A Comparative Study Of Autograft Versus Allograft, Interporous Tricalcium Phosphate And Xenogeneic Bone Grafting In Femoral Shaft Comminuted Fracture

Objective To compare the character of allograft, interporous tricalcium phosphate and xenogeneic bone with autograft used in comminuted fracture of femoral shaft.Methods A retrospective study was done in 106 cases of hospitalized from January 2005 to June 2008, 69 cases of male, female 37 cases. All the patients received open reduction and intramedullary interlocking nail fixation and bone graft. The patients were followed up 9 months to 3 years, with an average of 17 months. These 106 cases were divided into four groups. Patients in group A received autograft (n=16),10 cases of male, female 6 cases, the patients were 27 to 45 years old, with a mean age of 34.9 years. Among them, there were Winquist-Hanson typeⅠin 4 cases,typeⅡ5 cases, typeⅢ5 cases,typeⅣ2 cases. Patients in group B received allograft (n=32), 21 cases of male, female 11 cases, the patients were 18 to 59 years old,with a mean age of 34.9 years, including Winquist-Hanson typeⅠin 6 cases, typeⅡ13 cases, typeⅢ9 cases, typeⅣ4 cases. Patients in group C received interporous tricalcium phosphate graft (n=30), 20 cases of male, female 10 cases, the patients were 18 to 67 years old,with a mean age of 36.7 years, Winquist-Hanson typeⅠin 8 cases, typeⅡ11 cases, typeⅢ8 cases, typeⅣ3 cases. Patients in group D received xenogeneic bone graft (n=28), male 18 cases , 10 cases of female , the patients were 20 to 76 years old,with a mean age of 39.0 years, including Winquist-Hanson typeⅠin 9 cases, typeⅡ10 cases, typeⅢ6 cases, typeⅣ3 cases.Operation time, blood loss, complication, drainage amount, postoperative fever, bone healing period, delayed union and nonunion rate, bone fusion, creeping substitution were compared among the four groups during 3～9 months.Results (1) Operation time and blood loss. There was statistical difference between group A and other groups (P < 0.05). (2) Complication. There was statistical difference between group A and other groups (P < 0.05) in donor site pain. There was no statistical difference between group A and other groups(P> 0.05) in wound effusion and delayed wound healing.(3) Drainage amount. There was no statistical difference between group B,C,D and group A(P >0.05).(4) Postoperative fever. There was statistical difference between group B, D and group A (P < 0.05). There was no statistical difference between group C and group A(P> 0.05).(5) Delayed union and nonunion. There was no statistical difference between group A and other groups(P >0.05).(6) Bone fusion. There was no statistical difference between group A and group B,C(P >0.05). There was statistical difference between group D and group A (P < 0.05).(7) Creeping substitution. There was no statistical difference between group A and group B(P > 0.05). There was statistical difference between group C, D and group A (P < 0.05).Conclusion (1) Allogenic bone and interporous tricalcium phosphate can substitute self-bone as void filler in the defects of femoral shaft comminuted frac- ture,they can avoid the complication at donor site, reduce operationtime and blood loss.(2) Interporous tricalcium phosphate as a kind of bioceramics, is a safe, effective bone graft substitute material for the filling of defects associated with trauma. It is worth to be spreaded and utilized in clinic for its good biocompatibility and osteoconductivity.(3) Xenogeneic bone grafting alone is ineffective.(4) The anterior and lateral of femur should be grafted conventional in femoral shaft comminuted fracture.