Comparative analysis of autologous bone and custom hydroxyapatite implants (Custom bone) for post traumatic skull defects in paediatric patients

Title : Comparative analysis of autologous bone and custom hydroxyapatite implants (Custom bone) for post traumatic skull defects in paediatric patients

Abstract:

Introduction: The concept of reconstruction  post-traumatic skull defects is based on restoring anatomical relationships to maximize recovery of brain function, i.e., it is considered as a mandatory stage of surgical rehabilitation. The choice of  implant, taking into account age-related features, is limited for the pediatric patients. According to the literature, the use of autobone is accompanied by a high percentage of resorption. Hydroxyapatite-based implants are considered as an alternative material.
Objective: To compare the effectiveness of autologous bone and custom hydroxyapatite implants (Custombone) in paediatric patients with post‑traumatic skull defects.
Material and methods: The study included 85 patients aged 1.5 to 17 years with post-traumatic skull defects > 5 cm in diameter. Autograft was used in 57 cases, and in 28 cases - an individual Custombone implant. The follow-up period ranged from 1 to 10 years.
Results: Early-stage infectious complications were 2.5% (2 patients)in patients with autobone. Complete resorption requiring repeated surgical treatment was 6 observations (10.1%).

When using Custombone, no complications were observed in the early and late postoperative period. However, the use of the implant was not possible in children under 3 years due to the mismatch between the thickness of the implant and the thickness of the child's bone, and the high cost limited its widespread use. According to the literature, the average osteointegration coefficient of Custombone is 37.4% (Wim Maenhoudt, 2018). In our observations, partial osteointegration was diagnosed in 9 patients (31%).
Conclusion. Both materials have distinct advantages and limitations:

1. Autologous bone: risk of complications (infections, resorption).
2. Custombone: no early/late complications, but age restrictions and incomplete osteointegration (31 % partial vs. 37.4 % average).

The findings support the need for further development of hydroxyapatite‑based implants to improve osteointegration and adapt them for younger patients. Supported by a grant  № 0511-9/25 from the Moscow Department of Health

Biography:

Semenova Zhanna Borisovna, Chief of Pediatric Neurosurgeons Health Deartment of .Moscow and Central Federal District of the Ministry of Health of the Russian Federation. Head of the Department of Neurosurgery and Neurotrauma of the Research Institute of Emergency Pediatric Surgery and Traumatology - Clinic of Dr. Roshal. Professor at the Department of Pediatric Neurosurgery, Russian Medical Academy of Continuig Professional Education. Member of the European Multidisciplinary Academy of Neurotrauma (EMN). Academic Secretary of the Association of Neurosurgeons of Russia. President of the Society for Pediatric Neurosurgery of the Russian Federation. Member of the Editorial Board of the journal  Burdenko's Journal of Neurosurgery
Awards and titles: 2016 -Holder of the golden Arty Order "For Honor and Dignity", 2016 -National Award for the best doctors of Russia, 2021 -Prof. V. V. Lebedev  Medal  "For merits in emergency neurosurgery".