Repair of long bone defects with demineralized bone matrix and autogenous bone composite

Abstract

Background:Repair of diaphyseal bone defects is a challenging problem for orthopedic surgeons. In large bone defects the quantity of harvested autogenous bone may not be sufficient to fill the gap and then the use of synthetic or allogenic grafts along with autogenous bone becomes mandatory to achieve compact filling. Finding the optimal graft mixture for treatment of large diaphyseal defects is an important goal in contemporary orthopedics and this was the main focus of this study. The aim of this study is to investigate the efficacy of demineralized bone matrix (DBM) and autogenous cancellous bone (ACB) graft composite in a rabbit bilateral ulna segmental defect model.Materials and Methods:Twenty-seven adult female rabbits were divided into five groups. A two-centimeter piece of long bone on the midshaft of the ulna was osteotomized and removed from the rabbits’ forearms. In group 1 (n=7) the defects were treated with ACB, in group 2 (n=7) with DBM, and in group 3 (n=7) with ACB and DBM in the ratio of 1:1. Groups 4 and 5, with three rabbits in each group, were the negative and positive controls, respectively. Twelve weeks after implantation the rabbits were sacrificed and union was evaluated with radiograph (Faxitron), dual-energy x-ray absorptiometry (DEXA), and histological methods (decalcified sectioning).Results:Union rates and the volume of new bone in the different groups were as follows: group 1 - 92.8% union and 78.6% new bone; group 2 - 72.2% union and 63.6% new bone; and group 3 - 100% union and 100% new bone. DEXA results (bone mineral density [BMD]) were as follows: group 1 - 0.164 g/cm2, group 2 - 0.138 g/cm2, and group 3 - 0.194 g/cm2.Conclusions:DBM serves as a graft extender or enhancer for autogenous graft and decreases the need of autogenous bone graft in the treatment of bone defects. In this study, the DBM and ACB composite facilitated the healing process. The union rate was better with the combination than with the use of any one of these grafts alone.

Radiological evaluation of radial bone defects treated with demineralized bone matrix in an experimental rabbit model

“…The selected model avoided the use of fastening means that could have interfered with the healing process. All the experimental defects treated with DBM were cured, thus surpassing the previously reported rates of 60-100% (Chakkalakal et al, 1999;2001;Ozdemir et al, 2011). The ideal bone implant should be osteoconductive, osteoinductive, resorbable and radiolucent to permit the radiological assessment of bone formation and repair (Babis & Suocacos, 2005).…”

Demineralized bone matrix and human cancellous bone enhance fixation of porous-coated titanium implants in sheep

“…We have demonstrated that the bone formation and implant fixation results in the DBM/allograft group were comparable to those of the control group consisting of allograft alone. The combination of DBM with allograft has also been reported by other authors (Kohler et al ., ; Ozdemir and Kir, ; Urrutia et al ., ; Ziran et al ., ). Urrutia et al .…”

“…Finally, the present study investigated the early effect of implant fixation. Ozdemir and Kir () evaluated the effect of DBM alone and in combination with autograft at a ratio of 1:1 in a rabbit diaphyseal bone defect; they reported significantly better healing in the composite group compared with autograft or DBM alone. However, the different methods of evaluation, composites and ratios of the graft materials used might explain the different results.…”

High-Performance Materials for Biomedical Applications-A Short Review

“…[3][4][5] The biopolymers, dematerialized bone matrices and natural fibers also provide an innate increased resistance to corrosion in the human body environment, owing to which the implants fabricated of these materials shall present a more conducive environment for bone growth during healing. 6,7 The use of these composites is not limited to just implant applications, and extends to external fixations and prosthetic applications such as prosthetic sockets, liners, foot, fabric resistance temperature detectors (for supracutaneous applications, smart clothing, medical electronics, etc.). [8][9][10][11] The non-functionalized carbon nanotubes may also be used to augment poly-methyl-methacrylate (PMMA) matrix for cementing prosthetics, medical implants, dental restorations or fixations.…”