Kurzfassung

Autologous bone grafting is considered a standard procedure and gold standard for reconstruction of fracture defects and voids due to the highest level of osteoconductive, osteoinductive, and osteogenic properties of autologous bone. However, the harvesting procedure may be associated with some typical complications and higher morbidity [1](Myeroff, 2011 #28). As a result, different bone graft substitutes based on hydroxyapatite, calcium phosphate or calcium sulphate have been developed for...Autologous bone grafting is considered a standard procedure and gold standard for reconstruction of fracture defects and voids due to the highest level of osteoconductive, osteoinductive, and osteogenic properties of autologous bone. However, the harvesting procedure may be associated with some typical complications and higher morbidity [1](Myeroff, 2011 #28). As a result, different bone graft substitutes based on hydroxyapatite, calcium phosphate or calcium sulphate have been developed for specific indications to overcome the shortcomings of the autologous bone grafting.
One of the recent developments in this field is Cerament Bone Void FillerTM, (BONESUPPORT AB, Sweden) which is a self-setting bone substitute based on calcium sulphate and hydroxyapatite. Cerament BVF is a resorbable osteoconductive cement, which hardens to form a dense filler, which in turn becomes subsequently resorbed during the first year after the implantation. Current experience shows that Cerament can be used successfully to to fill metaphyseal bone defects [2](Myeroff, 2011 #28) and to enhance fixation of osteosynthesis devices [3](Kurz, 1989 #47). Calcium sulphate is highly biocompatible and does not cause a foreign body reaction [4]. But, however, it tends to become resorbed quickly [4]. This problem has been solved in Cerament BVF by combination with nanocristaline hydroxyapatite, which possess slower resorption rate [5].
Bone substitutes based on pure hydroxyapatite have been shown to persist within the bone for years due to its slow resorption rate. Therefore, in case of history of local infection, HA-based bone substitutes may become a spot of biofilm formation subsequently causing a chronic infection.
. Different bacterial species have been reported to form biofilms on bone graft substitutes [6]. A proper design of a bone graft substitute may provide benefits for both bone remodeling [7, 8] and prevention of biofilm formation by the concept of the ‘race for the surface’ [9]. Cerament BVF delivers highly osteoconductive hydroxyapatite particles embedded in an injectable and curable calcium sulphate paste seems to provide the desired properties. Because its capacity to resorb quickly, Cerament BVF possesses continuing changes of its surface morphology. This feature may prevent adherence of bacteria to the surface and subsequently the formation of a biofilm. On the other hand, during the dissolution of the calcium sulphate Ca- and sulfate ions become released in a very high concentration and help regulate the local pH, which in turn may have a bacteriostatic effect.
The aim of this study is to investigate the effects of CERAMENT™ on relevant bacterial species and its possible effects on biofilm formation.
Hypotheses:
CERAMENT™ prevents biofilm formation on its surface.CERAMENT™ is bacteriostatic
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