;  62 40-46
• 29 Posner A S. The mineral of bone.  Clin Orthop Relat Res. 1985;  87-99
• 30 Rajan G P, Fornaro J, Trentz O et al. Cancellous allograft versus autologous bone grafting for repair of comminuted distal radius fractures: a prospective, randomized trial.  J Trauma. 2006;  60 1322-1329
• 31 Rauschmann M A, Wichelhaus T A, Stirnal V et al. Nanocrystalline hydroxyapatite and calcium sulphate as biodegradable composite carrier material for local delivery of antibiotics in bone infections.  Biomaterials. 2005;  26 2677-2684
• 32 Rikli D A, Regazzoni P. The double plating technique for distal radius fractures.  Tech Hand Up Extrem Surg. 2000;  4 107-114
• 33 Rogachefsky R A, Ouellette E A, Sun S et al. The use of tricorticocancellous bone graft in severely comminuted intra-articular fractures of the distal radius.  J Hand Surg [Am]. 2006;  31 623-632
• 34 Rüedi T P, Murphy W M. AO Principles of Fracture Management. Stuttgart, New York, Thieme 2000
• 35 Sakano H, Koshino T, Takeuchi R et al. Treatment of the unstable distal radius fracture with external fixation and a hydroxyapatite spacer.  J Hand Surg [Am]. 2001;  26 923-930
• 36 Sakhaii M, Groenewold U, Klonz A et al. [Results after palmar plate-osteosynthesis with angularly stable T-plate in 100 distal radius fractures: a prospective study].  Unfallchirurg. 2003;  106 272-280
• 37 Schnettler R, Stahl J P, Alt V et al. Calcium phosphat-based bone substitutes.  Eur J Trauma. 2004;  4 219-229
• 38 Schwarz F, Bieling K, Latz T et al. Healing of intrabony peri-implantitis defects following application of a nanocrystalline hydroxyapatite (Ostim) or a bovine-derived xenograft (Bio-Oss) in combination with a collagen membrane (Bio-Gide). A case series.  J Clin Periodontol. 2006;  33 491-499
• 39 Seeman E, Delmas P D. Bone quality – the material and structural basis of bone strength and fragility.  N Engl J Med. 2006;  354 2250-2261
• 40 Siebert H R, Klonz A. [Fracture of the distal radius].  Chirurg. 2006;  77 545-562
• 41 Sommer C, Brendebach L, Meier R et al. [Distal radius fractures – retrospective quality control after conservative and operative therapy].  Swiss Surg. 2001;  7 68-75
• 42 Sturzenegger M. [“Sandwich” osteosynthesis of the distal radius].  Chir Main. 2001;  20 447-453
• 43 Suckel A, Spies S, Munst P. Dorsal (AO / ASIF) pi-plate osteosynthesis in the treatment of distal intraarticular radius fractures.  J Hand Surg [Br]. 2006;  31 673-679
• 44 Sun J S, Chang C H, Wu C C et al. Extra-articular deformity in distal radial fractures treated by external fixation.  Can J Surg. 2001;  44 289-294
• 45 Tobe M, Mizutani K, Tsubuku Y. Treatment of distal radius fracture with the use of calcium phosphate bone cement as a filler.  Tech Hand Up Extrem Surg. 2004;  8 95-101
• 46 Ubhi C S, Morris D L. Fracture and herniation of bowel at bone graft donor site in the iliac crest.  Injury. 1984;  16 202-203
• 47 Voigt C, Lill H. [What advantages does volar plate fixation have over K-wire fixation for distal radius extension fractures in the elderly?].  Unfallchirurg. 2006;  109 845-854
• 48 Werber K D, Brauer R B, Weiss W et al. Osseous integration of bovine hydroxyapatite ceramic in metaphyseal bone defects of the distal radius.  J Hand Surg [Am]. 2000;  25 833-841
• 49 Younger E M, Chapman M W. Morbidity at bone graft donor sites.  J Orthop Trauma. 1989;  3 192-195
• 50 Zimmermann R, Gabl M, Lutz M et al. Injectable calcium phosphate bone cement Norian SRS for the treatment of intra-articular compression fractures of the distal radius in osteoporotic women.  Arch Orthop Trauma Surg. 2003;  123 22-27
• 51 Zuev V P, Dmitrieva L A, Pankratov A S et al. [The comparative characteristics of stimulators of reparative osteogenesis in the treatment of periodontal diseases].  Stomatologiia (Mosk). 1996;  75 31-34