Mechanical properties of the femur filled with calcium phosphate cement under torsional loading: a model in rabbits.

We conducted an experimental study using rabbits to determine the effect of injection of calcium phosphate cement (CPC) through a small cortical window on the torsional strength of the long bone. A drill hole created in the femoral shaft and medullary curettage before CPC injection simulates the clinical procedure for managing benign bone tumors. Torsional loading always produced a spiral fracture through the drill hole. The CPC-treated femurs, but not the polymethylmethacrylate-treated femurs, tolerated greater torsional loads and had greater energy absorption to failure at 24 h and 2 weeks postoperatively compared with the contralateral sham-operated femurs. These two parameters, however, were only 54% and 26%, respectively, of those in normal femurs at 24 h, but they were 71% and 51% of those in normal femurs at 12 weeks. Histologic sections demonstrated progressive covering of the drill hole by new bone in the CPC-treated specimens and invagination by newly formed cortical bone into the medullary cavity following sham operation. CPC increases the torsional strength of the long bones immediately after injection, although not sufficiently to preclude the need for external fixation in clinical applications. Better management of the cortical defect is needed to further improve torsional strength.