Clinical Experience on Bioactive Glass S53P4 in Reconstructive Surgery in the Upper Extremity Showing Bone Remodelling, Vascularization, Cartilage Repair and Antibacterial Properties of S53P4

Abstract

Bioactive glass (BAG) S53P4 is a bone bonding, osteoconductive and osteostimulative bone substitute with proven antibac-terial properties. In this paper, several clinical aspects using BAG S53P4 in reconstructive surgery in the upper extremity is presented, demonstrating bone remodelling, vascularization, cartilage repair and antibacterial properties of BAG S53P4. In a prospective, randomized, long-term study, BAG S53P4 was compared to autograft bone, in nine patients, in treatment of benign bone tumours in the hand. No radiological difference between the two groups was observed at 18 months. No material-related adverse effects were observed at the 14-year long-term follow-up. In the BAG group, a thickened cortex was observed on CT. MRI revealed that the bone marrow was mainly or partly fatty. BAG S53P4 was used in treatment of an intra-articular condylar open fracture in a child. In a re-operation, it was observed that the treated region was vascularized at three months, which was histopathologically confirmed. The vascularized bone substitute mass had supported the injured cartilage. An angulation of the proximal interphalangeal joint was observed but this did not affect the use of the hand. The finger was painless and stable. Finally, BAG S53P4 was used in treatment of an infected comminuted olecranon fracture. The patient had sustained a fistular formation to a previously used bone substitute. The pathogen causing the infection was S epidermidis. In a re-operation BAG S53P4 was used as bone substitute. No re-infection was observed during a six-month follow-up.