Bone Graft in Distal Radius Fractures - Mark Falworth 28/11/2000

Colles (1814): 'On the fracture of the carpal extremity of the radius.' Edin Med & Surg J.

Frykman & Gosta ('67):' # of the D. Radius including sequelae.' Acta Orthop. Scand. ~ not a prognostic classification system, Older classification better (?) .

Normal radiographic anatomy ; Volar tilt (Palmer slope) of D. rad 11-120 . (Lat); Radial inclination 22-230 (AP rad); Radial length 11-12 mm. (AP rad)

Loss of Volar tilt > decreased grip strength, pain, mid carpel instability

Shortening > dysfunctional distal R-U joint; limited rotation of forearm and impingement of ulna on radius.

Lafontaine ('89): 'Stability assessment of distal radius #'. Acta Orthop Scand.

3 or more; - dorsal angulation > 200

- dorsal comminution

- intra-articular #

- associated ulnar #

- age > 60 yrs

Knirk & Jupiter ('86); 'Intraarticular # of the dist. Radius in young adults.' JBJS A

1-2 mm of residual articular incongruency was associated with posttraumatic OA in 91 -100% of cases at a mean of 6.7 yrs after injury.

Bone graft material is any implanted material ( +/- other materials) that promotes bone healing by osteogenic (living cells > bone), osteoconductive (receptive scaffold) or osteoinductive ( biologic stimulus inducing local/transplanted cells to differentiate into mature bone cells) avtivity.

Autograft; osteogenic,(viable cells), osteoinductive (matrix proteins), osteoconductive ( bony matrix).

Allograft; osteoconductive (and mechanical strength) vary depending on graft processing. Possibly some osteoinductive.

Vascularised Autograft; gold standard, +/- 90% osteocytes survive.

Cancellous autograft ; majority of cells die but primitive mesenchymal cells may survive and be stimulated by ischaemia, pH and cytokine environments. Invaded by granulation tissue quickly.

Non vascularised cortical autograft; does not allow sufficient diffusion to support survival of osteocytes. Therefore not osteogenic but are osteoconductive and provide mechanical support but more donor site morbidity. Little advantage of allograft cortical bone.



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