Clin Orthop Surg.  2011 Sep;3(3):191-201. 10.4055/cios.2011.3.3.191.

Grafting Using Injectable Calcium Sulfate in Bone Tumor Surgery: Comparison with Demineralized Bone Matrix-based Grafting

• Kim JH
• Oh JH
• Han I
• Kim HS
• Chung SW

• KMID: 1743909
• DOI: http://doi.org/10.4055/cios.2011.3.3.191

Abstract

BACKGROUND
Injectable calcium sulfate is a clinically proven osteoconductive biomaterial, and it is an injectable, resorbable and semi-structural bone graft material. The purpose of this study was to validate the clinical outcomes of injectable calcium sulfate (ICS) grafts as compared with those of a demineralized bone matrix (DBM)-based graft for filling in contained bony defects created by tumor surgery.
METHODS
Fifty-six patients (41 males and 15 females) with various bone tumors and who were surgically treated between September 2003 and October 2007 were included for this study. The patients were randomly allocated into two groups, and either an ICS graft (28 patients) or a DBM-based graft (28 patients) was implanted into each contained defect that was developed by the surgery. The radiographic outcomes were compared between the two groups and various clinical factors were included for the statistical analysis.
RESULTS
When one case with early postoperative pathologic fracture in the DBM group was excluded, the overall success rates of the ICS and DBM grafting were 85.7% (24/28) and 88.9% (24/27) (p > 0.05), respectively. The average time to complete healing was 17.3 weeks in the ICS group and 14.9 weeks in the DBM group (p > 0.05). Additionally, the ICS was completely resorbed within 3 months, except for one case.
CONCLUSIONS
Although the rate of resorption of ICS is a concern, the injectable calcium sulfate appears to be a comparable bone graft substitute for a DBM-based graft, with a lower cost, for the treatment of the bone defects created during surgery for various bone tumors.

Keyword

Injectable calcium sulfate; Demineralized bone matrix; Bone tumor

MeSH Terms

Absorbable Implants
Adolescent
Adult
Biocompatible Materials/*administration & dosage
Bone Demineralization Technique
Bone Matrix/*transplantation
Bone Neoplasms/radiography/surgery/*therapy
Bone Substitutes/*administration & dosage
Calcium Sulfate/*administration & dosage
Child
Child, Preschool
Curettage
Female
Humans
Infant
Injections
Male
Middle Aged
Wound Healing
Young Adult

Figure

• 

  Fig. 1 The serial radiographs of a 55-year-old female patient show (A) intramedullary calcified bone tumor in the proximal humeral metaphysis preoperatively. The follow-up radiographs taken (B) immediately after the operation, (C) 6 weeks postoperatevely and, (D) 12 weeks postoperatively show the gradual resorption of the injectable calcium sulfate. (E) The final radiograph shows skeletal incorporation.

• 

  Fig. 2 Linear regression analysis demonstrated that the volume of the injectable calcium sulfate (ICS) graft was correlated with (A) the time to resorption and (B) the time to healing. On the contrary, (C) the volume of the demineralized bone matrix (DBM)-based graft was not correlated with the time to healing.

• 

  Fig. 3 The anteroposterior radiographs of a 21-year-old man with fibrous dysplasia of his left femur neck show (A) the three months postoperative view after the curettage and injectable calcium sulfate grafting with prophylactic fixation. (B) Six months postoperatively, he complained of continuous pain on his left hip, and the radiograph showed the cortical breakage on the superior aspect of the femur neck (arrow). (C) Ten months postoperatively, complete fracture occurred in spite of activity restriction. Note that the calcium sulfate is not completely resorbed. (D) The final radiograph after curettage of the remnant calcium sulfate and internal fixation with autogenous bone grafting.

• 

  Fig. 4 The radiographs showed a 20-year-old man who had undergone surgery for myxoid chondrosarcoma that arose from the calcaneus (A, B). (A) The immediate postoperative view shows the status of injectable calcium sulfate injection. At the follow-up, the calcium sulfate was (B) gradually resorbed in a centripetal fashion, and (C) it was completely resorbed at 6 weeks postoperatively. (D) The magnetic resonance imaging taken 6 months postoperatively shows a peripherally enhanced cystic lesion within the calcaneus, and this indicated failure of healing.

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