LAUSR

Background Based on debatable recommendations of using bone substitutes for filling of metaphyseal void in elderly unstable distal radius fractures; this study investigated the following question “Do bone substitutes effectively contribute to postoperative stability of k-wire fixation construct and accelerate healing in elderly unstable distal radius fractures?”. Methods This prospective cohort study was conducted from October 2014 to April 2021. According to use of bone substitutes, 40 patients of elderly unstable distal radius fractures were alternately allocated into; group-(A) of bone substitutes-augmented percutaneous pinning (19 patients); and group-(B) of non-augmented percutaneous pinning (21 patients). Groups were compared for preoperative patients’ demographics and postoperative ROM, Quick-DASH and Mayo Wrist scores, radiographic parameters (palmar tilt, radial height and inclination, ulnar variance and intra-articular step-off) and duration until radiographic fracture healing. Results Statistically, augmented and non-augmented groups were matched in terms of patients’ demographics (mean age; 58.7 vs. 62.0 years respectively, P -value = 0.25). All included fractures have healed with insignificantly longer duration in augmented group (7.1 vs. 6.8 weeks, P -value = 0.26). At 12-week postoperative evaluation, radiographic parameters of both groups were comparably well-maintained except for intra-articular step-off which showed significantly less secondary displacement in augmented group (0.1 vs. 0.4 mm, P -value = 0.01). There were insignificant differences in 6-month postoperative ROM, and Quick-DASH and Mayo Wrist scores. Conclusion Compared to its bone substitutes-augmented counterpart; non-augmented percutaneous pinning of elderly unstable distal radius fractures can offer advantages of comparable healing rates and functional and radiographic outcomes, less-invasive approach, shorter operative time and lower cost. Level of evidence III 1- When used to augment percutaneous pinning of elderly unstable distal radius fractures, bone substitutes did not significantly offer additional postoperative mechanical stability of fixation construct. 2- When used to augment percutaneous pinning of elderly unstable distal radius fractures, bone substitutes did not significantly accelerate fracture healing. 3- Compared to bone substitutes-augmented pinning; stand-alone percutaneous pinning of elderly unstable distal radius fractures can achieve comparable healing rates and satisfactory functional and radiographic outcomes; and in addition, less-invasive approach, shorter operative time and lower cost.