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The Journal of Bone and Joint Surgery 79:495-502 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

Treatment of Acute Fractures with a Collagen-Calcium Phosphate Graft Material. A Randomized Clinical Trial*{dagger}

MICHAEL W. CHAPMAN, M.D.{ddagger}, DAVIS, CALIFORNIA, ROBERT BUCHOLZ, M.D.§, DALLAS, TEXAS and CHARLES CORNELL, M.D.¶, NEW YORK, N.Y.

*Although none of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article, benefits have been or will be received but are directed solely to a research fund, foundation, educational institution, or other non-profit organization with which one or more of the authors are associated. Funds were received in total or partial support of the research or clinical study presented in this article. The funding source was a clinical research grant from Zimmer, Warsaw, Indiana.

A prospective, randomized clinical trial was conducted concurrently at eighteen medical centers in order to compare the safety and efficacy of two types of graft material for the treatment of fractures of long bones: autogenous bone graft obtained from the iliac crest, and a composite material composed of purified bovine collagen, a biphasic calcium-phosphate ceramic, and autogenous marrow. Two hundred and thirteen patients (249 fractures) were followed for a minimum of twenty-four months to monitor healing and the occurrence of complications. We observed no significant differences between the two treatment groups with respect to rates of union (p = 0.94, power = 88 per cent) or functional measures (use of analgesics, pain with activities of daily living, and impairment in activities of daily living; p > 0.10). The prevalence of complications did not differ between the treatment groups except for the rate of infection, which was higher in the patients who were managed with an autogenous graft. Twelve patients who were managed with a synthetic graft had a positive antibody titer to bovine collagen; seven of them agreed to have intradermal challenge with bovine collagen. One patient had a positive skin response to the challenge but had no complications with regard to healing of the fracture. We concluded that, for traumatic defects of long bones that necessitate grafting, use of the composite graft material appears to be justified on the grounds of safety, efficacy, and elimination of the increased operative time and risk involved in obtaining an autogenous graft from the iliac crest.


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