Use of an allo-cancellous chip bone graft to treat AO/OTA type C3 distal radius comminuted articular fractures: a retrospective case series

Purpose: AO/OTA type C3 distal radius fractures often involve severe intra-articular comminution with subchondral and metaphyseal defects, making stable fixation difficult. We evaluated the radiographic and clinical outcomes of volar locking plate (VLP) fixation combined with allo-cancellous chip bone grafting.Methods: We retrospectively reviewed 27 patients with AO/OTA type C3 distal radius fractures treated with VLP fixation and allo-cancellous chip bone grafting. The mean age was 66.7 years, and the mean follow-up duration was 14.2±3.8 months, with a minimum follow-up of 12 months. Radiographic outcomes included union, radial inclination (RI), volar tilt (VT), and Soong grade. Clinical outcomes included the Mayo wrist score, visual analogue scale (VAS), range of motion (ROM), and grip strength.Results: All fractures achieved union at a mean of 12.7±2.2 weeks. At final follow-up, RI (21.0°±3.6°) and VT (6.9°±4.6°) were not significantly different from immediate postoperative values or the contralateral wrist. Mean Soong grade was 0.6. The mean Mayo wrist score was 85.4, with 74% of patients showing good-to-excellent outcomes. Mean VAS score was 0.5. ROM and grip strength recovered to 89% and 91% of the contralateral side, respectively. One flexor pollicis longus rupture and two cases of post-traumatic arthritis occurred.Conclusion: Allo-cancellous chip bone grafting combined with VLP fixation achieved union and acceptable radiographic and clinical outcomes in AO/OTA type C3 distal radius fractures. This technique may be useful when periarticular or metaphyseal defects persist after reduction.