Reaming debris as a novel source of autologous bone to enhance healing of bone defects

Bakker, Astrid D.; Kroeze, Robert Jan; Korstjens, Clara M.; Kleine, Ruben H de; Frölke, Jan Paul M.; Klein‐Nulend, Jenneke

doi:10.1002/jbm.a.33080

Cited by 15 publications

(6 citation statements)

References 29 publications

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“…In addition, Auto-BM in different regions of the body also possesses considerable osteogenic capacity (e.g. iliac bone [55], mandible [56], femur [64]), whether for in situ or ex situ bone defect repair. Considering there are also the same demands of bone regeneration in other specialties, such as orthopedics and maxillofacial surgery, we believe that the collection and preservation of Auto-BM that has been resected or suffered from trauma will be useful for MLC-Auto-Bone.…”

Section: Discussionmentioning

confidence: 99%

Multi-level customized 3D printing for autogenous implants in skull tissue engineering

Chen

Zhang

et al. 2019

Biofabrication

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Three-dimensional (3D) printing of decellularized extracellular matrix (ECM) has been achieved to ensure real physiological environments for tissue engineering. However, the limited source, biocompatibility, and biosafety of decellularized ECM are deficiencies in its large clinical use. Autogenous ECM is biocompatible, bioactive, and biosafe, making it an optimal choice for future clinical applications of 3D printing. Here, we developed a multi-level customized 3D printing (MLC-3DP) strategy applying autogenous bone matrix (Auto-BM). This MLC-3DP includes shape specificity (shape), material specificity (Auto-BM), and cell specificity (autogenous cells) for true patient-specific repairs. Auto-BM (skull flaps) is readily accessible for specific patients after craniectomy, providing sufficient autogenous materials for MLC-3DP. Under mild conditions of this strategy, human-scale 3D printed samples can be fabricated using bioactive micron-sized Auto-BM particles. Multi-level customized autogenous bones (MLC-Auto-Bones) are finally obtained by combining autogenous bone marrow-derived mesenchymal stem cells (Auto-BMSCs). With autogenous materials and cells, MLC-Auto-Bones are inherently biocompatible and biosafe, providing good bioactivity for osteogenesis. In this implant, Auto-BMSCs can spontaneously differentiate into osteoblasts in vitro without additional osteogenic factors. In critical-sized skull defect models in vivo (3 months), implants integrate tightly to the defects’ margin, facilitate mineralization, and generate vascularized mature bone. This work provides not only feasibility for patient-specific implants for skull defects, but also potential patient-specific solutions for other similar clinical requirements.

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Section: Discussionmentioning

confidence: 99%

Multi-level customized 3D printing for autogenous implants in skull tissue engineering

Chen

Zhang

et al. 2019

Biofabrication

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“…Reaming debris contains viable osteoblast-like cells and growth factors and might thus act as a natural osteoinductive scaffold. In a sheep tibia model, bones treated with reaming debris demonstrated a larger callus volume, increased bone volume, decreased cartilage volume in the fracture gap, and increased torsional toughness compared to the empty gap group [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Reamed intramedullary exchange nailing: treatment of choice of aseptic femoral shaft nonunion

et al. 2014

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BackgroundThe aim of this study was to evaluate a standardized method of treatment of femoral nonunion of the isthmal femur excluding non-united metaphyseal fractures.MethodsBetween 2003 and 2010, 72 consecutive patients with nonunion of the femoral shaft were operated using a standardized protocol in our trauma department and followed up for successful union and functional result.ResultsOsseous healing was observed in 71 patients (98%). Only one patient was lacking bone healing following a time period of 24 months after the first exchange nailing and 5 months after the second exchange nailing. In 59 patients (82%), uneventful and timely bone healing after exchange nailing was detected. In 18% of patients (n = 13), delayed bone healing was observed and required additional therapy. In the majority of patients (61%), bone healing occurred within the first 2 to 5 months, only 18% of patients’ duration of bone healing exceeded 8 months. In 62 patients (86%), no relevant or clinically apparent leg-length discrepancy prior to and after exchange nailing was detected as well as no significant axis deviation or malrotation. Functional studies including simple clinical gait and standing analysis, return to activities of daily life, return to sports activities, and return to work were all reached on a satisfying level.DiscussionReamed intramedullary exchange nailing as described in this study is the treatment of choice for aseptic femoral shaft nonunion with a high rate of bone healing and a low rate of complications including length discrepancy or malrotation and a good functional outcome.

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“…Intramedullary devices are introduced by closed procedure with indirect fracture reduction, maintaining vascularity of the fracture zone with less disruption of the fracture hematoma. Reaming stimulates periosteal reaction and generates debris that serves as autogenous graft material at the fracture site [ 11 ]. Intramedullary insertion of implant a is a technically demanding procedure.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Outcomes of Proximal Femoral Nail Antirotation II in the Treatment of Trochanteric Fracture in Elderly Patients

Rai¹,

Singh²,

Singh³

et al. 2022

Cureus

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Background Intertrochanteric fractures are common injuries among the elderly population and those with osteoporosis. The study was conducted in order to evaluate the outcome of Proximal Femoral Nail Antirotation II (PFN-A2) in the treatment of these fractures in elderly patients. Methods Twenty-five elderly patients (range 60 to 73 years) with trochanteric fractures who were treated with PFN-A2 at Government Medical College Amritsar were included in this prospective observational study. These patients were followed up regularly until six months post-operatively. The functional and radiological evaluations were done at six, 12, 16, and 20 weeks. The functional outcome was evaluated using the Harris Hip Score (HHS). Results The mean age incidence for trochanteric fractures was 64 years. There were no cases of intra-operative and postoperative femoral fractures. The mean operating time was 85.6 minutes. Radiological union was seen in all of the 25 patients. The mean time for fracture union time in our study was 13.8 weeks. The average Harris Hip Score in our study was calculated at three months as 74.3 and at six months as 85.08. The p-value was highly significant (0.001) for this improved outcome. This study found PFN-A2 related secondary varus deformities in 8.0% of the patients (two patients). Only one patient (4%) developed surgical site infection (SSI). Conclusion PFN-A2 provides adequate functional results in terms of fixation and healing. This can be further enhanced by good pre-operative planning, correct technique of entry point, and meticulous placement of implant with a helical blade in both anteroposterior (AP), lateral view, and distal locking and non-acceptance of reduction in varus. A good reduction is required to achieve a good functional outcome. We conclude that the PFN-A2 has the benefit of closed reduction, short operative time, preservation of biology, less soft tissue damage, and early rehab.

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Reaming debris as a novel source of autologous bone to enhance healing of bone defects

Cited by 15 publications

References 29 publications

Multi-level customized 3D printing for autogenous implants in skull tissue engineering

Multi-level customized 3D printing for autogenous implants in skull tissue engineering

Reamed intramedullary exchange nailing: treatment of choice of aseptic femoral shaft nonunion

Evaluation of the Outcomes of Proximal Femoral Nail Antirotation II in the Treatment of Trochanteric Fracture in Elderly Patients

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