Injectable Calcium Phosphate in the Treatment of Distal Radial Fractures

Kopylov, Philippe; Jonsson, K.; Thorngren, K.-G.; Aspenberg, Per

doi:10.1016/s0266-7681(96)80184-7

Cited by 132 publications

(67 citation statements)

References 7 publications

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“…Calciumphosphate (CaP) cements are used in several orthopedic applications [15,18], and are under consideration for vertebral column reinforcement [1,23]. Again, there are only few data available on their applicability and mechanical effect.…”

Section: Augmentation Of Mechanical Properties In Osteoporotic Vertebmentioning

confidence: 99%

Augmentation of mechanical properties in osteoporotic vertebral bones – a biomechanical investigation of vertebroplasty efficacy with different bone cements

et al. 2001

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IntroductionOsteoporosis is a disease characterized by low bone mass, which leads to increased susceptibility to fractures. It is a common condition in the elderly, affecting predominantly women over the age of 65 [2]. The spine is the most common site of fracture in patients with osteoporosis. In the United States, 25% of women over the age of 70 and 50% of women over the age of 80 show evidence of vertebral fractures, the majority of which occur in the midthoracic region and the thoracolumbar junction [16,20]. The potential sequelae include disabling pain, vertebral collapse, and progressive loss of physiologic spinal alignment [22]. Declines in physical function and changes in appearance contribute to social isolation and loss of self-esteem, thus impairing quality of life. Significant neurological compromise due to spontaneous fracture of osteoporotic vertebrae has been described [12,19]. The morbidity associated with osteoporosis and vertebral fractures represents an enormous socio-economic cost [2].Abstract Recent clinical trials have reported favorable early results for transpedicular vertebral cement reinforcement of osteoporotic vertebral insufficiencies. There is, however, a lack of basic data on the application, safety and biomechanical efficacy of materials such as polymethylmethacrylate (PMMA) and calciumphospate (CaP) cements. The present study analyzed 33 vertebral pairs from five human cadaver spines. Thirty-nine vertebrae were osteoporotic (bone mineral density <0.75 g/cm 2 ), 27 showed nearly normal values. The cranial vertebra of each pair was augmented with either PMMA (Palacos E-Flow) or experimental brushite cement (EBC), with the caudal vertebra as a control. PMMA and EBC were easy to inject, and vertebral fillings of 20-50% were achieved. The maximal possible filling was inversely correlated to the bone mineral density (BMD) values. Cement extrusion into the spinal canal was observed in 12% of cases.All specimens were subjected to axial compression tests in a displacement-controlled mode. From loaddisplacement curves, the stiffness, S, and the maximal force before failure, F max, were determined. Compared with the native control vertebrae, a statistically significant increase in vertebral stiffness and F max was observed by the augmentation. With PMMA the stiffness increased by 174% (P=0.018) and F max by 195% (P=0.001); the corresponding augmentation with EBC was 120% (P=0.03) and 113% (P=0.002). The lower the initial BMD, the more pronounced was the augmentation effect. Both PMMA and EBC augmentation reliably and significantly raised the stiffness and maximal tolerable force until failure in osteoporotic vertebral bodies. In nonporotic specimens, no significant increase was achieved.

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Section: Augmentation Of Mechanical Properties In Osteoporotic Vertebmentioning

confidence: 99%

Augmentation of mechanical properties in osteoporotic vertebral bones – a biomechanical investigation of vertebroplasty efficacy with different bone cements

et al. 2001

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“…Norian SRS is an injectable calcium phosphate paste that sets to carbonated hydroxyapatite in situ. It has been used previously, mainly in surgery for distal radial fractures (Kopylov et al 1996) but also for osteotomies of malunited distal radial fractures (Luchetti 2004).…”

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Osteotomy of dorsally displaced malunited fractures of the distal radius: No loss of radiographic correction during healing with a minimally invasive fixation technique and an injectable bone substitute

et al. 2008

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“…In a mechanical study by Stankewich et al (1996), augmentation with calcium phosphate cement provided enhanced stiffness, stability and strength of fixed femoral neck fractures. When resorbable substances are used, the idea is that the initial reinforcement will be followed by progressive resorption over timeassociated with a simultaneous increase in structural support provided by the healing bone (Witschger et al 1991, Constantz et al 1995, Kopylov et al 1996, Stankewich et al 1996, Mainil et al 1997, Moore et al 1997, Frankenburg et al 1998, Goodman et al 1998, Knaack et al 1998, Yetkinler et al 1999, Larsson and Bauer 2002.…”

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confidence: 99%

Calcium phosphate cement for augmentation did not improve results after internal fixation of displaced femoral neck fractures: A randomized study of 118 patients

Mattsson

Larsson

2006

Acta Orthopaedica

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Background We wanted to evaluate whether augmentation with calcium phosphate cement can improve clinical and functional outcome following internal fixation of displaced femoral neck fractures.Patients 118 patients aged 60-98 years (95 women) were included. All patients were physically active and ambulatory before the fracture. Patients were randomized to treatment with closed reduction and fixation with two cannulated screws alone (controls: 60 patients) or screws combined with injection of calcium phosphate for augmentation around the screw threads and at the fracture site (augmented: 58 patients). All patients were allowed free weight bearing. Clinical and radiographic examinations were done by a physiotherapist directly after surgery, at 1 and 6 weeks, and at 6, 12 and 24 months.Results 24 patients, 14 augmented and 10 controls, died during the follow-up. There was 1 deep infection (augmented). Another 34 patients were reoperated with a total arthroplasty (20 in the augmented group and 14 controls) due to loss of reduction, nonunion or avascular necrosis (p = 0.1). There was no difference in pain or muscle strength between groups. Some activities of daily living (ADLs) were slightly better in the augmented patients during the first weeks, while there were no differences between groups later on.Interpretation Due to a trend towards more reoperations in the augmented group, and only a temporary clinical improvement during the early rehabilitation, augmentation as we used it cannot be recommended.

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Injectable Calcium Phosphate in the Treatment of Distal Radial Fractures

Cited by 132 publications

References 7 publications

Augmentation of mechanical properties in osteoporotic vertebral bones – a biomechanical investigation of vertebroplasty efficacy with different bone cements

Augmentation of mechanical properties in osteoporotic vertebral bones – a biomechanical investigation of vertebroplasty efficacy with different bone cements

Osteotomy of dorsally displaced malunited fractures of the distal radius: No loss of radiographic correction during healing with a minimally invasive fixation technique and an injectable bone substitute

Calcium phosphate cement for augmentation did not improve results after internal fixation of displaced femoral neck fractures: A randomized study of 118 patients

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