title: Hydroxyapatite ceramic implants for cranioplasty in children: a single-center experience.
abstract: OBJECTIVE
  The use of hydroxyapatite ceramic (HAC) implants for the treatment of skull defects in pediatric patients started 2010 at our institution. Ceramic implants facilitate osteoblast migration and therefore optimize osteointegration with the host bone. The purpose of this study is to report a single-center experience with this treatment modality.
  
  
  METHODS
  A retrospective review of all patients from July 2010 through June 2014 undergoing a cranioplasty using hydroxyapatite ceramic implant and managed at a single institution was performed. Indication for cranioplasty, the hospital course, and follow-up were reviewed. Bone density was measured in Hounsfield Units (HU) and osteointegration was calculated using Mimics Software® (Mimics Innovation Suite v17.0 Medical, Materialize, Leuven, Belgium).
  
  
  RESULTS
  Over the 4-year period, six patients met criteria for the study. Five patients had an osteointegration of nearly 100%. One patient had an incomplete osteointegration with a total bone-implant contact area of 69%. The mean bone density was 2800 HU (2300-3000 HU). Bone density alone is estimated to have a Hounsfield value between 400 and 2000 HU depending on the body region and bone quality. There were no major complications, and the patients were highly satisfied with the esthetical result.
  
  
  CONCLUSIONS
  Hydroxyapatite ceramic implants for cranioplasty in pediatric patients are a good choice for different indications. The implants show excellent osteointegration and esthetical results.
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital, Berne, Switzerland.
authors.forename: Laura
authors.initials: L
authors.lastname: Zaccaria
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
authors.forename: Sasha Job
authors.initials: SJ
authors.lastname: Tharakan
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland. stefan.altermatt@kispi.uzh.ch.
authors.forename: Stefan
authors.initials: S
authors.lastname: Altermatt
mesh_terms: D000293:Adolescent; D002516:Ceramics / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D003399:Craniotomy / Q000295:instrumentation* / Q000379:methods*; D017886:Durapatite / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods
chemical_list: D017886:Durapatite
keywords: Cranioplasty; Hounsfield unit; Hydroxyapatite; Osteointegration; Pediatric