Abstract
BackgroundManagement of traumatic bone voids has always been challenging. Gentamicin eluting synthetic bone graft substitute (Cerament-G) showed encouraging results in achieving good bone healing with a satisfactory degree of resorption when utilised as a void filler. This study aims to assess the radiological signs of Cerament-G remodelling when used for patients with traumatic bone voids.MethodsRetrospective data analysis of all patients admitted to our unit between 2015 and 2021 with traumatic bone voids who had Cerament-G applied intraoperatively as a void filler. Postoperative radiographic images of the fracture site at six weeks, three months, six months, and at the final follow-up were reviewed. The radiological signs of Cerament-G integration, percent of void healing at the final follow-up were assessed.ResultsA total of 51 patients (52 fractures) were included in the study. Among them 10 were female and 41 were male with a mean age of 42.7 (11 - 90) years. The mean void size was 6.58 cm3. Mean follow-up duration was 9.73 months. Primary fracture union was achieved in 44 (86.3%) patients. Delayed union was reported in six (11.7%) patients, while one (1.9%) patient had non-union. Twenty-seven (52%) patients had >90% of void healing with normal trabecular bone. Twenty (38.5%) patients had 50-90% void healing with normal bone. Whereas only five (9.5%) patients had less than 50% of void healing.ConclusionCerament-G used as a void filler for patients with traumatic bone void has resulted 98% fracture union rate with good signs of radiological remodelling into a trabecular bone. More than 50% void filling with new trabecular bone was reported in more than 90% of patients. Non-union was reported in only one patient.
Highlights
Over the years, traumatic bone voids have continued to be a challenge for orthopaedic surgeons
This study aims to evaluate the radiological signs of remodelling and the outcomes of bone healing when Cerament-G was used as a void filler and local antibiotics carrier for patients with fractures associated with significant bone voids
In an animal study performed by Dvorzhinskiy et al in 2015, they concluded that Cerament-G had resulted in a 56% increase in bone formation at the void site when it was applied as a void filler compared to cases where no void filler was applied [14]
Summary
Traumatic bone voids have continued to be a challenge for orthopaedic surgeons. Bone loss can happen at the time of injury or during surgical debridement of devitalised bone fragments [1,2]. Due to difficulties in skeletal reconstruction and potential risk on limb salvage, amputation was the primary treatment for patients with significant traumatic bone loss. Fractures associated with bone voids had been managed via different strategies, such as autograft, allograft, bone graft substitute, or even by bone shortening [4]. Autologous cancellous bone graft was considered the gold standard, due to its excellent osteoconductive, osteoinductive, and osteogenic properties. Its limited availability, donor site complications (e.g., pain and bleeding), and increase operative time are the main disadvantages associated with autologous bone graft [5]. This study aims to assess the radiological signs of Cerament-G remodelling when used for patients with traumatic bone voids
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