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Utilisation of bioactive glass S53P4 inside an induced membrane for severe bone defect with high risk of infection: a multi-center preliminary experience

  • Jean-Charles Aurégan
    Correspondence
    Corresponding author at: Department of Orthopaedic, Trauma and Reconstructive Surgery, Antoine Béclère Hospital, AP-HP, Paris Sud University, 157 rue de la Porte de Trivaux, 92140 Clamart, France.
    Affiliations
    Department of Orthopaedic, Trauma and Reconstructive Surgery, Antoine Béclère Hospital, AP-HP, Paris Sud University, 157 rue de la Porte de Trivaux, 92140 Clamart, France

    Laboratory of Bioengineering and Biomechanics for Bone Articulation (B2OA - UMR CNRS 7052), Paris-Diderot University, 10 avenue de Verdun, 75010 Paris, France
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  • Benoît Villain
    Affiliations
    Department of Orthopaedic, Trauma and Reconstructive Surgery, Antoine Béclère Hospital, AP-HP, Paris Sud University, 157 rue de la Porte de Trivaux, 92140 Clamart, France
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  • Martin Glombitza
    Affiliations
    Department of Orthopaedic and Trauma surgery, University of Duisburg-Essen.
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  • Taco Blokhuis
    Affiliations
    Department of trauma surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
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  • Mikko Heinänen
    Affiliations
    Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital
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  • Thierry Bégué
    Correspondence
    Corresponding author at: Service de Chirurgie Orthopédique, Traumatologique et Réparatrice, Université Paris-Sud, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140 Clamart, France.
    Affiliations
    Department of Orthopaedic, Trauma and Reconstructive Surgery, Antoine Béclère Hospital, AP-HP, Paris Sud University, 157 rue de la Porte de Trivaux, 92140 Clamart, France
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      Highlights

      • The induced membrane technique is used for bone defect of critical size.
      • Bioactive glass S53P4 (BAG-53P4) in induced membrane technique failures is a new treatment proposal.
      • In cases of high risk of failure because of the occurrence or the recurrence of an infection, bioactive glass may help the surgeon to improve bone union.
      • BAG-S53P4 may be considered as bone graft in an induced membrane technique.

      Abstract

      Background

      The induced membrane technique has been developed to address bone defect of critical size from various origins. Despite its exceptional efficacy, several cases underwent a failure, which is regularly associated with a septic problem. The best way to conduct in this situation remains debated.

      Purpose

      To estimate use of bioactive glass S53P4 (BAG-53P4) in induced membrane technique failures or with an anticipated high risk of failure.

      Material and method

      We conducted a retrospective analysis of patients from several medical centers in Europe where BAG-S53P4 has been used inside an induced membrane. The etiology of the defect, the bone fixation used, the delay the bioactive glass was placed, the reason why the bioactive glass was used and the results were reported.

      Results

      Eight cases were included (3 women and 5 men). Mean age was 43 years (16-82; Standard deviation 23). Mean height was 171 cm (162-184; SD 7), mean weight was 69 kg (60-85; SD 8) and Body Mass Index was 23,39 M/Kg2 (21,9-25,1; SD 1,22). Mean length of defect was 68 mm (40-100mm, SD 23). All patients received BAG-S53P4 granules (BonAlive Biomaterials Ltd, Turku, Finland) to fill the resultant cavity (3 as a stand-alone in the induced membrane and 5 mixed with autograft). Three patients were implanted with BAG-S53P4 during the second stage of a first induced membrane technique because of a high risk of infection (three open fractures); two patients were implanted with BAG-S53P4 during the second stage of a first induced membrane technique because of the great size of the defect (two infectious non-union); two patients were implanted with BAG-S53P4 as a third stage of induced membrane technique, i.e. inside a previously grafted membrane, because of a recurrence of the infection; and one patient was implanted with BAG-S53P4 during the second stage of a second induced membrane technique to avoid a new failure. At a follow-up of 16 months, all healed without any recurrence of the infection.

      Discussion

      Critical size bone defects caused by an open fracture or an active infection can usually be addressed by the induced membrane technique. However, some cases are at high risk of failure because of the occurrence or recurrence of an infection. In these cases, bioactive glass may help the surgeon to improve the rate of bone union.

      Conclusion

      BAG-S53P4 may be considered as bone graft in an induced membrane technique, especially when there is a high probability of occurrence or recurrence of a bone infection.

      Key words

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