Use of Calcium-Based Demineralized Bone Matrix/Allograft for Nonunions and Posttraumatic Reconstruction of the Appendicular Skeleton: Preliminary Results and Complications

Ziran, Bruce H.; Smith, Wade R.; Morgan, Steve J.

doi:10.1097/01.ta.0000240452.64138.b0

Cited by 51 publications

(52 citation statements)

References 7 publications

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“…14,16,17,32 Complications encountered have included persistent drainage from the wound, superficial or deep infection, and failure of union. No reports of allergic reaction, metabolic derangement, or end organ damage have been reported.…”

Section: Complicationsmentioning

confidence: 99%

Calcium Sulfates: What Is the Evidence?

Beuerlein

McKee

2010

Journal of Orthopaedic Trauma

147

104

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Calcium sulphate has been used extensively as a bioabsorbable bone substitute for 90 years. Its advantages include its low cost, ready availability and unlimited supply, lack of donor site morbidity, use as a delivery vehicle for other compounds (especially antibiotics), inherent osteoconductive properties (based on a structure similar to bone), and its proven safety record. We sought to determine the evidence-based medical studies (prospective and/or randomized clinical trials) that support the use of calcium sulphate as a bioabsorbable bone substitute. At the present time, the majority of reports are basic science investigations, animal studies, and retrospective clinical reviews of varying degrees of quality. Multiple retrospective reviews reveal that calcium sulphate is an effective void-filler in contained bony defects such as metaphyseal voids after impacted fracture reduction (calcaneus, tibial plateau), simple bone cysts, or posttraumatic defects. Three case series examining the use of calcium sulphate in the treatment of bone nonunions revealed a significant failure rate, suggesting that this material, used in isolation, is not optimal to promote union in that setting. A low but consistent complication rate, specifically serous drainage from the wound as the calcium sulphate absorbs, has been reported. This complication is higher when the material is used in higher volumes (greater than 20 mL) or in subcutaneous bones (tibia, ulna). There is some Level I to II evidence (one randomized trial, one case-control study, one prospective cohort study) that antibiotic-impregnated bioabsorbable calcium sulphate has the potential to reduce the number of procedures and surgical morbidity associated with the surgical treatment of chronic osteomyelitis and infected nonunion while maintaining a high rate of infection eradication. Calcium sulphate remains an inexpensive, safe, reliable bone void filler that can also serve as a absorbable delivery vehicle for antibiotics or other compounds. Further high-quality randomized and prospective clinical trials are required to define the role of calcium sulphate in modern orthopaedics.

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Section: Complicationsmentioning

confidence: 99%

Calcium Sulfates: What Is the Evidence?

Beuerlein

McKee

2010

Journal of Orthopaedic Trauma

147

104

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“…Ziran et al reported that use of CS in non-unions led to no improvement in bone healing and increased wound drainage because of its rapid resorption within 6-8 weeks. 35 Therefore, CS is not recommended for non-unions or periarticular fractures, but Osteoset bone graft substitutes may be used as a drug carrier to deposit tobramycin in local areas. According to the aforementioned studies, CP is difficult to resorb within one year in clinical use, and HAp lasts longer than CP.…”

Section: Discussionmentioning

confidence: 99%

Combination of calcium sulfate and simvastatin-controlled release microspheres enhances bone repair in critical-sized rat calvarial bone defects

Fu¹,

Wang²,

Ch³

et al. 2015

IJN

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Most allogenic bone graft substitutes have only osteoconductive properties. Developing new strategies to improve the osteoinductive activity of bone graft substitutes is both critical and practical for clinical application. Previously, we developed novel simvastatin-encapsulating poly(lactic-co-glycolic acid) microspheres (SIM/PLGA) that slowly release simvastatin and enhance fracture healing. In this study, we combined SIM/PLGA with a rapidly absorbable calcium sulfate (CS) bone substitute and studied the effect on bone healing in critical-sized calvarial bone defects in a rat model. The cytotoxicity and cytocompatibility of this combination was tested in vitro using lactate dehydrogenase leakage and a cell attachment assay, respectively. Combination treatment with SIM/PLGA and the CS bone substitute had no cytotoxic effect on bone marrow stem cells. Compared with the control, cell adhesion was substantially enhanced following combination treatment with SIM/PLGA and the CS bone substitute. In vivo, implantation of the combination bone substitute promoted healing of critical-sized calvarial bone defects in rats; furthermore, production of bone morphogenetic protein-2 and neovascularization were enhanced in the area of the defect. In summary, the combination of SIM/PLGA and a CS bone substitute has osteoconductive and osteoinductive properties, indicating that it could be used for regeneration of bone in the clinical setting.

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“…In animal models, it has been well established that DBM is capable of stimulating new bone formation, but also that its combination with osteoprogenitor cells produces better results [16,109,110]. In humans this approach proved controversial as the use of injectable demineralised bone resulted in a high rate of complications [123]. Percutaneous bone grafting on the other hand has been proven successful in the safe treatment of nonunions [5,54,56].…”

Section: Discussionmentioning

confidence: 99%

“…Their results revealed an 85.1% union rate. On the other hand, a recent study by Ziran et al, which evaluated an open application of a new calcium sulphate-demineralised bone matrix/allomatrix in the treatment of nonunions, presented an unacceptably high rate of complications which included postoperative drainage (54%), deep infection (34%) and an overall failure rate of 46% [123].…”

Section: Percutaneous Pattymentioning

confidence: 99%

Efficacy of minimally invasive techniques for enhancement of fracture healing: evidence today

Pountos

Georgouli

Kontakis

et al. 2009

International Orthopaedics (SICOT)

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The successful treatment of nonunions represents a major challenge for orthopaedic surgeons. Lately, ongoing advances made in the field of molecular medicine and molecular biology have increased our understanding of the pathways and involvement of mediators surrounding the bone healing process. As a result, the surgeon's armamentarium has been increased in terms of options for intervention. This article aims to provide an overview of minimally invasive techniques applicable in the treatment of nonunions of fractures.

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Use of Calcium-Based Demineralized Bone Matrix/Allograft for Nonunions and Posttraumatic Reconstruction of the Appendicular Skeleton: Preliminary Results and Complications

Cited by 51 publications

References 7 publications

Calcium Sulfates: What Is the Evidence?

Calcium Sulfates: What Is the Evidence?

Combination of calcium sulfate and simvastatin-controlled release microspheres enhances bone repair in critical-sized rat calvarial bone defects

Efficacy of minimally invasive techniques for enhancement of fracture healing: evidence today

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