Mostafa A Ayoub1, Mahmoud A El-Rosasy. 1. Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Tanta University Hospital, University of Tanta, Al-Geish Street, Tanta, Egypt, maayoub@yahoo.com.
Abstract
OBJECTIVES: Management of post-traumatic bone defects continues to be a substantial clinical challenge in orthopaedic trauma. This retrospective study evaluates the results of primary hybrid grafting of residual bone defects or voids, in displaced and comminuted long-bone fractures treated by plate fixation, using β-tricalcium phosphate and demineralized bone matrix. MATERIALS AND METHODS: Fifty-four patients having 62 fractures were included. Their mean age was 40.7±10.7 years; femoral and tibial fractures were the commonest (70.9%) in this study. Eight fractures (12.9%) were open injuries; 13 fractures had critical-sized defects that averaged 3.4±0.9 cm. Cortical bone defects occurred in 51 cases, and cancellous bone voids in eleven. Eleven patients (20%) were polytraumatized. Tobramycin powder was added to the graft in all open fractures. The functional outcome was evaluated according to a modified Karlström and Olerud criteria. RESULTS: All fractures (100%) had solid union without any implant failure. There was a significant delayed union (P<0.001) in all critical-sized defects. The mean healing time showed a highly significant difference (P<0.001) between closed and open fractures. The functional outcome was excellent in 28 fractures, good in 21 fractures, fair in nine fractures and poor in four fractures. CONCLUSIONS: We believe that the ideal bone graft substitute for all situations does not exist; however, this hybrid grafting is a very good alternative to autogenous grafts especially in polytraumatized patients and when massive bone grafting is needed to reconstruct more than one bone in absence of segmental defects.
OBJECTIVES: Management of post-traumatic bone defects continues to be a substantial clinical challenge in orthopaedic trauma. This retrospective study evaluates the results of primary hybrid grafting of residual bone defects or voids, in displaced and comminuted long-bone fractures treated by plate fixation, using β-tricalcium phosphate and demineralized bone matrix. MATERIALS AND METHODS: Fifty-four patients having 62 fractures were included. Their mean age was 40.7±10.7 years; femoral and tibial fractures were the commonest (70.9%) in this study. Eight fractures (12.9%) were open injuries; 13 fractures had critical-sized defects that averaged 3.4±0.9 cm. Cortical bone defects occurred in 51 cases, and cancellous bone voids in eleven. Eleven patients (20%) were polytraumatized. Tobramycin powder was added to the graft in all open fractures. The functional outcome was evaluated according to a modified Karlström and Olerud criteria. RESULTS: All fractures (100%) had solid union without any implant failure. There was a significant delayed union (P<0.001) in all critical-sized defects. The mean healing time showed a highly significant difference (P<0.001) between closed and open fractures. The functional outcome was excellent in 28 fractures, good in 21 fractures, fair in nine fractures and poor in four fractures. CONCLUSIONS: We believe that the ideal bone graft substitute for all situations does not exist; however, this hybrid grafting is a very good alternative to autogenous grafts especially in polytraumatized patients and when massive bone grafting is needed to reconstruct more than one bone in absence of segmental defects.
Authors: Jeffrey C Wang; A Alanay; Davies Mark; Linda E A Kanim; Pat A Campbell; Edgar G Dawson; Jay R Lieberman Journal: Eur Spine J Date: 2007-01-05 Impact factor: 3.134