Using of injectable bio-degradable calcium sulfate as bone graft substitute in the treatment of periarticular fractures

Although the use of calcium sulfate has been used as a bone graft substitute in the treatment of fractures for more than a century, few studies investigate the use of recently developed injectable calcium sulfate-based bone graft substitute with high compressive strength after curing in situ. In this study, we evaluated preliminary results of a high compressive strength calcium sulfate-based bone graft substitute used in the treatment of periarticular fractures. Eighty-five patients with periarticular fractures who were treated with an injectable bio-degradable calcium sulfate cement (BCSC) (MIIG X3, Wright Medical Technology, Inc, Arlington, TN, USA) between October 2005 and June 2012 were included in this study. The fracture location distribution was as follows: Fourteen proximal humeral fractures, eight acetabular fractures, thirty-six tibial plateau fractures, seventeen distal tibial fractures and ten calcaneal fractures. Postoperative roentgenologic study was adapted to evaluate the congruity of the articular surface, bone replacement profile and the resorption process of the bone substitute. The postoperative joint function recovery assessment was achieved with Neer’s score system, modified D’Aubigne and Postel hip scale, Rasmussen’s functional and anatomical grading score system and Mazur ankle score correspondingly to the shoulder, hip, knee and ankle joints. The Maryland Foot Score Profile was adapted for the postoperative evaluation of calcaneal fractures. Seventy-seven of the 85 patients were followed-up successfully. The average length of follow-up was 20.2 months (range: 12-27 months). Fractures healed uneventfully in all patients without infection. According to the corresponding functional score system in each location, joint function was excellent or good. Two patients with tibial plateau fractures had an articular subsidence of 2 mm showed by X-ray film one year after operation without joint dysfunction. Four weeks after surgery, partial absorption of BCSC was evident on radiographs. Six months postoperatively, radiographs showed areas previously filled with BCSC with the same bone density as normal cancellous bone. This study showed that the use of a high compressive strength calcium sulfate-based bone graft substitute to fill metaphyseal defects in the treatment of periarticular fractures can provide adequate immediate stability and strength for fracture reduction while improving the safety of early stage joint motion in functional rehabilitation.