CHIP FREEZE DRIED CANCELLOUS BONE ALLOGRAFT AS SCAFFOLD ON FILLING BONE DEFECT OF FRACTURES

1. CHIP FREEZE DRIED CANCELLOUS BONE ALLOGRAFT AS SCAFFOLD ON FILLING BONE DEFECT OF FRACTURES RONALD VINANTIUS MUNTHE

2. BACKGROUND • The union of fracture can be disrupted by trauma especially with bone and soft tissue defect. • The incidence of bone defect of all fracture cases is approximately0.4% (Edinburgh Orthopaedic Trauma Unit) with the highest occurence in tibia (68%) and femur (22%) • Bone graft is one of methods to fill bone defect on trauma cases with bone loss • Bone graft :Autograft,Allograftdan xenograft

3. Auto bone graft is considered as gold standard. • Side effects: persistent pain, infection, prolonged surgery procedure, increased blood loss, and limited sources. • Bone allografts have been used as natural substitute to fill the bone defect • Allograftis available on various shape and size, therefore it can fill bone defect and have a better availability than auto graft

4. Comparison between bone graft characteristic Taken from: Bone Graft Substitutes: Facts, Fictions & Applications, AAOS, 2006 p 3

5. Indonesia has implemented bone allograft usage for a quite long time. The amount of graft request is gradually increasing. Based on Tissue Bank data of Dr Soetomo Hospital, in 2010allograft have been applied 62 times, in 2011 75 times, and in 2012 178 times • Up to date, there is no research evaluating the effectifity of bone allograft compared with bone autograft in Indonesia.

6. OBJECTIVE The aim of this research is to evaluate fracture union of chip freeze driedcancellousbone allograftapplication compared with bone autograft on filling small bone defect of long bone in Surabaya

7. Definition of small bone defect: • Bone loss >50% circumferential diameter • Defecton comminutive <50% • Malunion post osteotomy

8. MATERIAL AND METHOD RESEARCH POPULATION The population is all patient that underwent surgery using bone graft in RS Dr Soetomo, RS Vincentius A Paulo, RS William Booth and RS AdiHusada Surabaya. SAMPLE The sample is all patient that underwent surgery using chip freeze driedcancellous bone allograft ordered from tissue bank of RS Dr Soetomo dan bone autograft.

9. RESEARCH METHOD • Research method used is Cohort Retrospective study. From the total sample, some is getting different treatment. Both group will be examined radiologically after 20-52 weeks post op. • Sample of each group is 10

10. RADIOLOGICAL EVALUATION To evaluate bone union, we use Hammer classification as radiological evaluation

11. Radiological Bone Union • Fracture healing grade 1 : Union • Fracture healing grade 2 : Union • Fracture healing grade 3 : indeterminate • Fracture healing grade 4 : Non Union • Fracture healing grade 5 : Non Union

12. Patient characteristic of chip freeze dried allograft dan autograft application based on age The group age is divided per 10 years, with the highest frequency on 20-30 years old group and 40-50 years old group

13. Patient characteristic of chip freeze dried allograft • dan autograft application based on diagnosis Graft is mostly used in close fracture cases. On non union fracture cases, allograft usage is more frequent compared with autograft

14. Patient characteristic of chip freeze dried allograft • dan autograft application based on fixation Graft is mostly applied on plate and screw fixation.

15. Patient with Chip Freeze Dried Cancellous Allograft Post Op Post Op 30 weeks Radiological evaluation: massive callous formation, fracture line barely discernable (Hammer grade 2)

16. Pasien dengan Auto Bone Graft Pre Op Post Op I Post Op 1 year Radiological evaluation: homogenous bone structure, fracture line obliterated (Hammer grade 1)

17. Data Description

18. Radiological evaluation based on Hammer classification • Highest count on autograft group is grade 2 (70%) and grade 3 (40%) on allograft group

19. DATA ANALYSIS • There are no significant union rate difference between bone autograft control group and bone allograft treatment group (p=0,579).

20. DISCUSSION • There are no significant bone healing diference between bone autograft dan chip freeze dried cancellous boneallograft (p=0,579). • On prospective randomized study research by Rajan et al, the application of cancellous allograft on comminutive fracture of distal radius, there were no significant diference compared with bone autograft on healing aspect Rajan et al, The Journal of Trauma, Jun 2006

21. Retrospective research that were conducted by Flierl et al in 2013 involving 182 patient resulted: Union rate on bone autograft compared with bone allograft showed significant difference (p<0,01), Autograft group have faster union rate (198 ± 172 – 225 hari) compared with allograft group (416 ± 159 – 619 hari). But statistically there were no significant difference of bone healing Flierl et al, J.OrthopaedicSurg & Res, 2013

22. CONCLUSION • From radiological evaluation post op, there were no significant difference of bone union between group that were treated with bone autograft compared with chip freeze dried cancellous bone allograft.

23. SUGGESTION • Chip freeze dried cancellous bone allograft can be used as alternative method to fill small bone defect because there were no significant diference compared with bone autograft. • Further research should be conducted to determine the best method in filling bone defect on fracture cases

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