Current Management and Volar Locking Plate Fixation with Bone Cement Augmentation for Elderly Distal Radius Fractures-An Updated Narrative Review

Abstract

Distal radius fractures (DRFs) are the most common among all kinds of fractures with an increase in incidence due to the rapidly expanded size of the elderly population in the past decades. Both non-surgical and surgical treatments can be applied for this common injury. Nowadays, more and more elderly patients with DRFs undergo surgical treatments to restore pre-injury activity levels faster. However, optimal treatment for geriatric DRFs is still debated, and careful evaluation and selection of patients are warranted considering clinical and functional outcomes, and complications following surgical treatments. Furthermore, osteoporosis is a predominant factor in elderly DRFs mostly deriving from a low-energy trauma, so many treatment modalities are developed to enhance better bone healing. Among various options for bone augmentation, bone cement is one of the most widely used measures. Bone cement such as calcium phosphate theoretically improves fracture stability and healing, but whether the elderly patients with DRFs can significantly benefit from surgical fixation with bone cement augmentation (BCA) remains controversial. Hence, in the present review, the latest literature regarding current concepts of management and evidence about volar locking plate fixation (VLPF) with BCA for elderly DRFs was searched in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science; out of >1000 articles, full texts of 48 and 6 articles were then examined and analyzed separately for management and VLPF with BCA for elderly DRFs. We aim to provide the readers with updates concerning the above issues.

Keywords: bone cement augmentation; elderly distal radius fracture; management; volar plate.

Figure 1

Comparison of volar locking plate fixation (VLPF) (A1–A3) with or (B1–B3) without calcium phosphate bone cement augmentation (CPBCA) in elderly distal radial fractures (DRFs). Patient A with (A1) a right DRF underwent (A2) VLPF with CPBCA (arrows) and received (A3) a radiologic follow up at 6 months post-surgically; similarly, patient B also with (B1) a right DRF underwent (B2) VLPF without CPBCA and received (B3) a radiologic follow up at 6 months post-surgically. Compared to patient A treated with VLPF with CPBCA (arrows), gradually decreased radial height, loss of volar tilting, and dorsal migration of DRF fragments (arrowhead) were noted in patient B treated with VLPF without CPBCA.