Infection Rates and Healing Using Bone Wax and a Soluble Polymer Material

Abstract

The effects of using a newly available watersoluble polymer bone hemostatic material in a contaminated environment were assessed in a rabbit tibial defect model. Infection rates and healing of polymer-treated bone were compared with the infection and healing of bone waxtreated bone and untreated controls after a bacterial challenge. Defects created in 24 rabbit tibias were treated with the polymer or bone wax, or left without a hemostatic agent. The defects were inoculated with Staphylococcus aureus ATCC-29213 (2.5 · 10 4 colony-forming units). After 4 weeks, all defects treated with bone wax were infected and osteomyelitis had developed, and none had evidence of bone healing. In the polymer and control groups, two defects in each group (25%) had osteomyelitis develop. The remaining six defects in each group (75%) showed no osteomyelitis and exhibited normal bone healing. The polymer-treated defects had a considerably lower rate of osteomyelitis and positive bone cultures compared with the bone wax-treated group. There were no differences between the polymer-treated and control groups in the rates of osteomyelitis, positive cultures, or bone healing. The use of a soluble polymer as an alternative to bone wax may decrease the rates of postoperative bone infections.

The effects of surgicel and bone wax hemostatic agents on bone healing: An experimental study

“…The bone mineral density (BD) too was significantly low compared to that of the control and surgicel filled defects [Tables 1 and 3]. This is supported by numerous animal and clinical studies16171819 which have demonstrated that the bone wax remains at the implantation site indefinitely and inhibits new bone formation.…”

“…Since then bone wax has been used widely as a nonabsorbable hemostatic bone sealant. However, certain adverse reactions reported with its use include persistent granulomatous inflammation, foreign body reaction and promotion of infection, delayed bone healing and potential for neurological complications 414151617…”

Does Bone Wax Induce a Chronic Inflammatory Articular Reaction?

“…Based on our findings, we have abandoned the use of intraarticular bone wax during FAI surgery. Alternatives to bone wax, including absorbable copolymers and gelatin-based agents that do not provoke adverse tissue response or interfere with bone healing [17,18,21,[26][27][28][29], may be preferable absorbable hemostatic agents for treating bone bleeding.…”

Era of Bloodless Surgery: Spotlights on Hemostasic Materials and Techniques

“…Since it is biochemically unchanged in the human body and is erased from the human body safely, it is thought to be better than bone wax. Wellisz et al showed a comparison of Ostene with bone wax in rabbit experiments and found that Ostene showed stronger binding than bone wax [17]. While Ostene seems to carry out hemostasis without blunting bone healing or increasing incidence of infection, randomized controlled studies in human cases have not been reported.…”