Ceramic cement as a potential stand-alone treatment for bone fractures: An in vitro study of ceramic-bone composites.

BACKGROUND: A vertebral burst fracture (VBF) treated with vertebroplasty using a ceramic cement consists of four regions; native bone fragments, native ceramic cement, ceramic cement-trabecular bone (ceramic-bone) composite and ceramic-bone interface. Although the mechanical properties of native bone and native ceramic cements have been well investigated, the mechanical properties of ceramic-bone composite and ceramic-bone interface remain unknown. Therefore, the aim of this study was to determine the mechanical properties of ceramic-bone composites and ceramic-bone interfaces. Two types of ceramic cement, calcium aluminate (CAC) with (w/F) and without (wo/F) fiber reinforcement, were investigated.

METHODS: Ceramic-bone composite (Full, wo/F and w/F) and ceramic-bone interface (Fract, wo/F and w/F) groups were tested to determine their compressive and tensile properties. While a continuous bone cylinder was used for samples in the Full groups, each bone cylinder for the samples in the Fract groups contained a 3mm geometrical discontinuity to mimic the fracture gaps in VBFs. Two Cement groups (wo/F and w/F) and a Bone group were included in the study as controls. Micro-CT images were used to determine the bone morphological parameters, as potential predictors of the mechanical properties of Full and Fract groups.

RESULTS: The compressive strengths of Full and Fract groups were substantially lower than native CAC, but higher than bone. The tensile strength of the Full group was equal to bone, while the tensile strength of the Fract group was equivalent to CAC. Variable relationships between the bone morphological parameters and mechanical properties of Full and Fract groups were observed. Fiber reinforcement at an injectable level had a minimal influence on the mechanical properties.

CONCLUSIONS: CAC augmentation does not provide adequate stabilization of bone fragments. The interface between bone and cement represents a weak point. The effect of cement augmentation cannot be predicted by bone morphological properties.