Use of an injectable complex of β-tricalcium phosphate granules, hyaluronate, and fibroblast growth factor-2 in the treatment of unstable intertrochanteric fractures with bone defects

Abstract

We have developed a paste-like complex of β-tricalcium phosphate (β-TCP) granules, hyaluronate, and recombinant human fibroblast growth factor-2 (rhFGF-2) on repair of unstable intertrochanteric fractures. For the preparation of an injectable bone substitute, 2 g of β-TCP granules with 60% porosity, 2 mL of 1% hyaluronate, and 1 mg of rhFGF-2 were mixed aseptically. Patients having 31.A2 intertrochanteric fractures according to the AO classification were treated with injection of the complex followed by intramedullary nails. Fracture union occurred in all cases and union of the displaced lesser trochanter to the shaft was obtained in 4 out of 5 cases by 12 weeks. β-TCP is a calcium phosphate ceramic used in bone grafting as an alternative bone substitute to autograft. FGF-2 is a growth factor having various physiological activities such as bone formation and angiogenesis. The use of the complex promoted the repair of the cortical bone defect in the posterolateral part and the fusion of the lesser trochanter to the shaft. In conclusion, the complex of β-TCP granules, hyaluronate, and FGF-2 can facilitate bone formation and may be useful for the treatment of other cortical bone defects such as long-bone fractures with displaced fragments with minimal surgical invasion.