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Retrospective Comparative Study of Clinical Outcomes and Cost-Effectiveness with Bone Substitutes on Volar Locking Plate Fixation of Unstable Distal Radial Fractures in the Elderly

Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

This work was performed in hospitals of the trauma research (TRON) group associated with the Department of Orthopaedic Surgery of Nagoya University Graduate School of Medicine.

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Yasuhiko TAKEGAMI

Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

E-mail Address: takegami@med.nagoya-u.ac.jp

Correspondence to: Yasuhiko Takegami, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. Tel: +81-52-744-2111, Fax: +81-52-744-2260.

This work was performed in hospitals of the trauma research (TRON) group associated with the Department of Orthopaedic Surgery of Nagoya University Graduate School of Medicine.

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Katsuhiro TOKUTAKE

Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

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Yoshiharu OKA

Department of Orthopaedic Surgery, Chubu Rosai Hospital, Nagoya, Japan

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, and

Shiro IMAGAMA

Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

This work was performed in hospitals of the trauma research (TRON) group associated with the Department of Orthopaedic Surgery of Nagoya University Graduate School of Medicine.

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https://doi.org/10.1142/S2424835523500091Cited by:5 (Source: Crossref)

Abstract

Background: This multicenter retrospective study aimed to compare clinical outcomes and cost-effectiveness with bone substitutes on volar locking plate (VLP) fixation of unstable distal radial fractures (DRF) in the elderly.

Methods: The data of 1,980 patients of ≥65 years of age who underwent surgery for the DRF with a VLP in 2015–2019 were extracted from a database (named TRON). Patients lost to follow-up or who received autologous bone grafting were excluded. The patients (n = 1,735) were divided into the VLP fixation alone (Group VLA) and VLP fixation with bone substitutes (Group VLS). Propensity score matching of background characteristics (ratio, 4:1) was performed. The modified Mayo wrist scores (MMWS) were evaluated as clinical outcomes. The implant failure rate, bone union rate, volar tilt (VT), radial inclination (RI), ulnar variance (UV) and distal dorsal cortical distance (DDD) were evaluated as radiologic parameters. We also compared the initial surgery cost and total cost for each group.

Results: After matching, the backgrounds of Groups VLA (n = 388) and VLS (n = 97) were not significantly different. The MMWS values of the groups were not significantly different. Radiographic evaluation revealed no implant failure in either group. Bone union was confirmed in all patients in both groups. The VT, RI, UV and DDD values of the groups were not significantly different. The initial surgery cost and total cost in the VLS group were significantly higher than those in the VLA group ($3,515 vs. $3,068, p < 0.001).

Conclusions: In patients of ≥65 years of age with DRF, the clinical and radiological outcomes of VLP fixation with bone substitutes did not differ from those of VLP fixation alone, yet the additional use of bone augmentation was associated with higher medical costs. The indications for bone substitutes should be more strictly considered in the elderly with DRF.

Level of Evidence: Level IV (Therapeutic)

Keywords:

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