A Retrospective Case-Series on the Use of S53p4 Bioactive Glass for the Adjunctive Treatment of Septic Diaphyseal Non-Union

Abstract

Objective:Non-union and persistence of infection at a fracture site for long periods are always described as a challenge to orthopedists, especially in cases of severe compound fractures with comminution and segmental bone loss. This is a case series of septic non-unions, using S53P4 bioactive glass for adjunctive treatment, using internal syntheses or external fixators. The objective is to retrospectively evaluate the results of the use of S53P4 bioglass for the adjunctive treatment of septic non-unions.Methods:We reviewed 18 patients with septic non-unions. The patients were preoperatively classified using the Non-union Scoring System (NUSS) and union outcomes were assessed by the modified radiographic union scale in tibial (RUST) fractures. Of the 18 patients treated, six underwent internal osteosynthesis and 12 were treated with external fixators in combination with bioactive glass grafting.Results:The patients had a mean NUSS score of 56.6 (standard deviation of 7.6) and fracture union was achieved according to the RUST score in 17 of 18 cases (94.4%), with a mean value of 10.2 (standard deviation of 1.0). One patient was lost to follow-up. Reevaluation using the modified RUST score was 12.3 (SD = 1.0), maintaining union of 17/18.Conclusion:The fracture union rate was high, according to the literature, as was control of infection. Level of Evidence IV, Case series.

Treatment of Infection-Related Non-Unions with Bioactive Glass—A Promising Approach or Just Another Method of Dead Space Management?

“…At least in this setting of highly active osteitis, S53P4 could not meet the expectations generated by reports in vitro [31] and in patients [26,45]. One explanation for this discrepancy could be the missing systemic antibiotic therapy in our model, which would have been administered as part of the standard patient treatment [45]. Non-compliancy of the investigated animals could also have affected our results with a mentionable incidence of wound healing disorders.…”

Treatment of infected tibial non-unions using a BMAC and S53P4 BAG combination for reconstruction of segmental bone defects: A clinical case series

“…This bioactive glass has been proven effective in treatment of e.g. chronic osteomyelitis, mastoiditis, benign bone defects and is recently gaining interest in treatment of non-unions [19][20][21][22] . The key concepts for using this BAG is based on the combination of its osteostimulative and its antibacterial characteristics.…”