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The Use of Bone Graft Substitute in Hand Surgery

View Article: PubMed Central - PubMed

ABSTRACT

Bone defects are a very common problem in hand surgery, occurring in bone tumor surgery, in complicated fractures, and in wrist surgery. Bone substitutes may be used instead of autologous bone graft to avoid donor site morbidity. In this article, we will review our experience with the use of Cerament bone void filler (Bonesupport, Lund, Sweden) in elective and trauma hand surgery. A prospective clinical study was conducted with 16 patients treated with this bone graft substitute in our department over a period of 3.5 years. Twelve patients (2 female, 10 male; with an average age of 42.42 years) with monostoic enchondroma of the phalanges were treated and 4 patients (1 female, 3 male; with an average age of 55.25 years) with complicated metacarpal fractures with bone defect. Data such as postoperative course with rating of pain, postoperative complications, functional outcome assessment at 1, 2, 3, 6 months, time to complete remodeling were registered. Postoperative redness and swelling after bone graft substitute use was noticed in 7 patients with enchondroma surgery due to the thin soft-tissue envelope of the fingers. Excellent total active motion of the involved digit was noticed in 10 of 12 enchondroma patients and in all 4 fracture patients at 2-month follow-up. In summary, satisfying results are described, making the use of injectable bone graft substitute in the surgical treatment of enchondromas, as well as in trauma hand surgery a good choice.

No MeSH data available.


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X-ray of the left second digit of a 35-year-old patient with enchondroma in the proximal phalanx of the second digit preoperatively (A, B), direct postoperatively after curettage and Cerament use (C, D), at 2 weeks postoperatively (E, F), and at 8 weeks after surgery (G, H). Postoperative redness and swelling developed, third postoperative day, due to milky drainage (I).
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Figure 3: X-ray of the left second digit of a 35-year-old patient with enchondroma in the proximal phalanx of the second digit preoperatively (A, B), direct postoperatively after curettage and Cerament use (C, D), at 2 weeks postoperatively (E, F), and at 8 weeks after surgery (G, H). Postoperative redness and swelling developed, third postoperative day, due to milky drainage (I).

Mentions: Twelve patients (2 female, 10 male) with an average age of 42.42 ± 17.2 years were treated with Cerament after the curettage of an enchondroma tumor. Complications of grade II according to the Clavien-Dindo classification[9] occurred. In 7 patients (53.8%) redness and swelling appeared, lasting up to 10 postoperative days (Fig. 3). In these cases, an oral antibiotic therapy (second-generation cephalosporin) was initiated on the first postoperative day for 7 days. In one of these patients a fracture in the mid zone of the cement appeared 2 weeks after surgery during intensive physiotherapy. This fracture healed well with conservative treatment, but this patient needed the splint for 6 weeks. One patient developed a chronic regional pain syndrome (CRPS), which was treated successfully with intensive conservative treatment and healed without any residual symptoms within 1 year.


The Use of Bone Graft Substitute in Hand Surgery
X-ray of the left second digit of a 35-year-old patient with enchondroma in the proximal phalanx of the second digit preoperatively (A, B), direct postoperatively after curettage and Cerament use (C, D), at 2 weeks postoperatively (E, F), and at 8 weeks after surgery (G, H). Postoperative redness and swelling developed, third postoperative day, due to milky drainage (I).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998432&req=5

Figure 3: X-ray of the left second digit of a 35-year-old patient with enchondroma in the proximal phalanx of the second digit preoperatively (A, B), direct postoperatively after curettage and Cerament use (C, D), at 2 weeks postoperatively (E, F), and at 8 weeks after surgery (G, H). Postoperative redness and swelling developed, third postoperative day, due to milky drainage (I).
Mentions: Twelve patients (2 female, 10 male) with an average age of 42.42 ± 17.2 years were treated with Cerament after the curettage of an enchondroma tumor. Complications of grade II according to the Clavien-Dindo classification[9] occurred. In 7 patients (53.8%) redness and swelling appeared, lasting up to 10 postoperative days (Fig. 3). In these cases, an oral antibiotic therapy (second-generation cephalosporin) was initiated on the first postoperative day for 7 days. In one of these patients a fracture in the mid zone of the cement appeared 2 weeks after surgery during intensive physiotherapy. This fracture healed well with conservative treatment, but this patient needed the splint for 6 weeks. One patient developed a chronic regional pain syndrome (CRPS), which was treated successfully with intensive conservative treatment and healed without any residual symptoms within 1 year.

View Article: PubMed Central - PubMed

ABSTRACT

Bone defects are a very common problem in hand surgery, occurring in bone tumor surgery, in complicated fractures, and in wrist surgery. Bone substitutes may be used instead of autologous bone graft to avoid donor site morbidity. In this article, we will review our experience with the use of Cerament bone void filler (Bonesupport, Lund, Sweden) in elective and trauma hand surgery. A prospective clinical study was conducted with 16 patients treated with this bone graft substitute in our department over a period of 3.5 years. Twelve patients (2 female, 10 male; with an average age of 42.42 years) with monostoic enchondroma of the phalanges were treated and 4 patients (1 female, 3 male; with an average age of 55.25 years) with complicated metacarpal fractures with bone defect. Data such as postoperative course with rating of pain, postoperative complications, functional outcome assessment at 1, 2, 3, 6 months, time to complete remodeling were registered. Postoperative redness and swelling after bone graft substitute use was noticed in 7 patients with enchondroma surgery due to the thin soft-tissue envelope of the fingers. Excellent total active motion of the involved digit was noticed in 10 of 12 enchondroma patients and in all 4 fracture patients at 2-month follow-up. In summary, satisfying results are described, making the use of injectable bone graft substitute in the surgical treatment of enchondromas, as well as in trauma hand surgery a good choice.

No MeSH data available.


Related in: MedlinePlus