Use of a biphasic cement bone substitute in the management of metaphyseal fractures

Abstract

Objectives: In recent years, the increase in utilisation of bone substitutes in the reconstruction of bone defects has been fuelled by donor site complications associated with autologous bone harvesting. However the ability of bone substitute to stimulate bone union while maintaining fracture reduction has been a topic of debate. Cerament Bone Void Filler (CBVF) is a novel biphasic and injectable ceramic bone substitute that has high compressive strength and the ability to promote cancellous bone healing. Materials and Method: This is a retrospective study to evaluate the surgical outcome of utilising CBVF in the treatment of depressed metaphyseal bone fractures over a two year period. The patients were followed up for at least six months after surgery and clinical parameters such as wound site complications were collated. Radiographic imaging was evaluated to determine loss of fracture reduction and rate of cement resorption. Results: Thirteen patients with depressed metaphyseal fractures were enrolled, which included: (i) one proximal humerus fracture; (ii) three tibial plateau fractures; and (iii) nine calcaneal fractures. None of the patients showed significant collapse in fracture reduction after six months of follow up. Cement resorption was noted in one patient as early as three weeks after surgery. There were no cases of cement leak or wound site complications. Conclusion: Cerament Bone Void Filler (CBVF) is a promising bone graft substitute in the management of depressed metaphyseal bone fractures, with the ability to maintain fracture reduction despite cement resorption.

Alternating Layers of Morselized Allograft and Injectable Ceramic Bone Graft Substitute in Acetabular Reconstruction: A Novel ‘Sandwich’ Technique

“…Impaction allografting has potential of integration and restores the bone stock. However, the allograft use has concerns about infection, antigenicity, stability, availability, cost, and aseptic loosening in the long term [ [5] , [6] , [7] ]. There is also a considerable delay in time to weight bearing when the allograft is used with revision shells or cages.…”

“…Noninjectable bone graft substitutes such as granules have been used with allografts for acetabular defects, mainly as allograft extenders [ 2 , 3 ]. The injectable biphasic bone graft substitute was introduced as a void filler for defects created after curettage of bone or due to fractures [ 4 , 5 ]. Several bone substitutes are commercially available for bone void filling 6 .…”

Nanocrystalline Hydroxyapatite–Poly(thioketal urethane) Nanocomposites Stimulate a Combined Intramembranous and Endochondral Ossification Response in Rabbits

“…However, intramembranous ossification cannot occur under hypoxic conditions . Creeping substitution is therefore limited to the periphery, resulting in slow resorption of the implant and poor osseointegration. − Biphasic CPCs allow for bone formation throughout the interior through pores resulting from the dissolution of a soluble phase (i.e., calcium sulfate). , However, calcium phosphate bone substitutes have insufficient mechanical properties for weight-bearing applications …”

“…3−5 Biphasic CPCs allow for bone formation throughout the interior through pores resulting from the dissolution of a soluble phase (i.e., calcium sulfate). 6,7 However, calcium phosphate bone substitutes have insufficient mechanical properties for weight-bearing applications. 8 Fractures with a large osseous defect heal by the formation of a cartilage intermediate that stimulates angiogenesis and consequent bone formation, a process known as endochondral ossification or secondary bone healing.…”