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Unidirectional porous β-tricalcium phosphate (UDPTCP; Affinos^®, Kuraray, Tokyo, Japan) has been in clinical use since 2015. Animal studies have confirmed the excellent potential of UDPTCP with regard to bone formation and material absorption. We present the first three clinical cases using UDPTCP as a bone substitute after curettage of benign bone tumors of the hand. All three patients were males, 29-, 30- and 81-years-old, two having a diagnosis of enchondroma and the other, a bone ganglion, with a pathological fracture identified in one case. Over a mean follow-up of 10 months, all patients achieved satisfactory clinical result, with no adverse events of UDPTCP noted. Radiographic evidence of good bone formation and material absorption was observable over the postoperative course. UDPTCP provided satisfactory clinical results, with good biocompatibility and fast resorption characteristics. Therefore, UDPTCP could provide a safe and reliable filling substitute for bone defects following curettage of small bone tumors.

Background: This multicenter retrospective study aimed to compare clinical outcomes and cost-effectiveness with bone substitutes on volar locking plate (VLP) fixation of unstable distal radial fractures (DRF) in the elderly.

Methods: The data of 1,980 patients of ≥65 years of age who underwent surgery for the DRF with a VLP in 2015–2019 were extracted from a database (named TRON). Patients lost to follow-up or who received autologous bone grafting were excluded. The patients (n = 1,735) were divided into the VLP fixation alone (Group VLA) and VLP fixation with bone substitutes (Group VLS). Propensity score matching of background characteristics (ratio, 4:1) was performed. The modified Mayo wrist scores (MMWS) were evaluated as clinical outcomes. The implant failure rate, bone union rate, volar tilt (VT), radial inclination (RI), ulnar variance (UV) and distal dorsal cortical distance (DDD) were evaluated as radiologic parameters. We also compared the initial surgery cost and total cost for each group.

Results: After matching, the backgrounds of Groups VLA (n = 388) and VLS (n = 97) were not significantly different. The MMWS values of the groups were not significantly different. Radiographic evaluation revealed no implant failure in either group. Bone union was confirmed in all patients in both groups. The VT, RI, UV and DDD values of the groups were not significantly different. The initial surgery cost and total cost in the VLS group were significantly higher than those in the VLA group ($3,515 vs. $3,068, p < 0.001).

Conclusions: In patients of ≥65 years of age with DRF, the clinical and radiological outcomes of VLP fixation with bone substitutes did not differ from those of VLP fixation alone, yet the additional use of bone augmentation was associated with higher medical costs. The indications for bone substitutes should be more strictly considered in the elderly with DRF.

Level of Evidence: Level IV (Therapeutic)

Calcium phosphate ceramic has been known for its properties of bioactivity and osteoconductivity and has been widely used in orthopedic, plastic and craniofacial surgeries. The biocompatibility, unlimited availability, lower morbidity for the patient and cost-effectiveness of calcium phosphate ceramics represent important advantages over other biological bone graft, such as autografts and allografts. A new synthetic biphasic calcium phosphate (BCP), Bicera™ (60% HA and 40% β-TCP), is manufactured by Wiltrom Co., Ltd., as a new bone graft substitute. It shows good biocompatibility without cytotoxicity in in vitro test. To evaluate the possible application for clinical use, we used New Zealand white rabbit femur defect model to compare the osteoconductivity of this new bone substitute to another commercially available bone substitute (Triosite^®) which was used as the control material.

According to the macroscopic observation, both bone substitutes show good biocompatibility and no abnormal inflammation either infection was seen at the implantation sites. X-rays image of implant sites at one month, three months and six months showed all implanted materials were well incorporated with host bone. All of them were not fully absorbed and replaced after six months implantation. In the histological and hitomorphometric data, new bone grew into the surface of the peripheral pores in both bone substitutes and increased over time. Moreover, the degree of bone regeneration appeared to be relatively greater in the specimens with Bicera™ when compared with Triosite^®. We concluded that this new synthetic BCP (Bicera™) showed similar biocompatibility and osteoconductive characteristic comparing with commercial product Triosite^® in rabbit femur defects model.

Objective: In the present study, we investigate the biological performance of a calcium phosphate ceramics (CPC) bone substitute combined with poly-hydroxybutyrate-co-hydroxyvalerate (PHBV). Materials and Methods: A particulate CPC [45% beta-tricalcium phosphate ($\beta$-TCP) and 55% of dihydrated dicalcium phosphate (DCPD)] was incorporated into a biodegradable copolymer PHBV. Two series of the composite, 1 and 2, with CPC–PHBV weight ratios of (40%–60% and 60%–40%), respectively, were prepared using chloroform for dissolving the polymer and a pressure molding process for shaping the composite samples. After particle size analysis, the two composites were characterized by scanning electron microscopy (SEM) and energy dispersive spectrometry (EDS). In a second step, a 10mm bony segmental defect created in the tibias of 20 New Zealand White Rabbits was filled randomly with either composite 1 for group 1 or composite 2 for group 2. There were 10 animals in each group. Clinical, radiological and histological assessments were then carried out to evaluate the biological properties of developed CPC–PHBV composites. Results: For both variants of the developed CPC–PHBV biocomposite, there was evidence of osseous consolidation within three months. An in vivo investigation revealed the biological properties of the biocomposite, namely, biocompatibility, bioactivity, biodegradability and osteoconductivity. The morphological characteristics, granule size and chemical composition, were indeed found to be favorable for osseous cell development. This study likewise showed lower mortality for the variant with weight ratio (40%CPC–60%PHBV). Conclusion: An in vivo investigation revealed that the new biomaterial composed of CPC and PHBV exhibits manifest osteoconductivity and bioactivity with better degradation kinetics than the CPC. Moreover, the variant with 40%CPC/60%PHBV appeared more resistant to infection than the 60%CPC/40%PHBV which is an indicator of biocompatibility.

The purpose of this paper is to report the long-term results in patients with more than 10 years follow-up after calcium hydroxyapatite ceramic (CHA) implantation for the treatment of bone tumor surgery. Fifty-five patients were implanted with CHA for bone defects after the intralesional resection of benign bone tumors. The postoperative functional recovery was obtained within first one year in all patients. The radiographic density at the CHA implant sites appeared to increase during first 2 years, thereafter gradually decrease with time. The density at 10 years or more after operation was about one half of the maximum in some patients. No adverse effects and late complications were seen in any patients. These findings suggested strongly that CHA is useful for bone substitute to fill the defects in benign bone tumors.