Calcium sulfate as bone graft substitute in the treatment of osseous bone defects, a prospective study

Abstract

Background: Calcium sulfate belongs to synthetic ceramic group of bone graft substitutes having an osteoconductive property. Calcium sulfate is an easily available, economic bone graft substitute. It is a bio-inert material which over a period of weeks get resorbed and fibrovascular tissue takes its place which eventually allows neovascularisation and bone formation within the area. Use of calcium sulfate as a bone graft substitutes avoids the complications and morbidity associated with autograft like infection, second surgery, and finite amount of graft.

Material and methods: A total of 15 patients with benign bone lesions and chronic osteomyelitis were operated and the osseous defects were filled with calcium sulfate which was comprehensively sterilized. Patients were followed with serial radiographs at six week intervals. Calcium sulfate resorption and new bone formation was studied.

Results: Thirteen cases out of 15 showed calcium sulphate resorption and new bone incorporation. Calcaium sulphate resorption occurred at an average of 14.5 weeks (range,13-18weeks) whereas new bone incorporation occurred at an average of 6months ( range,5-7months). Thirteen patients out of these 15 cases returned to full activities of daily living. One patient had pathological fracture at the osseous defect postoperatively. One patient with GCT of distal end of tibia had recurrence of tumor and had to undergo second surgery.

Conclusion: Although autogenous bone graft is the gold standard for bone grafting, it has limitations like finite amount, additional surgery and donor site morbidity. Calcium sulphate is safe, efficient and easily available bone graft substitute in the treatment of osseous defects. Most common complication encountered was aseptic serous discharge. Functional results were favorable in most of the cases.

Keywords: Bone graft substitute; Calcium sulfate; Osseous defects.

[Table/Fig-1]:

Fibrous dysplasia Proximal Femur

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Postoperative day 1

[Table/Fig-3]:

Radiograph at six weeks showing calcium sulphate resorption

[Table/Fig-4]:

Radiograph at three month showing new bone formation

[Table/Fig-5]:

At 6 months new bone consolidating

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At one year

[Table/Fig-7]:

Radiograph at 18 months of follow up.

[Table/Fig-8]:

After curettage

[Table/Fig-9]:

After Calcium sulfate grafting