Minimal Invasive Bone Grafting for Comminuted Fractures
Distal radius is a common site for comminuted fractures. It usually developed after a significant trauma or in patients with osteoporosis. Very often, after closed or even open reduction of the fracture, the distal articular surface is not well-aligned and supported because of collapse in the metaphyseal cancellous bone. In order to restore joint movement and encourage rehabilitation, bone grafting any gap or collapsed cancellous bone is often necessary either to support the articular fragments or to act a scaffold for the growth of new bones.
Traditionally, bone graft is taken from the patient’s pelvic bone with an open wound (autograft), or bone taken from other patients or from cadaveric donors (allograft), or from animals like cow (Xenograft). All these organic grafts, however, carry risk of transmission of germs or pathological or contaminated tissues. Taking graft from the patient also means another surgical procedure on the patient. The current advocate is to use inorganic synthetic materials in order to avoid transmission of diseases. There are synthetic bone substitutes that can be used as toothpaste. It can be injected percutaneously to fill up a bone defect and then hardens in about 10 minutes to support the bony trabeculae. Bone grafting can then be accomplished with minimal amount of surgery and much shortened hospital stay and the chance of injury to the nerve and blood vessels is much less. This injection procedure does require X ray monitor and may translate to some additional irradiation.
After bone grafting, the wrist needs to be rested for about 6 weeks for the fracture to heal.
Dr. KO, But-sui