Spontaneous fractures in custom-made porous hydroxyapatite cranioplasty implants: is fragility the only culprit?

Background Although the porous hydroxyapatite (PHA) used in custom-made cranioplasty implants is a material appreciated for its biomimetic properties, before osteointegration it is initially very fragile. Nevertheless, we wondered whether this primary fragility is entirely due to brittleness or whether the surgeon’s actions may influence the behavior of the material.