The Use of Montage Bone Putty in Assisting in the Maintenance of Reduction in Comminuted Distal Radius Fractures

Abstract

Background The distal radius fracture is the most common fracture in the United States. Achieving stable reduction and fixation of complex fracture patterns can be challenging. In order to help maintain reduction of comminuted fracture to simplify plating, the calcium phosphate-based bone putty Montage has been developed. Questions/Purposes Does Montage assist in achieving stable reduction and fixation of complex distal radius fractures with an acceptable complication profile? Patient and Methods We retrospectively analyzed all patients who were treated intraoperatively with Montage bone putty along with volar plate fixation at a large-volume urban county hospital. Preoperative, intraoperative, and postoperative measurements of radiographic features were recorded at 2 and 6 months, as were any complications. Statistical analysis was then performed on these values. Results Preoperative and postoperative radiographs demonstrated significant improvement in standard distal radius fracture measurements, reflecting adequate reduction with the use of Montage intraoperatively. Critically, radiographs demonstrated maintenance of reduction compared to intraoperative fluoroscopy images at 2 months, showing short-term stability of the use of Montage in these fracture patterns as well as long-term stability at 6 months in a subset of patients. There were no major complications in this study. Conclusion In this study, we demonstrate the utility of Montage bone putty for complex distal radius fractures with short-term follow-up and limited long-term follow-up. This initial study underlines its efficacy in maintaining reduction without major complications. Level of Evidence IV, Therapeutic.

Keywords: Montage bone putty; comminuted fracture; distal radius fracture; nonunion.

Fig. 1

This patient is 48-year-old right hand dominant male construction worker who fell on his outstretched hand off a ladder. He was a nonsmoker and otherwise healthy. He presented for operation 23 days after injury. Intraoperatively, he had a tourniquet time of 120 minutes. He had no postoperative complications with his last follow-up visit and X-ray about 187 days after surgery. ( a ) Preoperative X-rays. ( b ) Intraoperative fluoroscopy images. ( c ) Postoperative X-rays. Note the persistent visualization of Montage and preservation of intraoperative reduction nearly 6 months out from surgery.

Fig. 2

This patient is a 44-year-old right hand dominant unemployed male who fell on his outstretched hand from a ground level fall. He was a smoker but otherwise healthy. He presented for operation 10 days after injury. Intraoperatively, he had a tourniquet time of 83 minutes. He had no postoperative complications at his last follow-up visit and X-ray 27 days after surgery. ( a ) Preoperative X-rays. ( b ) Intraoperative fluoroscopy images. ( c ) Postoperative X-rays. Montage is slightly obscured by projection of the volar plate, but reduction is stable.

Fig. 3

This patient is a 47-year-old right hand dominant male who fell on his outstretched hand. He presented for operation 12 days after injury. As demonstrated from left to right, the preoperative image shows a complex distal radius fracture with adequate reduction with evident radiodensity corresponding to Montage in the middle image. Reduction is maintained at 1 year postoperatively with healing of the fracture line and reabsorption of the Montage, as evident by the uniform appearance of the bone.