The effect of demineralized bone matrix-calcium sulfate with vancomycin on calcaneal fracture healing and infection rates: a prospective study.

Abstract

BACKGROUND:

Displaced intra-articular calcaneal fractures may have a central cancellous bone defect area. We hypothesized that human demineralized bone matrix (DBM) calcium sulfate (CaSO(4)) might act as a reasonable alternative to autograft in calcaneal fractures. When combined with antibiotic powder, this bone graft substitute also may act as a local antibiotic delivery device. This is the first clinical study evaluating bone healing and complications associated with DBM-calcium sulfate bone graft substitute in the treatment of displaced intra-articular calcaneal fractures with a central cancellous bone defect.

METHODS:

Over a 29-month period, 33 displaced intra-articular calcaneal fractures with central cancellous defects were treated with open reduction and internal fixation (ORIF) and grafting with vancomycin/DBM-calcium sulfate bone graft substitute. Eleven fractures without bone defects were treated with ORIF only. Patient demographics, medical history, and CT fracture classification were recorded. Postoperatively, fractures were monitored every 2 weeks for healing and complications.

RESULTS:

The mean time to union was 8.2 weeks in the grafted, while the control group mean time to union was 10.4 weeks (p = 0.0117). Wound problems occurred in five (15%) of the 33 patients with grafting, all in type III fractures with severe soft-tissue swelling, and included two minor wound healing delays, and three serious wound problems. At a mean followup time of 22.4 months, no DBM-calcium sulfate grafted calcaneus demonstrated evidence of osteomyelitis.

CONCLUSIONS:

This is the first study examining human DBM-calcium sulfate bone graft substitute to treat displaced intra-articular calcaneal fractures. Based on these initial data, human DBM-calcium sulfate acted as an acceptable and safe autograft alternative in displaced intra-articular calcaneal fractures with moderate (5 cc to 10 cc) central cancellous bone defects.

• Authors: Christopher Bibbo, Dipak V Patel
• Journal: Foot & ankle international (Foot Ankle Int) Vol. 27 Issue 7 Pg. 487-93 (Jul 2006) ISSN: 1071-1007 [Print] United States
• PMID: 16842714 (Publication Type: Clinical Trial, Comparative Study, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Bone Substitutes
• Vancomycin
• Calcium Sulfate

Topics

• Adolescent
• Adult
• Anti-Bacterial Agents (therapeutic use)
• Bone Matrix (transplantation)
• Bone Substitutes (therapeutic use)
• Bone Transplantation (methods)
• Calcaneus (injuries, surgery)
• Calcium Sulfate (therapeutic use)
• Female
• Fracture Healing (drug effects)
• Fractures, Bone (therapy)
• Humans
• Male
• Middle Aged
• Postoperative Complications
• Prospective Studies
• Surgical Wound Infection (etiology, prevention & control)
• Time Factors
• Treatment Outcome
• Vancomycin (therapeutic use)