USE OF CALCIUM HYDROXY APATITE BLOCKS WITH OR WITHOUT CORTICO-CANCELLOUS BONE GRAFTING IN DIFFERENT TREATMENT MODALITIES ? A RETROSPECTIVE AND PROSPECTIVE STUDY

This is a retrospective and prospective study of patients having a Gap Non-union of the long bones treated with autogenous bone graft and calcium hydroxy Apatite bone block. The study was oriented to observe and treat the gap non-unions of long bones. In this study of 48 patients, majorities (83%) were males and 16% were females. Maximum number of patients belonged to 3rd decade. Out of 42 patients with trauma, 38 had compound grade III fracture. 62.5% involved tibia, 31.2% femur and 6.2% humerus. In 87.2% Bone-Gap was due to Injury and in 12.5% was due to excision of bone segment. In 22 cases implant was used to stabilize the fracture, while in 26 cases, no implant was used. Average time of osseous union was 22.6 weeks to 30 weeks. Full weight bearing was allowed only when the fracture showed an evidence of adequate bridging callus formation on x-ray and clinically when fracture site was painless on examination and on weight bearing. In upper limb, light physical activity was allowed at 14.6 weeks and full physical activity was allowed at 24.6 weeks. Deformity in the form of angulation was seen in 55% of cases. Out of 48 patients in study group, 9 developed shortening. There was no patient that showed delayed union or non-union. Based on Klemm and Borner’s (1986)(9) Criteria for functional assessment, 20 out of 48 cases (41.6%) showed excellent functional results, good results in 14 cases (29.1%), fair results in 12 cases (24.9%) poor results in 2 cases out of 48 (4.1%). Radiologically, the radiographic density increased with lapse of time (which is a presumptive evidence of bone regeneration). No refracture was observed till the end of follow up. Thus, the use of implant allows early weight bearing, prevents development of a deformity, prevents shortening, and also prevents joint stiffness by allowing early mobilization of the affected part and is an important conjunct in management of segmental bone defects. Calcium Hydroxy Apatite is a suitable alternative to bone graft. When used in conjunction with autogenous bone graft, it serves as an excellent method of filling the bone gaps as large as 2 inches with excellent results