Bone Substitute Materials in Trauma and Orthopedic Surgery-Properties and Use in Clinic

Large defects resulting from among other things, trauma, infection, or tumor resection, often do not heal spontaneously and require surgical intervention. Not only variations in size or location of the defect but also patient-related factors, such as age and disease status, determine the therapeutic approach. Herein, bone grafts provide support, fill voids, and enhance the biological repair of the defect. Autogenous bone, either cortical or cancellous, harvested from the patient's iliac crest is considered the gold-standard graft. However, as the cells do not necessarily survive transplantation, the clinical benefit is not guaranteed. Moreover, autografting is associated with complications and is not always possible. Alternative bone grafts like iso-, allo-, and xeno-transplants have been applied, but due to (major) disadvantages their use is discouraged. An increasing number of graft alternatives is available; these contain (combinations of) tricalciumphosphate (TCP) and hydroxyapatite (HA), calcium sulphate (gypsum), type I collagen and nonbiological substrates like degradable polymers and bioactive glass. The products available differ in composition, characteristics, appearances, and delivery forms (e.g., pastes, solid matrices, or granules). Availability of an increasing number of products may seem attractive; however, without sufficient knowledge on their properties and behavior in vivo it will become more and more complicated to select the product that best mimics the bone to be replaced. Determining which product to use is based upon many factors including the size and location of the defect, as well as the handling properties and ability to deliver the material to the surgical site. This chapter provides an overview of currently available bone substitute products and their structure and biological and biomechanical behavior in vitro and in vivo. It also provides an overview of the current clinical use of these products.

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