TREATMENT OF BONY DEFECTS IN CHILDREN USING AUTOLOGOUS GROWTH FACTORS AND HYDROXYAPATITE

Abstract

Purpose: In paediatric patients, autografts are limited by the quantity of available bony tissue in donor regions, the need for a second incision, the longer surgical time, and donor site morbidity. Bone substitutes would be an advantage in many cases. Serum and platelet autologous growth factors favouring osteo-induction can be obtained readily. When used in conjunction with osteoconductive materials, they can favour bone growth. The purpose of this work was to evaluate the use of combined autologous growth factors (AGF) and hydroxyapatite (HA) in paediatric patients instead of autologous grafts.

Material and methods: This prospective study was conducted in 14 children (16 grafts), nine boys and six girls, mean age 9.4 years. These children required bone grafting related to femoral osteotomy, osteomyelitis, benign cystic tumours, bone nonunion, triple arthrodesis with osteopenia, and insufficient autologous graft material. The AGF-HA combination with human thrombin was used in all cases. AGF was prepared after fractioning autologous blood according to the child’s blood volume, height and weight. A platelet ultraconcentrate was added to thrombin (500 IU) and HA (500 R) at the time of implantation. Mean preparation time was 20 minutes. An autologous graft was not used in any of the children.

Results: There were no cases of superficial or deep infection after implantation. Bone healing as assessed clinically and radiologically was obtained in eleven weeks on average (range 8–16) except in two cases (11%).

Discussion: The AGF-HA combination is a useful alternative to autologous bone grafting in children. It is a simple technique which accelerates bone healing and HA integration. There were no cases of rejection.

Conclusion: 1) In children, this method is a valid alternative which avoids the need for bone harvesting and the corresponding morbidity. 2) Use of AGF-HA in combination does not transmit infection, does not lengthen surgery time, and is an interesting alternative to autologous or heterologous bone grafting.