Levoč surgeons used a new surgical method for the first time. They used bioactive glass to fill the bone defect – Human
AGEL Levoča Hospital surgeons used bioactive glass to fill a bone defect for the first time during a trauma operation.
It is an alternative to spongioplasty – a replacement taken from another part of the bone. For the operators, this method is technically and takes a lot of time, but for the patient it means the possibility of earlier rehabilitation and the elimination of pain. The operation required the presence of two doctors, Ľubomír Strelka and Dr. Michal Sedlák. Traumatologist Michal Sedlák provided answers to the questions.
Under what circumstances was the use of bioactive glass indicated for the patient during surgery?
He was a patient with pseudarthrosis (ie sprain) of one of the wrist bones, which was caused by a failure to heal the fracture. In the beginning, it was a simple fracture, so they did not indicate primarily for surgical treatment. Later, however, it turned out that the injury also caused damage to the nutrient vessel (nutrition), and therefore, despite the correctly selected procedure for fixing the fracture using a cast and later also orthosis, it did not heal. On the contrary, the so-called occlusion – covering the surface of the fracture line with cartilage. The patient was limited by the pain caused by the movement of individual fragments of the fracture relative to each other. As a result of the movement of these fragments, a bone defect was created at the fracture site, which had to be filled in some way. Therefore, we indicated the osteosynthesis using a compression screw and a plastic defect.
What is the specialty of the operation?
In that, under normal circumstances, we use a piece of cancellous bone as a cancellous graft (spongy bone tissue), which we take from the patient himself from another place on the body (for example, from the spindle bone – the -bone of the arm) and fill the defect at the fracture site of the carpal bone. This procedure carries certain risks (infection of the collection site or weakening of the bone structure from which the bone tissue is taken, and therefore its greater predisposition to fractures later. Last but not least at least, the collection site hurts as much as the fracture itself, which prevents the patient from early rehabilitation due to the pain. That was the reason why we decided to use bioactive glass in the form of a paste as “bone graft”. This is a preparation used mainly in bone oncosurgery and septic bone surgery, but in this case it seemed to be the best for the particular type of operation and for the choice of -a particular patient.
Is this type of trauma surgery difficult for the operator?
This type of material should not come into contact with the cartilage, so it is important for the operator to first remove the cartilage from the surface of the fracture line (“clean the joint”), then a precise osteosynthesis is required – so that the cortical parts of the individual fragments fit well on top of each other, and only then the central bone defect is filled with bioactive glass in the form of a paste. This in itself is time and technically more demanding than when using a cancellous vaccination taken from the patient, where this problem is eliminated.
What benefit will it bring to the patient?
The advantage for the patient is that we do not have a cancellous bone collection site, so there is a lower risk of complications after the operation. The patient can have earlier mobilization, less pain, faster rehabilitation and a lower risk of developing neuroalgodystrophic syndrome (a period of fracture healing when the patient experiences a state of excessive pain). The advantage for the hospital, as well as for the health system itself, is also in the fact that the costs of treating the particular fracture will ultimately be reduced (if we also include all the complications of ‘healing statistically possible, which is also supported by studies) .
For which patient is a used replacement surgery suitable? It affects e.g. age or other diagnosis?
This type of replacement is indicated basically for all patients. Elderly patients with a tendency to osteoporosis rather benefit from it (the removal of cancellous bone from a patient with osteoporosis or osteopenia is more complicated because the bone tissue is of poor quality). Personally, I also indicate this type of surgery for a younger adult patient who is physically active and we expect an earlier return to full physical activity after surgery. Patient compliance is also important, which means that it is necessary to select a patient who goes for post-operative check-ups at set intervals and follows the recommended course of treatment.
Are you planning more operations with this procedure?
Yes. We currently have two other patients under regular follow-up who benefit from this type of surgery. One also has “confusion” as a result of improper fracture healing. The second is an oncology patient with osteolytic bone metastasis in the middle part of the long bone.
For what types of fractures can this surgical procedure be applied?
This type of material is suitable for filling bone defects – fractures, osteolytic metastases, bone sequestrations caused by osteomyelitis (inflammation of the bone marrow). So, in short, in different types of complications of healing bone defects.
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