Hybrid grafting of post-traumatic bone defects using β-tricalcium phosphate and demineralized bone matrix.

Abstract

OBJECTIVES:

Management of post-traumatic bone defects continues to be a substantial clinical challenge in orthopaedic trauma. This retrospective study evaluates the results of primary hybrid grafting of residual bone defects or voids, in displaced and comminuted long-bone fractures treated by plate fixation, using β-tricalcium phosphate and demineralized bone matrix.

MATERIALS AND METHODS:

Fifty-four patients having 62 fractures were included. Their mean age was 40.7±10.7 years; femoral and tibial fractures were the commonest (70.9%) in this study. Eight fractures (12.9%) were open injuries; 13 fractures had critical-sized defects that averaged 3.4±0.9 cm. Cortical bone defects occurred in 51 cases, and cancellous bone voids in eleven. Eleven patients (20%) were polytraumatized. Tobramycin powder was added to the graft in all open fractures. The functional outcome was evaluated according to a modified Karlström and Olerud criteria.

RESULTS:

All fractures (100%) had solid union without any implant failure. There was a significant delayed union (P<0.001) in all critical-sized defects. The mean healing time showed a highly significant difference (P<0.001) between closed and open fractures. The functional outcome was excellent in 28 fractures, good in 21 fractures, fair in nine fractures and poor in four fractures.

CONCLUSIONS:

We believe that the ideal bone graft substitute for all situations does not exist; however, this hybrid grafting is a very good alternative to autogenous grafts especially in polytraumatized patients and when massive bone grafting is needed to reconstruct more than one bone in absence of segmental defects.

• Authors: Mostafa A Ayoub, Mahmoud A El-Rosasy
• Journal: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie (Eur J Orthop Surg Traumatol) Vol. 24 Issue 5 Pg. 663-70 (Jul 2014) ISSN: 1432-1068 [Electronic] France
• PMID: 23756643 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Biocompatible Materials
• Calcium Phosphates
• beta-tricalcium phosphate

Topics

• Adult
• Age Factors
• Biocompatible Materials (therapeutic use)
• Bone Matrix (transplantation)
• Bone Transplantation (methods, rehabilitation)
• Calcium Phosphates (therapeutic use)
• Female
• Fracture Fixation, Internal (methods)
• Fracture Healing (physiology)
• Fractures, Bone (physiopathology, rehabilitation, surgery)
• Humans
• Length of Stay
• Male
• Middle Aged
• Physical Therapy Modalities
• Postoperative Complications (etiology)
• Preoperative Care (methods)
• Retrospective Studies
• Treatment Outcome
• Young Adult