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. 2023 Sep 18;24(18):14232.
doi: 10.3390/ijms241814232.

Retrospective Analysis of Bone Substitute Material for Traumatic Long Bone Fractures: Sex-Specific Outcomes

Jonas Pawelke  1 , Vithusha Vinayahalingam  1 , Christian Heiss  1   2 , Thaqif El Khassawna  1 , Gero Knapp  2
Affiliations

Retrospective Analysis of Bone Substitute Material for Traumatic Long Bone Fractures: Sex-Specific Outcomes

Jonas Pawelke et al. Int J Mol Sci. .

Abstract

Male patients often experience increased bone and muscle loss after traumatic fractures. This study aims to compare the treatment outcomes of male and female patients with large bone defects. A total of 345 trauma patients underwent surgery, with participants divided into two groups: one receiving bone substitute material (BSM) for augmented defects (n = 192) and the other without augmentation (empty defects = ED, n = 153). Outcome parameters were assessed among female (n = 184) and male (n = 161) patients. Descriptive statistics revealed no significant differences between male and female patients. Approximately one-half of the fractures resulted from high-energy trauma (n = 187). The BSM group experienced fewer complications (p = 0.004), including pseudarthrosis (BSM: n = 1, ED: n = 7; p = 0.02). Among female patients over 65, the incidence of pseudarthrosis was lower in the BSM group (p = 0.01), while younger females showed no significant differences (p = 0.4). Radiologically, we observed premature bone healing with subsequent harmonization. Post hoc power analysis demonstrated a power of 0.99. Augmenting bone defects, especially with bone substitute material, may reduce complications, including pseudarthrosis, in female patients. Additionally, this material accelerates bone healing. Further prospective studies are necessary for confirmation.

Keywords: bone substitutes; calcium phosphates; fractures; gender medicine; hydroxyapatites; musculoskeletal system; sex.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Comparing the age divided in geriatric (>65 years) and adult fractures (<65 years). Graphic of (a) all patients, (b) the female patient group, and (c) the male patient group.
Figure 2
Figure 2
The top line shows the comparison of the groups of empty defect treatment and the treatment with bone substitute augmentation: (a) all patients, (b) the female patient group, and (c) the male patient group. The bottom line shows the comparison of empty defect treatment groups with the groups of calcium phosphate and the group of nanocrystalline hydroxyapatite: (d) all patients, (e) the female patient group, and (f) the male patient group.
Figure 3
Figure 3
Comparing the Body Mass Index (BMI) using the WHO classification of obesity: (a) all patients, (b) the female patient group, and (c) the male patient group.
Figure 4
Figure 4
Overview of patients suffering postsurgical complications: (a) all patients, (b) the female patient group, and (c) the male patient group. No statistically significant differences between the groups were observed.
Figure 5
Figure 5
Bone defect augmentation in a proximal tibia fracture in follow-up examinations. (a) Assessment by conventional examination and (b) assessment by CT examination.
Figure 6
Figure 6
Overview of patient cohort election.
Figure 7
Figure 7
Worse postsurgical pseudarthrosis without defect void filling. (a) Postsurgical examination demonstrated initial treatment by osteosynthesis without bone defect augmentation. (b) Severe pseudarthrosis of the fracture more than a year post surgery.
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