{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:15:59Z","timestamp":1785928559521,"version":"3.56.0"},"reference-count":67,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T00:00:00Z","timestamp":1734566400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Traditional autologous bone grafts as a treatment for bone defects have drawbacks like donor-site morbidity and limited supply. PerOssal\u00ae, a ceramic bone substitute, may overcome those drawbacks and could offer additional benefits like prolonged, local antibiotic release. This study investigates the clinical and radiological outcomes, including patient-reported outcomes, of using PerOssal\u00ae in nonunions (NU) and high-grade chronic osteomyelitis (COM). Methods: A single-center, retrospective study, investigating patients treated with PerOssal\u00ae between January 2020 and December 2023. Collected data include patient characteristics as well as various surgical and outcome parameters including the Lower Extremity Functional Scale (LEFS). Results: A total of 82 patients were analyzed. Reinfection occurred in 19.5% of cases. Osseous integration of PerOssal\u00ae was achieved in 89% of cases, higher in cavitary defects (91.5%) than segmental defects (72.7%). The revision rate was 32.9%, mainly due to wound healing disorders and reinfections. Mean LEFS score was 53.4 which was heavily influenced by sex (male: 50.7 vs. female: 63.4), revision surgery (no: 55.7 vs. yes: 49.1), reinfection (no: 56.6 vs. yes: 39.4), and osseous integration of PerOssal\u00ae (yes: 55.8 vs. no: 38.4). Conclusions: PerOssal\u00ae demonstrates promising outcomes in treating NUs and high-grade COM, especially in cavitary defects, with high osseous integration rates and acceptable functional results. However, reinfection remains a concern, particularly with difficult-to-treat pathogens and extensive surgical histories. Early, comprehensive surgical intervention and tailored antibiotic strategies are essential. Patient selection, defect characteristics, and comorbidities significantly influence success. Further research is needed to optimize treatment protocols.<\/jats:p>","DOI":"10.3390\/jcm13247764","type":"journal-article","created":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T08:04:14Z","timestamp":1734595454000},"page":"7764","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Treatment of High-Grade Chronic Osteomyelitis and Nonunions with PerOssal\u00ae: A Retrospective Analysis of Clinical Efficacy and Patient Perspectives"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2486-665X","authenticated-orcid":false,"given":"Jonas","family":"Armbruster","sequence":"first","affiliation":[{"name":"BG Klinik Ludwigshafen, Department for Orthopedics and Trauma Surgery, Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Bussmann","sequence":"additional","affiliation":[{"name":"BG Klinik Ludwigshafen, Department for Orthopedics and Trauma Surgery, Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holger","family":"Freischmidt","sequence":"additional","affiliation":[{"name":"BG Klinik Ludwigshafen, Department for Orthopedics and Trauma Surgery, Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Reiter","sequence":"additional","affiliation":[{"name":"BG Klinik Ludwigshafen, Department for Orthopedics and Trauma Surgery, Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0730-4782","authenticated-orcid":false,"given":"Paul Alfred","family":"Gruetzner","sequence":"additional","affiliation":[{"name":"BG Klinik Ludwigshafen, Department for Orthopedics and Trauma Surgery, Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Siad","family":"El Barbari","sequence":"additional","affiliation":[{"name":"BG Klinik Ludwigshafen, Department for Orthopedics and Trauma Surgery, Clinic at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/00003086-199310000-00006","article-title":"Quality of Life Assessment of Patients with Posttraumatic Fracture Nonunion, Chronic Refractory Osteomyelitis, and Lower-Extremity Amputation","volume":"295","author":"Lerner","year":"1993","journal-title":"Clin. 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