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Bone grafts and bone substitutes for treating distal radial fractures in adults

  1. Helen HG Handoll1,*,
  2. Adam C Watts2

Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group

Published Online: 23 APR 2008

Assessed as up-to-date: 6 JUN 2007

DOI: 10.1002/14651858.CD006836.pub2


How to Cite

Handoll HHG, Watts AC. Bone grafts and bone substitutes for treating distal radial fractures in adults. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006836. DOI: 10.1002/14651858.CD006836.pub2.

Author Information

  1. 1

    University of Teesside, Centre for Rehabilitation Sciences (CRS), Research Institute for Health Sciences and Social Care, Middlesborough, Tees Valley, UK

  2. 2

    Edinburgh Royal Infirmary, Department of Orthopaedic Surgery, Edinburgh, UK

*Helen HG Handoll, Centre for Rehabilitation Sciences (CRS), Research Institute for Health Sciences and Social Care, University of Teesside, School of Health and Social Care, Middlesborough, Tees Valley, TS1 3BA, UK. h.handoll@tees.ac.uk. H.Handoll@ed.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 APR 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Surgical treatment of fractures of the distal radius can involve the implantation of bone scaffolding materials (bone grafts and substitutes) into bony defects that frequently arise after fracture reduction.

Objectives

To review the evidence from randomised controlled trials evaluating the implanting of bone scaffolding materials for treating distal radial fractures in adults.

Search methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (June 2007), the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and other databases, conference proceedings and reference lists. No language restrictions were applied.

Selection criteria

Randomised or quasi-randomised controlled clinical trials evaluating the use of bone scaffolding for treating distal radial fracture in adults.

Data collection and analysis

Two people independently selected studies and undertook assessment and data collection.

Main results

Ten heterogenous trials involving 874 adults with generally unstable fractures were grouped into six comparisons. No trial had proven allocation concealment.

Four trials (239 participants) found implantation of bone scaffolding (autogenous bone graft (one trial); Norian SRS - a bone substitute (two trials); methylmethacrylate cement (one trial)) improved anatomical outcomes compared with plaster cast alone; and two found it improved function. Reported complications of bone scaffolding were transient discomfort resulting from extraosseous deposits of Norian SRS; with surgical removal of one intra-articular deposit.

One trial (323 participants) comparing bone substitute (Norian SRS) versus plaster cast or external fixation found no difference in functional or anatomical outcomes at one year. Statistically significant complications in the respective groups were extraosseous Norian SRS deposits and pin track infection.

One trial (48 participants with external fixation) found that autogenous bone graft did not significantly change outcome. There was one serious donor-site complication.

One trial (21 participants) found some indication of worse outcomes for hydroxyapatite bone cement compared with Kapandji's intrafocal pinning.

Three trials (180 participants) found bone scaffolding (autogenous bone graft (one trial); Norian SRS (one trial); methylmethacrylate cement (one trial)) gave no significant difference in functional outcomes but some indication of better anatomical outcomes compared with external fixation. Most reported complications were associated with external fixation; extraosseous deposits of Norian SRS occurred in one trial.

One trial (93 participants with dorsal plate fixation) found autografts slightly improved wrist function compared with allogenic bone material but with an excess of donor site complications.

Authors' conclusions

Bone scaffolding may improve anatomical outcome compared with plaster cast alone but there is insufficient evidence to conclude on functional outcome and safety; or for other comparisons.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Bone grafts and bone substitutes for treating distal radial fractures in adults

A 'broken wrist' (from a fracture at the lower end of the two forearm bones) often results from a fall onto an outstretched hand in older adults and from high-energy trauma, such as a road traffic accident, in young adults. Surgery may be considered for more seriously displaced fractures. Surgical treatment can involve the implantation of bone scaffolding materials (bone grafts and substitutes) into bony defects that may affect the stability of the fracture fragments after they have been put back into place.

This review looked at the evidence from randomised controlled trials evaluating the use of bone scaffolding.

Ten very different trials involving 874 adults with generally unstable fractures were grouped into six comparisons. No trial used a best-practice method for preventing selection bias.

Four trials (239 participants) found implantation of bone scaffolding (autogenous - from the patient - bone graft (one trial); Norian SRS - a bone substitute (two trials); methylmethacrylate cement (one trial)) improved anatomical outcomes compared with plaster cast alone; and two found it improved function. Reported complications of bone scaffolding were transient discomfort resulting from deposits of Norian SRS outside the bone. One deposit required surgical removal.

One trial (323 participants) comparing Norian SRS versus plaster cast or external fixation found no difference in functional or anatomical outcomes at one year. External deposits of bone cement and pin track infection were the only significant differences between the two groups.

One trial (48 participants) found that autogenous (from the patient) bone graft in the context of external fixation did not significantly change outcome. There was one serious donor-site complication.

One trial (21 participants) found some indication of worse outcomes with bone cement compared with percutaneous (through the skin) pinning.

Three trials (180 participants) found bone scaffolding (autogenous bone graft (one trial); Norian SRS (one trial); methylmethacrylate cement (one trial)) gave no significant difference in functional outcomes but some indication of better anatomical outcomes compared with external fixation. Most reported complications were associated with external fixation; deposits of Norian SRS outside the bone occurred in one trial.

One trial (93 participants treated with plate fixation) comparing allogenic bone material (from other people) versus autogenic bone-graft found slightly improved wrist function for the autograft group but an excess of complications relating to graft harvesting.

The review concluded that while bone scaffolding may improve anatomical outcome compared with plaster cast immobilisation alone, there is insufficient evidence to conclude on function and safety; or on outcome for other comparisons.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

治療成人遠端橈骨骨折中骨骼移植與人工代替骨的使用

遠端橈骨骨折的手術治療中,可以包含在骨折復位後常見的骨質缺損處置入骨支架物質 (骨移植或骨骼替代品) 。

目標

回顧在評估使用骨支架物質來治療成人遠端橈骨骨折的隨機對照試驗中所得到的證據。

搜尋策略

資料搜尋包含了考科藍肌肉骨骼傷害組 (the Cochrane Bone, Joint and Muscle Trauma Group) Specialised Register (June 2007), the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and other databases, conference proceedings and reference lists. 無語言限制No language restrictions were applied.

選擇標準

評估使用骨支架物質來治療成人的遠端橈骨骨折的隨機或半隨機對照臨床試驗。

資料收集與分析

由兩位作者獨立挑選試驗並進行評估與數據收集。

主要結論

在十個包含了874位不穩定骨折的成人的試驗中,分別比較了六個項目。所有試驗都無法證明有分配隱密性 (allocation concealment) 。有四個試驗 (包含了239位病人) 顯示植入骨支架物質 (一個試驗使用自體移植骨,兩個試驗使用人工替代骨—Norian SRS,一個試驗使用骨水泥) 比單獨使用樹脂石膏更能達到良好的解剖學上的成果;其中兩個試驗還顯示在功能上也有同樣的成果。在使用骨支架物質造成的併發症部分,人工替代骨所造成的骨外鈣化沉積會造成暫時的不適感,其中有一位病人需要以手術來移除關節內的沉積物。一項包含323位病人的試驗比較了使用人工替代骨Norian SRS以及單純使用樹脂石膏或骨外固定,結果一年後在解剖學上和功能上都沒有顯著的差異。但在統計上各組的併發症例如骨外鈣化、Norian SRS沉積及骨釘感染卻有顯著的差異。另一項包含48位使用骨外固定的病人的試驗中,發現使用自體骨移植對於治療結果並沒有顯著幫助,甚至有一位病人在取移植骨的部位有嚴重的併發症產生。而一個包含21位病人的試驗則發現使用氫氧基磷灰石骨水泥的治療效果有遜於使用Kapandji骨釘的跡象。三個試驗 (共包含了180位病患) 分別使用自體骨移植、Noran SRS及骨水泥,發現其治療效果在功能上並沒有顯著的差異,但在解剖學上的治療效果,相較於使用骨外固定則有較好的跡象。絕大多數的併發症都和骨外固定有關,僅有一個試驗中有發生Norian SRS的骨外鈣化現象。一個包含了93位使用背側骨板固定的患者的試驗中,發現使用自體骨移植的治療效果,比起異體骨移植,功能上有些微的幫助,但也有較多的取骨處的併發症。

作者結論

骨支架物質比起單純使用樹脂石膏更能提供較好的解剖學結果,但在功能上的結果與安全度上,仍沒有足夠的證據來證明他優於其他治療方式。

翻譯人

本摘要由臺灣大學附設醫院賴昆鴻翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

治療成人遠端橈骨骨折中骨骼移植與人工代替骨的使用。手腕骨折 (指兩前臂長骨遠端的骨折) 常導因於年紀較長的成人跌倒時手臂的外展,或是年輕人遭遇如車禍一般的高能量創傷。在明顯位移的骨折中,手術治療可能是必要的。手術治療包含在骨折復位後仍可能會影響穩定度的骨質缺損處置入骨支架物質 (骨移植或骨骼替代品) 。這篇文章回顧評估了一些針對使用骨支架物質隨機對照試驗中所得到的證據。十個包含了874位不穩定骨折的成人的試驗中,分別比較了六個項目。沒有任何一個試驗使用最好的方法以避免選取上之誤差。有四個試驗 (包含了239位病人) 顯示植入骨支架物質 (一個試驗使用自體移植骨,兩個試驗使用人工替代骨—Norian SRS,一個試驗使用骨水泥) 比單獨使用樹脂石膏更能達到良好的解剖學上的成果;其中兩個試驗還顯示在功能上也有同樣的成果。在使用骨支架物質造成的併發症部分,人工替代骨所造成的骨外鈣化沉積會造成暫時的不適感,其中有一位病人需要以手術來移除關節內的沉積物。一項包含323位病人的試驗比較了使用人工替代骨Norian SRS以及單純使用樹脂石膏或骨外固定,結果一年後在解剖學上和功能上都沒有顯著的差異。但在統計上各組的併發症例如骨外鈣化、Norian SRS沉積及骨釘感染卻有顯著的差異。另一項包含48位使用骨外固定的病人的試驗中,發現使用自體骨移植對於治療結果並沒有顯著幫助,甚至有一位病人在取移植骨的部位有嚴重的併發症產生。而一個包含21位病人的試驗則發現使用氫氧基磷灰石骨水泥的治療效果有遜於使用Kapandji骨釘的跡象。三個試驗 (共包含了180位病患) 分別使用自體骨移植、Noran SRS及骨水泥,發現其治療效果在功能上並沒有顯著的差異,但在解剖學上的治療效果,相較於使用骨外固定則有較好的跡象。絕大多數的併發症都和骨外固定有關,僅有一個試驗中有發生Norian SRS的骨外鈣化現象。一個包含了93位使用背側骨板固定的患者的試驗中,發現使用自體骨移植的治療效果,比起使用異體骨移植而言,對於手腕功能上有些微的幫助,但也有較多的取骨處的併發症。這些回顧的總結認為,相較於單純使用樹脂石膏固定,使用骨支架物質可能可以改善解剖學上的治療效果,但沒有足夠的證據顯示在功能及安全性等其他方面上也有相同的優勢。