Hybrid grafting of post-traumatic bone defects using β-tricalcium phosphate and demineralized bone matrix

Abstract

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. 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. 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. 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.