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Evidence-Based Orthopaedics   |    
Commentary
Michael D. McKee, MD, FRCS(C)
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St Michael's Hospital, Toronto, Ontario, Canada

J Bone Joint Surg Am, 2003 Feb 01;85(2):386-a-386
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Extract

Biocompatible, bioresorbable bone cements were designed to fill bone voids and to provide immediate stability following reduction of fractures with metaphyseal defects. It was originally hoped that these products would "stand alone" and be inherently stable without the need for adjuvant fixation, and preliminary evidence has suggested that this might be the case 1 . One randomized trial with use of remodellable bone cement in the treatment of distal radial fractures showed that earlier mobilization led to a superior outcome compared with cast treatment alone 2 . However, the results of biomechanical studies involving models of unstable distal radial fractures have suggested that biocompatible bone cement alone may be insufficient to withstand flexion-extension or shear forces without supplemental fixation 3 . This study clinically supports this finding because the patients treated with hydroxyapatite cement alone had a loss of reduction (with resulting functional deficits) in comparison with those treated with standard pin fixation. The reason for failure in this select group of patients (only 21 patients were randomized over a one-year period at a busy medical center) is unclear but may relate to the properties of the bone cement that was used, the dorsal opening of the fracture site, or the type of fractures included in the study. Currently, hydroxyapatite bone cement may be useful as an adjunct to standard treatment, but its use in isolation is not recommended for the treatment of unstable fractures of the distal part of the radius that are candidates for pin fixation.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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