F. Deperetti et al., CORAL GRAFT AS SUPPORT IN THE SURGICAL-TR EATMENT OF ARTICULAR TRAUMATIC DEPRESSION - PROSPECTIVE-STUDY ON THE LOWER-EXTREMITY IN 23 CASES, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur, 82(3), 1996, pp. 234-240
Introduction Infection risk makes the management of a bone bank more a
nd more difficult. On the other hand, realizing an autologous graft is
not always without consequences. That is why we estimated the mechani
cal quality, the osteo-integration and the biocompatability of a coral
graft. Material and methods Between 1988 and 1992, two of us systemat
ically used coral graft as ''support'' after lifting of some articular
depression in fractures of inferior limb. Osteosynthesis was systemat
ically associated. In this way, we operated 13 fractures of the latera
l tibial plateau, 8 thalamic fractures of the calcaneus and 2 fracture
s of the inferior extremity of the tibia. Average follow-up is 20 mont
hs, with extremes of 68 and 12 months. Material ablation was realized
13 times and coral graft biopsy 4 times. Bone integration was estimate
d radiologically in 3 stages - stage 1 : non union = ''margin'' around
the coral, - stage 2 : possible integration = the coral is perfectly
visible, but its borders grow indistinct, - stage 3 : certain integrat
ion = peripheral disparition of the coral weft, radiological interpene
tration between coral and bone framework. We systematically searched f
or secondary displacements and complications. Results Mechanical condi
tions were respected, there was no secondary displacement, ''Possible
integration'' (stage 2) was found in 8 cases at an average follow-up o
f 20 months. In 9 cases, we found ''certain integration'' (stage 3), a
t an average follow-up of 28 months, It is possible that a more import
ant follow-up time would allow to find more integration cases. Biocomp
atibility is debatable under the operating conditions of the authors,
We counted 5 aseptic serous flows which continued to be aseptic (1 tib
ial plateau, 1 inferior extremity of the tibia, 3 calcaneum), Three co
ral grafts were removed to obtain healing. Discussion When biocompatib
ility is satisfactory the integration is certain. The longer the follo
w-up time, the more stage 3 cases can be observed. Nevertheless, this
integration runs out with time. We did not find any explication to ase
ptic serous flows. It may result from some impurities. On the other ha
nd, use of the coralin hydroxyapatite does not seem to drive to allerg
ic complications. Conclusion In accordance with this study, we use the
coral graft only in case of tibial plateau fracture, Our experience w
ith coral graft in the other fields of bone surgery is not sufficient
to express an opinion.