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Stempels HW, Lehr AM, Delawi D, Hoebink EA, Wiljouw IAAA, Kempen DHR, van Susante JLC, Kruyt MC. Efficacy of Biphasic Calcium Phosphate Ceramic With a Needle-Shaped Surface Topography Versus Autograft in Instrumented Posterolateral Spinal Fusion. Spine (Phila Pa 1976) 2024; 49:1323-1331. [PMID: 38881258 PMCID: PMC11386961 DOI: 10.1097/brs.0000000000005075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/06/2024] [Indexed: 06/18/2024]
Abstract
STUDY DESIGN A multicenter randomized controlled noninferiority trial with intrapatient comparisons. OBJECTIVE The aim of this study was to determine noninferiority of a slowly resorbable biphasic calcium phosphate with submicron microporosity (BCP<μm, MagnetOs Granules) as an alternative for autograft in instrumented posterolateral fusion (PLF). SUMMARY OF BACKGROUND DATA Successful spinal fusion with a solid bone bridge between the vertebrae is traditionally achieved by grafting with autologous iliac bone. However, the disadvantages of autografts and unsatisfactory fusion rates have prompted the exploration of alternatives, including ceramics. Nevertheless, clinical evidence for the standalone use of these materials is limited. METHODS Adults indicated for instrumented PLF (1 to 6 levels) were enrolled at 5 participating centers. After bilateral instrumentation and fusion-bed preparation, the randomized allocation side (left or right) was disclosed. Per segment 10 cc of BCP<μm granules (1 to 2 mm) were placed in the posterolateral gutter on one side and 10 cc autograft on the contralateral side. Fusion was systematically scored on 1-year follow-up CT scans. The study was powered to detect >15% inferiority with binomial paired comparisons of the fusion performance score per treatment side. RESULTS Of the 100 patients (57 ± 12.9 y, 62% female), 91 subjects and 128 segments were analyzed. The overall posterolateral fusion rate per segment (left and/or right) was 83%. For the BCP<μm side only the fusion rate was 79% versus 47% for the autograft side (difference of 32 percentage points, 95% CI, 23-41). Analysis of the primary outcome confirmed the noninferiority of BCP<μm with an absolute difference in paired proportions of 39.6% (95% CI, 26.8-51.2; p < 0.001). CONCLUSION This clinical trial demonstrates noninferiority and indicates superiority of MagnetOs Granules as a standalone ceramic when compared to autograft for posterolateral spinal fusion. These results challange the belief that autologous bone is the most optimal graft material.
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Affiliation(s)
- Hilde W Stempels
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Mechteld Lehr
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Diyar Delawi
- Department of Orthopaedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - Eric A Hoebink
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Inge A A A Wiljouw
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - Job L C van Susante
- Department of Orthopaedic Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Moyo C Kruyt
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Maniglio M, Aguiar F, Roner S, Zaidenberg EE. Assessment, Diagnosis and Management Strategies for Forearm Shaft Non-union: A Contemporary Perspective. J Hand Surg Asian Pac Vol 2024; 29:380-391. [PMID: 39205527 DOI: 10.1142/s2424835524400022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Forearm non-union poses a challenge in orthopaedic surgery due to its intricate anatomy and functional significance. This review provides a comprehensive overview of the assessment, diagnosis and management of forearm non-union. Initial evaluation involves a meticulous history, physical examination and imaging studies to identify factors contributing to non-union, including infection. Surgical approaches are discussed, with emphasis on restoring biomechanical stability and promoting bone healing. Treatment options range from autografts to allografts, with considerations for vascularised bone transfers in complex cases. Decision-making strategies are outlined, considering patient-specific factors and individualised treatment plans. Special considerations for specific types of forearm non-unions are addressed, along with postoperative care protocols to optimise healing and functional outcomes. Overall, this review aims to provide clinicians with a comprehensive understanding of forearm non-union management based on current evidence and clinical practice. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Mauro Maniglio
- Department of Hand Surgery, University Clinic, Balgrist, Zürich, Switzerland
| | - Francisco Aguiar
- Department of Orthopaedics and Traumatology, Clinica Francesa, Mendoza, Argentina
| | - Simon Roner
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ezequiel E Zaidenberg
- Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
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Takase K, Niikura T, Fukui T, Kumabe Y, Sawauchi K, Yoshikawa R, Yamamoto Y, Nishida R, Matsumoto T, Kuroda R, Oe K. Three-dimensional printed calcium phosphate scaffolds emulate bone microstructure to promote bone regrowth and repair. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2024; 35:53. [PMID: 39225913 PMCID: PMC11371849 DOI: 10.1007/s10856-024-06817-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Abstract
The interconnected structures in a 3D scaffold allows the movement of cells and nutrients. Therefore, this study aimed to investigate the in-vivo bioactivity of 3D-printed β-tricalcium phosphate (β-TCP) and hydroxyapatite (HAP) scaffolds that replicate biological bone. This study included 24-week-old male New Zealand white rabbits. A cylindrical bone defect with a diameter of 4.5 mm and a depth of 8 mm was created in the lateral aspect of the distal femur. A 3D-printed scaffold was implanted in the right femur (experimental side), whereas the left femur was kept free of implantation (control side). Micro-CT analysis and histological observations of the bone defect site were conducted at 4, 8, and 12 weeks postoperatively to track the bone repair progress. No evidence of new bone tissue formation was found in the medullary cavity of the bone defect on the control side. In contrast, on the experimental side, the 3D scaffold demonstrated sufficient bioactivity, leading to the growth of new bone tissue. Over time, new bone tissue gradually extended from the periphery toward the center, a phenomenon evident in both micro-CT images and biopsy staining. In the current study, we observed that the cells involved in bone metabolism adhered, spread, and proliferated on our newly designed 3D-printed scaffold with a bone microstructure. Therefore, it is suggested that this scaffold has sufficient bioactivity to induce new bone formation and could be expected to be a more useful artificial bone than the existing version.
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Affiliation(s)
- Kyohei Takase
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan.
- Visiting Medical Scientist, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Tomoaki Fukui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yohei Kumabe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichi Sawauchi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryo Yoshikawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuya Yamamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryota Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keisuke Oe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Sun H, Yin X, Yang C, Kuang H, Luo W. Advances in autogenous dentin matrix graft as a promising biomaterial for guided bone regeneration in maxillofacial region: A review. Medicine (Baltimore) 2024; 103:e39422. [PMID: 39183415 PMCID: PMC11346879 DOI: 10.1097/md.0000000000039422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 08/27/2024] Open
Abstract
Autogenous dentin matrix (ADM), derived from a patient's extracted tooth, can be repurposed as an autologous grafting material in reconstructive dentistry. Extracted teeth provide a source for ADM, which distinguishes itself with its low rejection rate, osteoinductive capabilities and ease of preparation. Consequently, it presents a viable alternative to autogenous bone. Animal studies have substantiated its effective osteoinductive properties, while its clinical applications encompass post-extraction site preservation, maxillary sinus floor augmentation, and guided bone tissue regeneration. Nevertheless, the long-term efficacy of ADM applied in bone regeneration remains underexplored and there is a lack of standardization in the preparation processes. This paper comprehensively explores the composition, mechanisms underlying osteoinductivity, preparation methods, and clinical applications of ADM with the aim of establishing a fundamental reference for future studies on this subject.
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Affiliation(s)
- Honglan Sun
- Key Laboratory of Emergency and Trauma of Ministry of Education, Department of Stomatology, Key Laboratory of Hainan Trauma and Disaster Rescue, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, China
- School of Stomatology, Hainan Medical University, Haikou, Hainan Province, China
| | - Xiaoyunqing Yin
- Key Laboratory of Emergency and Trauma of Ministry of Education, Department of Stomatology, Key Laboratory of Hainan Trauma and Disaster Rescue, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, China
- School of Stomatology, Hainan Medical University, Haikou, Hainan Province, China
| | - Chao Yang
- Department of Stomatology, The People’s Hospital of Longhua, Shenzhen, Guangdong Province, China
- Research and Development Department, Shenzhen Uni-medica Technology Co., Ltd, Shenzhen, Guangdong Province, China
| | - Huifang Kuang
- Key Laboratory of Emergency and Trauma of Ministry of Education, Department of Stomatology, Key Laboratory of Hainan Trauma and Disaster Rescue, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, China
- School of Stomatology, Hainan Medical University, Haikou, Hainan Province, China
| | - Wen Luo
- Key Laboratory of Emergency and Trauma of Ministry of Education, Department of Stomatology, Key Laboratory of Hainan Trauma and Disaster Rescue, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, China
- School of Stomatology, Hainan Medical University, Haikou, Hainan Province, China
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5
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Hung GY, Wang CY, Hsiao HY, Tu CS, Mana-Ay H, Chen CT, Lai PL, Feng KC, Chen PY. Composite bone graft of CaO-MgO-SiO 2 glass-ceramics and CaSO 4 ceramics for boosting bone formation rate. J Mater Chem B 2024; 12:6394-6409. [PMID: 38855886 DOI: 10.1039/d4tb00262h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
This study develops a composite bone graft of CaO-MgO-SiO2 glass-ceramic and CaSO4 [abbreviated as (CMS)3-x(CS)x] via the sponge replication technique with weight fractions of x = 0, 1, 1.5, 2, and 3. The (CMS)1.5(CS)1.5 composite displays a superior degradability and, a suitable compressive strength of ∼3 MPa, and excellent cell proliferation and differentiation. The in vivo rat femur test in the hybrid-pore (CMS)1.5(CS)1.5 composite granules achieves a higher rate of bone formation, which is ∼2.7 times better than that of the commercial HAP/β-TCP at 12 weeks. Improved expressions of osteocyte and mature osteocyte marker genes, namely (Spp1, Dmp1, and Fgf23), were observed in the (CMS)1.5(CS)1.5 group, indicating a faster differentiation into mature bone tissue. The ions release of (CMS)1.5(CS)1.5 through the ERK1/2 signaling pathway promotes osteogenic differentiation. The high bone generation rate can be attributed to faster active ions release and modified surface topography. This work highlights an excellent bone graft candidate for clinical applications in orthopedic surgery.
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Affiliation(s)
- Guan-Yi Hung
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
| | - Chi-Yun Wang
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
| | - Hui-Yi Hsiao
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
- Department of Biomedical Sciences, Chang Gung University, Taoyuan City 33305, Taiwan
| | - Chi-Shun Tu
- Department of Physics, Fu Jen Catholic University, New Taipei City 24205, Taiwan
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
| | - Haidee Mana-Ay
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
- Department of Physics, Silliman University, Dumaguete City 6200, Philippines
| | | | - Po-Liang Lai
- Bone and Joint Reserach Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan.
- College of Medicine, Chang Gung Univeristy, Taoyuan City 33305, Taiwan
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
| | - Kuei-Chih Feng
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
- Department of Mechanical Engineering, Ming Chi University of Technology, New Taipei City 24301, Taiwan
| | - Pin-Yi Chen
- International PhD Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
- Department of Mechanical Engineering, Chang Gung University, Taoyuan City 33302, Taiwan
- Research Center for Intelligent Medical Devices, Ming Chi University of Technology, New Taipei City 24301, Taiwan
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Ji Y, Mao Y, Lin H, Wang Y, Zhao P, Guo Y, Gu L, Fu C, Chen X, Lv Z, Wang N, Li Q, Bei C. Acceleration of bone repairation by BMSCs overexpressing NGF combined with NSA and allograft bone scaffolds. Stem Cell Res Ther 2024; 15:194. [PMID: 38956719 PMCID: PMC11218317 DOI: 10.1186/s13287-024-03807-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 06/18/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Repairation of bone defects remains a major clinical problem. Constructing bone tissue engineering containing growth factors, stem cells, and material scaffolds to repair bone defects has recently become a hot research topic. Nerve growth factor (NGF) can promote osteogenesis of bone marrow mesenchymal stem cells (BMSCs), but the low survival rate of the BMSCs during transplantation remains an unresolved issue. In this study, we investigated the therapeutic effect of BMSCs overexpression of NGF on bone defect by inhibiting pyroptosis. METHODS The relationship between the low survival rate and pyroptosis of BMSCs overexpressing NGF in localized inflammation of fractures was explored by detecting pyroptosis protein levels. Then, the NGF+/BMSCs-NSA-Sca bone tissue engineering was constructed by seeding BMSCs overexpressing NGF on the allograft bone scaffold and adding the pyroptosis inhibitor necrosulfonamide(NSA). The femoral condylar defect model in the Sprague-Dawley (SD) rat was studied by micro-CT, histological, WB and PCR analyses in vitro and in vivo to evaluate the regenerative effect of bone repair. RESULTS The pyroptosis that occurs in BMSCs overexpressing NGF is associated with the nerve growth factor receptor (P75NTR) during osteogenic differentiation. Furthermore, NSA can block pyroptosis in BMSCs overexpression NGF. Notably, the analyses using the critical-size femoral condylar defect model indicated that the NGF+/BMSCs-NSA-Sca group inhibited pyroptosis significantly and had higher osteogenesis in defects. CONCLUSION NGF+/BMSCs-NSA had strong osteogenic properties in repairing bone defects. Moreover, NGF+/BMSCs-NSA-Sca mixture developed in this study opens new horizons for developing novel tissue engineering constructs.
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Affiliation(s)
- Ying Ji
- Department of Orthopaedics, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, Guilin, 541001, China
| | - Yongkang Mao
- Department of Orthopaedics, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, Guilin, 541001, China
| | - Honghu Lin
- Department of Orthopaedics, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, Guilin, 541001, China
| | - Ye Wang
- Department of Orthopaedics, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, Guilin, 541001, China
| | - Peishuai Zhao
- Department of Orthopaedics, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, Guilin, 541001, China
| | - Yong Guo
- Department of Biomedical Engineering, School of Intelligent Medicine and Biotechnology, Guilin Medical University, 1 Zhiyuan Road, Guilin, 541199, China
| | - Lantao Gu
- Key Laboratory of Medical Biotechnology and Translational Medicine, Guilin Medical University, 1 Zhiyuan Road, Guilin, 541199, China
| | - Can Fu
- Key Laboratory of Medical Biotechnology and Translational Medicine, Guilin Medical University, 1 Zhiyuan Road, Guilin, 541199, China
| | - Ximiao Chen
- Department of Orthopaedics, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, Guilin, 541001, China
| | - Zheng Lv
- Department of Radiology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, Guilin, 541001, China
| | - Ning Wang
- Department of Orthopaedics, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, Guilin, 541001, China
| | - Qiang Li
- Department of Orthopaedics, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, Guilin, 541001, China.
| | - Chaoyong Bei
- Department of Orthopaedics, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, Guilin, 541001, China.
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Chen CF, Chou YS, Lee TM, Fu YC, Ou SF, Chen SH, Lee TC, Wang YH. The Uniform Distribution of Hydroxyapatite in a Polyurethane Foam-Based Scaffold (PU/HAp) to Enhance Bone Repair in a Calvarial Defect Model. Int J Mol Sci 2024; 25:6440. [PMID: 38928145 PMCID: PMC11203484 DOI: 10.3390/ijms25126440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Polyurethane (PU) is a promising material for addressing challenges in bone grafting. This study was designed to enhance the bone grafting capabilities of PU by integrating hydroxyapatite (HAp), which is known for its osteoconductive and osteoinductive potential. Moreover, a uniform distribution of HAp in the porous structure of PU increased the effectiveness of bone grafts. PEG/APTES-modified scaffolds were prepared through self-foaming reactions. A uniform pore structure was generated during the spontaneous foaming reaction, and HAp was uniformly distributed in the PU structure (PU15HAp and PU30HAp) during foaming. Compared with the PU scaffolds, the HAp-modified PU scaffolds exhibited significantly greater protein absorption. Importantly, the effect of the HAp-modified PU scaffold on bone repair was tested in a rat calvarial defect model. The microstructure of the newly formed bone was analyzed with microcomputed tomography (μ-CT). Bone regeneration at the defect site was significantly greater in the HAp-modified PU scaffold group than in the PU group. This innovative HAp-modified PU scaffold improves current bone graft materials, providing a promising avenue for improved bone regeneration.
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Affiliation(s)
- Chiu-Fang Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan;
| | - Ya-Shuan Chou
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (Y.-S.C.); (T.-C.L.)
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Tzer-Min Lee
- Institute of Oral Medicine, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan;
- School of Dentistry, National Cheng Kung University, Tainan 701, Taiwan
| | - Yin-Chih Fu
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (Y.-S.C.); (T.-C.L.)
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, Taiwan
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Shih-Fu Ou
- Department of Mold and Die Engineering, National Kaohsiung University of Science and Technology, Kaohsiung 807, Taiwan;
| | - Szu-Hsien Chen
- Institute of Polymer Science and Engineering, College of Engineering, National Taiwan University, Taipei 106216, Taiwan;
| | - Tien-Ching Lee
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (Y.-S.C.); (T.-C.L.)
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, Taiwan
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Yan-Hsiung Wang
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan;
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (Y.-S.C.); (T.-C.L.)
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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Tsai YH, Tseng CC, Lin YC, Nail HM, Chiu KY, Chang YH, Chang MW, Lin FH, Wang HMD. Novel artificial tricalcium phosphate and magnesium composite graft facilitates angiogenesis in bone healing. Biomed J 2024:100750. [PMID: 38838984 DOI: 10.1016/j.bj.2024.100750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 03/22/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Bone grafting is the standard treatment for critical bone defects, but autologous grafts have limitations like donor site morbidity and limited availability, while commercial artificial grafts may have poor integration with surrounding bone tissue, leading to delayed healing. Magnesium deficiency negatively impacts angiogenesis and bone repair. Therefore, incorporating magnesium into a synthetic biomaterial could provide an excellent bone substitute. This study aims to evaluate the morphological, mechanical, and biological properties of a calcium phosphate cement (CPC) sponge composed of tetracalcium phosphate (TTCP) and monocalcium phosphate monohydrate (MCPM), which could serve as an excellent bone substitute by incorporating magnesium. METHODS This study aims to develop biomedical materials composed mainly of TTCP and MCPM powder, magnesium powder, and collagen. The materials were prepared using a wet-stirred mill and freeze-dryer methods. The particle size, composition, and microstructure of the materials were investigated. Finally, the biological properties of these materials, including 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide (MTT) assay for biocompatibility, effects on bone cell differentiation by alkaline phosphatase (ALP) activity assay and tartrate-resistant acid phosphatase (TRAP) activity assay, and endothelial cell tube formation assay for angiogenesis, were evaluated as well. RESULTS The data showed that the sub-micron CPC powder, composed of TTCP/MCPM in a 3.5:1 ratio, had a setting time shorter than 15 minutes and a compressive strength of 4.39±0.96 MPa. This reveals that the sub-micron CPC powder had an adequate setting time and mechanical strength. We found that the sub-micron CPC sponge containing magnesium had better biocompatibility, including increased proliferation and osteogenic induction effects without cytotoxicity. The CPC sponge containing magnesium also promoted angiogenesis. CONCLUSION In summary, we introduced a novel CPC sponge, which had a similar property to human bone promoted the biological functions of bone cells, and could serve as a promising material used in bone regeneration for critical bone defects.
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Affiliation(s)
- Yuan-Hsin Tsai
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung 402, Taiwan Republic of China; Department of Orthopedic Surgery, Show-Chwan Memorial Hospital, Changhua 500, Taiwan Republic of China
| | - Chun-Chieh Tseng
- Metal Industries Research & Development Centre, 1001 Kaonan Highway, Nanzi Dist., Kaohsiung 811, Taiwan Republic of China; Combination Medical Device Technology Division, Medical Devices R&D Service Department, Metal Industries Research & Development Centre, Kaohsiung 802, Taiwan Republic of China
| | - Yun-Chan Lin
- Department of Food Science and Biotechnology, National Chung Hsing University, Taichung 402, Taiwan Republic of China
| | - Howida M Nail
- Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung 402, Taiwan Republic of China
| | - Kuan-Yu Chiu
- Metal Industries Research & Development Centre, 1001 Kaonan Highway, Nanzi Dist., Kaohsiung 811, Taiwan Republic of China; Combination Medical Device Technology Division, Medical Devices R&D Service Department, Metal Industries Research & Development Centre, Kaohsiung 802, Taiwan Republic of China
| | - Yen-Hao Chang
- Metal Industries Research & Development Centre, 1001 Kaonan Highway, Nanzi Dist., Kaohsiung 811, Taiwan Republic of China; Combination Medical Device Technology Division, Medical Devices R&D Service Department, Metal Industries Research & Development Centre, Kaohsiung 802, Taiwan Republic of China
| | - Ming-Wei Chang
- Nanotechnology and Integrated Bioengineering Centre, University of Ulster, Belfast, BT151AB, Northern Ireland, UK
| | - Feng-Huei Lin
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung 402, Taiwan Republic of China; Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan Republic of China; Institute of Biomedical Engineering and Nano-medicine, National Health Research Institutes, Zhunan, Miaoli 350, Taiwan Republic of China.
| | - Hui-Min David Wang
- Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung 402, Taiwan Republic of China; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan Republic of China; Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung City 404, Taiwan Republic of China.
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9
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Orlando JD, Li L, Limbu TB, Deng C, Wolf ME, Vickery WM, Yan F, Sydlik SA. Calcium phosphate graphene and Ti 3C 2T x MXene scaffolds with osteogenic and antibacterial properties. J Biomed Mater Res B Appl Biomater 2024; 112:e35434. [PMID: 38874589 DOI: 10.1002/jbm.b.35434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/26/2024] [Accepted: 05/18/2024] [Indexed: 06/15/2024]
Abstract
Bioactive degradable scaffolds that facilitate bone healing while fighting off initial bacterial infection have the potential to change established strategies of dealing with traumatic bone injuries. To achieve this a composite material made from calcium phosphate graphene (CaPG), and MXene was synthesized. CaPG was created by functionalizing graphene oxide with phosphate groups in the presence of CaBr with a Lewis acid catalyst. Through this transformation, Ca2+ and PO4 3- inducerons are released as the material degrades thereby aiding in the process of osteogenesis. The 2D MXene sheets, which have shown to have antibacterial properties, were made by etching the Al from a layered Ti3AlC2 (MAX phase) using HF. The hot-pressed scaffolds made of these materials were designed to combat the possibility of infection during initial surgery and failure of osteogenesis to occur. These two failure modes account for a large percentage of issues that can arise during the treatment of traumatic bone injuries. These scaffolds were able to retain induceron-eluting properties in various weight percentages and bring about osteogenesis with CaPG alone and 2 wt% MXene scaffolds demonstrating increased osteogenic activity as compared to no treatment. Additionally, added MXene provided antibacterial properties that could be seen at as little as 2 wt%. This CaPG and MXene composite provides a possible avenue for developing osteogenic, antibacterial materials for treating bone injuries.
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Affiliation(s)
- Jason D Orlando
- Department of Chemistry, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Li Li
- Department of Chemistry, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Tej B Limbu
- Department of Physical and Applied Sciences, University of Houston-Clear Lake, Houston, Texas, USA
- Department of Chemistry and Biochemistry, North Carolina Central University, Durham, USA
| | - Chenyun Deng
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Michelle E Wolf
- Department of Chemistry, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Walker M Vickery
- Department of Chemistry, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Fei Yan
- Department of Chemistry and Biochemistry, North Carolina Central University, Durham, USA
| | - Stefanie A Sydlik
- Department of Chemistry, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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Orozco Delclós L, Soler Rich R, Arriaza Loureda R, Moreno García A, Gómez Barrena E. Efficacy and safety of autologous or allogeneic mesenchymal stromal cells from adult adipose tissue expanded and combined with tricalcium phosphate biomaterial for the surgical treatment of atrophic nonunion of long bones: a phase II clinical trial. J Transl Med 2024; 22:493. [PMID: 38789992 PMCID: PMC11127443 DOI: 10.1186/s12967-024-05280-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Autologous bone grafting is the standard treatment for the surgical management of atrophic nonunion of long bones. Other solutions, such as bone marrow mesenchymal stem cells (BM-MSC) combined with phospho-calcium material, have also been used. Here we evaluate the safety and early efficacy of a novel procedure using autologous or allogenic adipose tissue mesenchymal stromal cells (AT-MSC) seeded in a patented tricalcium phosphate-based biomaterial for the treatment of bone regeneration in cases of atrophic nonunion. METHODS This was a prospective, multicentric, open-label, phase 2 clinical trial of patients with atrophic nonunion of long bones. Biografts of autologous or allogenic AT-MSC combined with a phosphate substrate were manufactured prior to the surgical procedures. The primary efficacy was measured 6 months after surgery, but patients were followed for 12 months after surgery and a further year out of the scope of the study. All adverse events were recorded. This cohort was compared with a historical cohort of 14 cases treated by the same research team with autologous BM-MSC. RESULTS A total of 12 patients with atrophic nonunion of long bones were included. The mean (SD) age was 41.2 (12.1) years and 66.7% were men. Bone healing was achieved in 10 of the 12 cases (83%) treated with the AT-MSC biografts, a percentage of healing similar (11 of the 14 cases, 79%) to that achieved in patients treated with autologous BM-MSC. Overall, two adverse events, in the same patient, were considered related to the procedure. CONCLUSIONS The results of this study suggest that AT-MSC biografts are safe for the treatment of bone regeneration in cases of atrophic nonunion and reach high healing rates. TRIAL REGISTRATION Study registered with EUDRA-CT (2013-000930-37) and ClinicalTrials.gov (NCT02483364).
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Affiliation(s)
- Lluís Orozco Delclós
- Institut de Teràpia Regenerativa Tissular, Centro Médico Teknon, Barcelona, Spain.
| | - Robert Soler Rich
- Institut de Teràpia Regenerativa Tissular, Centro Médico Teknon, Barcelona, Spain
| | | | - Alonso Moreno García
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | - Enrique Gómez Barrena
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
- School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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11
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Kunisada T, Nakata E, Fujiwara T, Hata T, Sato K, Katayama H, Kondo A, Ozaki T. Clinical Application of Unidirectional Porous Hydroxyapatite to Bone Tumor Surgery and Other Orthopedic Surgery. Biomimetics (Basel) 2024; 9:294. [PMID: 38786504 PMCID: PMC11117865 DOI: 10.3390/biomimetics9050294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Unidirectional porous hydroxyapatite (UDPHAp) was developed as a remarkable scaffold characterized by a distinct structure with unidirectional pores oriented in the horizontal direction and connected through interposes. We evaluated the radiographic changes, clinical outcomes, and complications following UDPHAp implantation for the treatment of bone tumors. Excellent bone formation within and around the implant was observed in all patients treated with intralesional resection and UDPHAp implantation for benign bone tumors. The absorption of UDPHAp and remodeling of the bone marrow space was observed in 45% of the patients at a mean of 17 months postoperatively and was significantly more common in younger patients. Preoperative cortical thinning was completely regenerated in 84% of patients at a mean of 10 months postoperatively. No complications related to the implanted UDPHAp were observed. In a pediatric patient with bone sarcoma, when the defect after fibular resection was filled with UDPHAp implants, radiography showed complete resorption of the implant and clear formation of cortex and marrow in the resected part of the fibula. The patient could walk well without crutches and participate in sports activities. UDPHAp is a useful bone graft substitute for the treatment of benign bone tumors, and the use of this material has a low complication rate. We also review and discuss the potential of UDPHAp as a bone graft substitute in the clinical setting of orthopedic surgery.
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Affiliation(s)
- Toshiyuki Kunisada
- Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama 700-8558, Japan
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama 700-8558, Japan
| | - Eiji Nakata
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama 700-8558, Japan
| | - Tomohiro Fujiwara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama 700-8558, Japan
| | - Toshiaki Hata
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama 700-8558, Japan
| | - Kohei Sato
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama 700-8558, Japan
| | - Haruyoshi Katayama
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama 700-8558, Japan
| | - Ayana Kondo
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama 700-8558, Japan
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12
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Su Y, Li D, Du B, Li Z, Lu Y, Xu Y, Wang Q, Li Z, Ren C, Ma T. Analysis of risk factors for the recurrence of osteomyelitis of the limb after treatment with antibiotic-loaded calcium sulfate and autologous bone graft. Front Bioeng Biotechnol 2024; 12:1368818. [PMID: 38807650 PMCID: PMC11130418 DOI: 10.3389/fbioe.2024.1368818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/01/2024] [Indexed: 05/30/2024] Open
Abstract
Objective We aimed to evaluate the efficacy of antibiotic-loaded calcium sulfate combined with autologous iliac bone transplantation in the treatment of limb-localized osteomyelitis (Cierny-Mader type III) and analyze the causes and risk factors associated with infection recurrence. Methods Clinical data of 163 patients with localized osteomyelitis of the extremities treated with antibiotic-loaded calcium sulfate combined with autologous iliac bone transplantation in Xi'an Honghui Hospital from January 2017 to December 2022 were retrospectively analyzed. All patients were diagnosed with localized osteomyelitis through clinical examination and treated with antibiotic-loaded calcium sulfate combined with autologous iliac bone. Based on the infection recurrence status, the patients were divided into the recurrence group and the non-recurrence group. The clinical data of the two groups were compared using univariate analysis. Subsequently, the distinct datasets were included in the binary logistic regression analysis to determine the risk and protective factors. Results This study included 163 eligible patients, with an average age of 51.0 years (standard deviation: 14.9). After 12 months of follow-up, 25 patients (15.3%) experienced infection recurrence and were included in the recurrence group; the remaining 138 patients were included in the non-recurrence group. Among the 25 patients with recurrent infection, 20 required reoperation, four received antibiotic treatment alone, and one refused further treatment. Univariate analysis showed that education level, smoking, hypoproteinemia, open injury-related infection, and combined flap surgery were associated with infection recurrence (p < 0.05). Logistic regression analysis showed that open injury-related infection (odds ratio [OR] = 35.698; 95% confidence interval [CI]: 5.997-212.495; p < 0.001) and combined flap surgery (OR = 41.408; 95% CI: 5.806-295.343; p < 0.001) were independent risk factors for infection recurrence. Meanwhile, high education level (OR = 0.009; 95% CI: 0.001-0.061; p < 0.001) was a protective factor for infection recurrence. Conclusion Antibiotic-loaded calcium sulfate combined with autologous iliac bone transplantation is an effective method for treating limb-localized osteomyelitis. Patients without previous combined flap surgery and non-open injury-related infections have a relatively low probability of recurrence of infection after treatment with this surgical method. Additionally, patients with a history of smoking and hypoproteinemia should pay attention to preventing the recurrence of infection after operation. Providing additional guidance and support, particularly in patients with lower education levels and compliance, could contribute to the reduction of infection recurrence.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Cheng Ren
- Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Teng Ma
- Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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13
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Kelly SS, Suarez CA, Mirsky NA, Slavin BV, Brochu B, Vivekanand Nayak V, El Shatanofy M, Witek L, Thaller SR, Coelho PG. Application of 3D Printing in Cleft Lip and Palate Repair. J Craniofac Surg 2024:00001665-990000000-01572. [PMID: 38738906 DOI: 10.1097/scs.0000000000010294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/03/2024] [Indexed: 05/14/2024] Open
Abstract
This manuscript reviews the transformative impact of 3-dimensional (3D) printing technologies in the treatment and management of cleft lip and palate (CLP), highlighting its application across presurgical planning, surgical training, implantable scaffolds, and postoperative care. By integrating patient-specific data through computer-aided design and manufacturing, 3D printing offers tailored solutions that improve surgical outcomes, reduce operation times, and enhance patient care. The review synthesizes current research findings, technical advancements, and clinical applications, illustrating the potential of 3D printing to revolutionize CLP treatment. Further, it discusses the future directions of combining 3D printing with other innovative technologies like artificial intelligence, 4D printing, and in situ bioprinting for more comprehensive care strategies. This paper underscores the necessity for multidisciplinary collaboration and further research to overcome existing challenges and fully utilize the capabilities of 3D printing in CLP repair.
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Affiliation(s)
- Sophie S Kelly
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL
| | | | | | | | | | | | - Muhammad El Shatanofy
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL
| | - Lukasz Witek
- Biomaterials Division, NYU Dentistry
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York
- Department of Biomedical Engineering, Tandon School of Engineering, New York University, Brooklyn, NY
| | - Seth R Thaller
- DeWitt Daughtry Family, Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Paulo G Coelho
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine
- DeWitt Daughtry Family, Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
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14
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Minehara H, Zenke Y, Maruo A, Matsushita T, Miclau T. Management of open fracture and related complications: the Japanese way. OTA Int 2024; 7:e325. [PMID: 38708042 PMCID: PMC11064782 DOI: 10.1097/oi9.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 05/07/2024]
Abstract
Open fractures continue to be a challenging clinical problem throughout the world, and Japan is no exception. Surgeons are faced with critical decisions throughout the care of these injuries that can have significant effects in clinical outcome, ranging from the type and timing of antibiotic administration, fixation, soft-tissue management, and interventions for postfracture complications. In October 2022, the Japanese Society for Fracture Repair (JSFR) was invited to represent Japan as the Guest Nation society at the 38th Annual Meeting of the Orthopaedic Trauma Society held in Tampa, Florida. The JSFR organized a symposium, entitled "Management of Open Fracture and related complications-the Japanese way," that featured cutting-edge approaches to open fractures in their country, including presentations on the "fix-and-flap" approach, local antibiotics perfusion delivery, and a "chipping" method for the stimulation of bone healing. This article summarizes the content of these 3 presentations from that symposium.
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Affiliation(s)
- Hiroaki Minehara
- Department of Traumatology, Fukushima Medical University, Trauma and Reconstruction Center, Shin-Yurigaoka General Hospital, Kawasaki, Japan
| | - Yukichi Zenke
- Trauma Reconstruction Center, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akihiro Maruo
- Department of Orthopaedic Surgery, Harima-Himeji General Medical Center, Himeji, Japan
| | - Takashi Matsushita
- Department of Traumatology, Fukushima Medical University, Trauma and Reconstruction Center, Shin-Yurigaoka General Hospital, Kawasaki, Japan
| | - Theodore Miclau
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California, San Francisco, School of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA
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15
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Jain A, Rathsam AM, Springer KJ, Perumbala K, Parker A, Burns PR, Manway JM. Morbidity Associated With Distal Tibial Autograft Harvest. J Foot Ankle Surg 2024; 63:345-349. [PMID: 38246336 DOI: 10.1053/j.jfas.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/29/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
Distal tibial autograft harvesting has been studied in the past, but morbidity at the level of the donor site is unclear. The purpose of this retrospective review is to assess morbidity in distal tibial autograft harvesting associated with foot and ankle arthrodesis procedures. A retrospective analysis was performed utilizing patients treated in the last 13 years at a large, multicenter, academic, tertiary referral, research institution. Included patients were between the ages of 18 and 80 years old. One-hundred and seven patients (39 male; 68 female) underwent ipsilateral distal tibial bone graft (n = 110) harvesting to augment the index procedure. Patients were followed for an average of 11.2 months after surgery (Range: 1-73 months). The incidence rate of distal tibial stress fractures was 4.5%, with an overall postoperative complication rate of 8.2%. Overall, low complication rates associated with distal tibial autograft harvesting were found, supporting the use of the distal tibia as an appropriate site for autograft harvesting in foot and ankle surgery.
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Affiliation(s)
- Akshay Jain
- University of Pittsburgh Medical Center, Mercy Hospital, Pittsburgh, PA.
| | - Aaron M Rathsam
- University of Pittsburgh Medical Center, Mercy Hospital, Pittsburgh, PA
| | - Katie J Springer
- University of Pittsburgh Medical Center, Mercy Hospital, Pittsburgh, PA
| | | | | | | | - Jeffrey M Manway
- University of Pittsburgh Medical Center, Mercy Hospital, Pittsburgh, PA
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16
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Villarreal-Villarreal GA, Simental-Mendía M, Arturo Ramírez Mendoza D, Peña-Martínez VM, Negreros-Osuna AA, Alberto Acosta-Olivo C. Three-dimensional analysis of bone site grafting on the upper extremity on computed tomography scans. J Orthop Surg (Hong Kong) 2024; 32:10225536241268607. [PMID: 39054928 DOI: 10.1177/10225536241268607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
PURPOSE To perform a quantitative analysis of the amount of cancellous bone in the distal radius and olecranon process by segmentation of computed tomographic scans. As a secondary analysis, the bone density by Hounsfield units was evaluated at the same sites. METHODS Computed tomography angiography images of the upper extremity were analyzed using 3-D Slicer™ medical imaging software. Bone volume (cm3) and density (Hounsfield units) from the cancellous bone between the distal radius and the olecranon process were compared by creating an advanced three-dimensional model. The images were analyzed in duplicate, and an intraclass correlation was performed to assess measurement consistency. RESULTS Twenty subjects were included. A total volume of 5.01 ± 1.21 cm3 and 5.81 ± 1.61 cm3 for the distal radius and the olecranon process (p < .0001), respectively, was found. Regarding Hounsfield units, the density of the olecranon process was 303.1 ± 73.26, and the distal radius was 206.5 ± 63.73 (p < .0001). All intraclass correlation coefficients were >0.992. CONCLUSION These results suggest that the olecranon process has a greater volume and a higher bone mineral density than the distal radius. With these results, the surgeon will have the ability to decide the quantity and quality of bone grafts according to the surgical procedure.
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Affiliation(s)
| | - Mario Simental-Mendía
- Facultad de Medicina y Hospital Universitario Dr José Eleuterio González, Universidad Autonoma de Nuevo Leon Monterrey, México
| | - Diego Arturo Ramírez Mendoza
- Facultad de Medicina y Hospital Universitario Dr José Eleuterio González, Universidad Autonoma de Nuevo Leon Monterrey, México
| | - Víctor Manuel Peña-Martínez
- Facultad de Medicina y Hospital Universitario Dr José Eleuterio González, Universidad Autonoma de Nuevo Leon Monterrey, México
| | - Adrian A Negreros-Osuna
- Facultad de Medicina y Hospital Universitario Dr José Eleuterio González, Universidad Autonoma de Nuevo Leon Monterrey, México
| | - Carlos Alberto Acosta-Olivo
- Facultad de Medicina y Hospital Universitario Dr José Eleuterio González, Universidad Autonoma de Nuevo Leon Monterrey, México
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Ren X, Xu C, Jiang Y, Teng D, Liu X, Wang J, Zhang W. Effect of structural support size and position on depressed tibial plateau fractures: A finite element analysis. Heliyon 2024; 10:e29453. [PMID: 38628729 PMCID: PMC11019227 DOI: 10.1016/j.heliyon.2024.e29453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
Objective Structural support for depressed tibial plateau fractures is receiving increasing attention. Currently, there has been little biomechanical evaluation of structural support. This work aimed to investigate the effect of structural support size and position on fracture fixation stability. Methods A split-depressed tibial plateau fracture model was created according to the fracture map. Cortical screws combined with structural filler were used for fracture fixation. The filler diameter was set to small, medium and large, and the filler position was set to the center and offset by 1, 2 and 3 mm to study the effect of position and size on stability. Results The maximum stress on the implant in all scenarios occurs at the lower contact surface between the anterior screw and the filler. Increased support size resulted in increased mean maximum screw stress, depressed fragment axial displacement and separated fragment transverse displacement (screw stress: 266.6 ± 37.7 MPa vs. 266.7 ± 51.0 MPa vs. 273.8 ± 41.5 MPa; depressed displacement: 0.123 ± 0.036 mm vs. 0.133 ± 0.049 mm vs. 0.158 ± 0.050 mm; separated displacement: 0.402 ± 0.031 mm VS 0.412 ± 0.047 mm VS 0.437 ± 0.049 mm). The larger the offset of the support position was, the larger the peak screw stress and the larger the reduction loss of depressed and separated fragment reduction, regardless of the support size. The medium support combined with the central position presented the minimum of peak stress and reduction loss. Cortical bone was below 2 % and trabecular strain was below 10 % for all scenarios. Conclusion Central placement of structural support provides superior stability for the treatment of depressed tibial plateau fractures compared to the eccentric placement. When a support is placed centrally, optimal stability is achieved when the diameter matches the diameter of the depressed region. Thus, the utilization of equal-diameter fillers to provide central support appears to be an ideal selection for depressed tibial plateau fractures.
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Affiliation(s)
- Xiaomeng Ren
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100089, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100089, China
| | - Yu Jiang
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100089, China
| | - Da Teng
- Senior Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100089, China
| | - Xinmo Liu
- Senior Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100089, China
| | - Junsong Wang
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100089, China
| | - Wei Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100089, China
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Liu L, Hou S, Xu G, Gao J, Mu J, Gao M, He J, Su X, Yang Z, Liu Y, Chen T, Dong Z, Cheng L, Shi Z. Evaluation of osteogenic properties of a novel injectable bone-repair material containing strontium in vitro and in vivo. Front Bioeng Biotechnol 2024; 12:1390337. [PMID: 38707496 PMCID: PMC11069309 DOI: 10.3389/fbioe.2024.1390337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/11/2024] [Indexed: 05/07/2024] Open
Abstract
Objective: This study aims to develop and evaluate the biocompatibility and osteogenic potential of a novel injectable strontium-doped hydroxyapatite bone-repair material. Methods: The properties of strontium-doped hydroxyapatite/chitosan (Sr-HA/CS), hydroxyapatite/chitosan (HA/CS) and calcium phosphate/chitosan (CAP/CS) were assessed following their preparation via physical cross-linking and a one-step simplified method. Petri dishes containing Escherichia coli and Staphylococcus epidermidis were inoculated with the material for in vitro investigations. The material was also co-cultured with stem cells derived from human exfoliated deciduous teeth (SHEDs), to assess the morphology and proliferation capability of the SHEDs, Calcein-AM staining and the Cell Counting Kit-8 assay were employed. Osteogenic differentiation of SHEDs was determined using alkaline phosphatase (ALP) staining and Alizarin Red staining. For in vivo studies, Sr-HA/CS was implanted into the muscle pouch of mice and in a rat model of ovariectomy-induced femoral defects. Hematoxylin-eosin (HE) staining was performed to determine the extent of bone formation and defect healing. The formation of new bone was determined using Masson's trichrome staining. The osteogenic mechanism of the material was investigated using Tartrate-resistant acid phosphatase (TRAP) staining and immunohistochemical studies. Results: X-ray diffraction (XRD) and energy-dispersive spectroscopy (EDS) showed that strontium was successfully doped into HA. The Sr-HA/CS material can be uniformly squeezed using a syringe with a 13% swelling rate. Sr-HA/CS had a significant antibacterial effect against both E. coli and S. epidermidis (p < 0.05), with a stronger effect observed against E. coli. The Sr-HA/CS significantly improved cell proliferation and cell viability in vitro studies (p < 0.05). Compared to CAP/CS and CS, Sr-HA/CS generated a substantially greater new bone area during osteoinduction experiments (p < 0.05, p < 0.001). The Sr-HA/CS material demonstrated a significantly higher rate of bone repair in the bone defeat studies compared to the CAP/CS and CS materials (p < 0.01). The OCN-positive area and TRAP-positive cells in Sr-HA/CS were greater than those in control groups (p < 0.05). Conclusion: A novel injectable strontium-doped HA bone-repair material with good antibacterial properties, biocompatibility, and osteoinductivity was successfully prepared.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lijia Cheng
- Clinical Medical College, Affiliated Hospital, School of Basic Medical Sciences of Chengdu University, Chengdu, China
| | - Zheng Shi
- Clinical Medical College, Affiliated Hospital, School of Basic Medical Sciences of Chengdu University, Chengdu, China
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Gou Y, Huang Y, Luo W, Li Y, Zhao P, Zhong J, Dong X, Guo M, Li A, Hao A, Zhao G, Wang Y, Zhu Y, Zhang H, Shi Y, Wagstaff W, Luu HH, Shi LL, Reid RR, He TC, Fan J. Adipose-derived mesenchymal stem cells (MSCs) are a superior cell source for bone tissue engineering. Bioact Mater 2024; 34:51-63. [PMID: 38186960 PMCID: PMC10770370 DOI: 10.1016/j.bioactmat.2023.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/26/2023] [Accepted: 12/02/2023] [Indexed: 01/09/2024] Open
Abstract
Effective bone regeneration through tissue engineering requires a combination of osteogenic progenitors, osteoinductive biofactors and biocompatible scaffold materials. Mesenchymal stem cells (MSCs) represent the most promising seed cells for bone tissue engineering. As multipotent stem cells that can self-renew and differentiate into multiple lineages including bone and fat, MSCs can be isolated from numerous tissues and exhibit varied differentiation potential. To identify an optimal progenitor cell source for bone tissue engineering, we analyzed the proliferative activity and osteogenic potential of four commonly-used mouse MSC sources, including immortalized mouse embryonic fibroblasts (iMEF), immortalized mouse bone marrow stromal stem cells (imBMSC), immortalized mouse calvarial mesenchymal progenitors (iCAL), and immortalized mouse adipose-derived mesenchymal stem cells (iMAD). We found that iMAD exhibited highest osteogenic and adipogenic capabilities upon BMP9 stimulation in vitro, whereas iMAD and iCAL exhibited highest osteogenic capability in BMP9-induced ectopic osteogenesis and critical-sized calvarial defect repair. Transcriptomic analysis revealed that, while each MSC line regulated a distinct set of target genes upon BMP9 stimulation, all MSC lines underwent osteogenic differentiation by regulating osteogenesis-related signaling including Wnt, TGF-β, PI3K/AKT, MAPK, Hippo and JAK-STAT pathways. Collectively, our results demonstrate that adipose-derived MSCs represent optimal progenitor sources for cell-based bone tissue engineering.
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Affiliation(s)
- Yannian Gou
- Ministry of Education Key Laboratory of Diagnostic Medicine, and Department of Clinical Biochemistry, School of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Yanran Huang
- Ministry of Education Key Laboratory of Diagnostic Medicine, and Department of Clinical Biochemistry, School of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
- Departments of Orthopedic Surgery and Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wenping Luo
- Laboratory Animal Center, Southwest University, Chongqing, 400715, China
| | - Yanan Li
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, The Stomatological Hospital of Chongqing Medical University, Chongqing, 401147, China
| | - Piao Zhao
- Ministry of Education Key Laboratory of Diagnostic Medicine, and Department of Clinical Biochemistry, School of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
- Departments of Orthopedic Surgery and Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jiamin Zhong
- Ministry of Education Key Laboratory of Diagnostic Medicine, and Department of Clinical Biochemistry, School of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Xiangyu Dong
- Ministry of Education Key Laboratory of Diagnostic Medicine, and Department of Clinical Biochemistry, School of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Meichun Guo
- Ministry of Education Key Laboratory of Diagnostic Medicine, and Department of Clinical Biochemistry, School of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Aohua Li
- Ministry of Education Key Laboratory of Diagnostic Medicine, and Department of Clinical Biochemistry, School of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Ailing Hao
- Ministry of Education Key Laboratory of Diagnostic Medicine, and Department of Clinical Biochemistry, School of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Guozhi Zhao
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
- Departments of Orthopedic Surgery and Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yonghui Wang
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
- Department of Geriatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200000, China
| | - Yi Zhu
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
- Department of Orthopaedic Surgery, Beijing Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Hui Zhang
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
- The Breast Cancer Center, Chongqing University Cancer Hospital, Chongqing, 4000430, China
| | - Yunhan Shi
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
- Department of Psychology, School of Arts and Sciences, University of Rochester, Rochester, NY, 14627, USA
- Department of Surgery, The University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - William Wagstaff
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Hue H. Luu
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Lewis L. Shi
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Russell R. Reid
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
- Laboratory of Craniofacial Biology and Development, Department of Surgery Section of Plastic Surgery, The University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Tong-Chuan He
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
- Laboratory of Craniofacial Biology and Development, Department of Surgery Section of Plastic Surgery, The University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Jiaming Fan
- Ministry of Education Key Laboratory of Diagnostic Medicine, and Department of Clinical Biochemistry, School of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
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20
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Kook I, You J, Kim DH, Park KC, Hwang KT. A retrospective cohort study of autogenous iliac strut bone grafting in large bone defects of the lower extremity. Sci Rep 2024; 14:6059. [PMID: 38480840 PMCID: PMC10937995 DOI: 10.1038/s41598-024-56726-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/11/2024] [Indexed: 03/17/2024] Open
Abstract
Autogenous iliac bone graft (AIBG) is the treatment of choice for managing bone defects, and favorable results have been reported for bone defects < 5 cm in length. In large bone defects ≥ 5 cm, it is difficult to obtain good results with simple bone grafting, and other management options have drawbacks, such as long immobilization periods and high complication rates. We hypothesized that AIBG in the strut form might show favorable results in large bone defects with minimal complications. This study aimed to investigate the outcomes of strut-type AIBG and evaluate its effectiveness compared to cancellous AIBG. This retrospective study included 50 patients who underwent AIBG for bone defects at a single institution between March 2011 and April 2020. We performed corticocancellous AIBG in a strut form to manage bone defects ≥ 5 cm in the lower extremities. The strut bone was harvested along the iliac crest and grafted slightly longer than the bone defect to apply a sufficient compressive force. Demographic information and radiographic and clinical results of patients who underwent strut AIBG (Group S) were analyzed. The outcomes of union, time to union, complications, and reoperation were compared with those of patients who underwent cancellous AIBG (Group C). The study population comprised 37 men (74%) and 13 women (26%), with a mean age of 50.0 (range: 19-78). The average follow-up period was 25.6 months (12-104 months). Group S included 16 patients with a mean bone defect length of 6.8 ± 1.2 cm. In Group S, union was achieved in all patients, with an average time to union of 6.7 months. Complications occurred in four cases, all related to wound problems. Group C comprised d 34 patients with a mean defect length of 2.8 ± 1.1 cm. Complications occurred in five patients in Group C, including four soft tissue problems and one implant failure. When comparing the outcomes of Groups S and C, no significant differences were observed. AIBG is an effective and safe technique for managing bone defects. Strut AIBG can be used effectively for bone defects ≥ 5 cm in the lower extremities.
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Affiliation(s)
- Incheol Kook
- Department of Orthopaedic Surgery, Hanyang University Hospital, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jooyoung You
- Department of Orthopaedic Surgery, Hanyang University Hospital, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Dong Hong Kim
- Department of Orthopaedic Surgery, Hanyang University Hospital, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Ki-Chul Park
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Gyeonggi-do, Republic of Korea
| | - Kyu Tae Hwang
- Department of Orthopaedic Surgery, Hanyang University Hospital, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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21
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Kook I, Oh CW, Shon OJ, Kim JW, Kim JW, Hwang KT, Park KC. Comparing outcomes of plate augmentation, nail exchange, and nail exchange with plate augmentation in the treatment of atrophic femoral shaft nonunion after intramedullary nailing: a multicenter retrospective study. Arch Orthop Trauma Surg 2024; 144:1259-1268. [PMID: 38372763 DOI: 10.1007/s00402-023-05183-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/11/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Intramedullary (IM) nailing is the treatment of choice for femoral shaft fractures, but nonunion rates have been reported to be as high as 12%. Surgical interventions for nonunion involve exchange nailing or plate augmentation. Recently, a combined treatment of exchange nailing and plate augmentation has demonstrated good results, but its comparative effectiveness remains unclear. This study aimed to compare the clinical and radiographic outcomes of three different surgical interventions for atrophic femoral shaft nonunion, and investigate the factors that affect bone healing after reoperation. MATERIALS AND METHODS A retrospective study was conducted at five university hospitals involving 149 patients with aseptic atrophic nonunion after IM nailing. These patients underwent reoperation with plate augmentation, exchange nailing, or combined treatment. Clinical and radiographic outcomes were assessed and compared according to reoperation procedure. Logistic regression analysis was performed to identify factors affecting persistent nonunion after reoperation. RESULTS Of the cohort, 57 patients underwent plate augmentation, 64 underwent exchange nailing, and 28 received combined treatment. There were no significant differences in patient demographics among the groups. Exchange nailing produced a significantly lower union rate than did the combined treatment (82.8% vs. 100%, p = 0.016), whereas no significant difference was observed in the union rate and time to the union between plate augmentation and the combined treatment. Combined treatment showed the longest operative time and the greatest transfusion requirements. The risk factors for persistent nonunion included age, absence of autogenous bone grafts, and use of an exchange nailing technique. CONCLUSIONS Exchange nailing as a treatment for atrophic femoral shaft nonunion after IM nailing resulted in a lower union rate. The efficacy of the combined treatment requires further study, and persistent nonunion may be influenced by age, bone grafting, and surgical techniques. A comprehensive approach targeting both biological environment and mechanical stability is crucial in the treatment of atrophic femoral shaft nonunion.
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Affiliation(s)
- Incheol Kook
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Oog-Jin Shon
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, South Korea
| | - Joon-Woo Kim
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Ji-Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyu Tae Hwang
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - Ki-Chul Park
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, 153, Gyeongchun-ro, Guri, Gyeonggi-do, 11923, South Korea.
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22
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Wei Y, Guo H, Chen Z, Sun N, Zeng C. Autologous Costal Chondral/Osteochondral Transplantation and Costa-Derived Chondrocyte Implantation for Articular Cartilage Repair: Basic Science and Clinical Applications. Orthop Surg 2024; 16:523-531. [PMID: 38272834 PMCID: PMC10925498 DOI: 10.1111/os.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
There has been increasing application of autologous costal chondral/osteochondral transplantation (ACCT/ACOT) and costa-derived chondrocyte implantation (ACCI) for articular cartilage repair over the past three decades. This review presents the major evidence on the properties of costal cartilage and bone and their qualifications as grafts for articular cartilage repair, the major clinical applications, and the risks and strategies for costal chondral/osteochondral graft(s) harvest. First, costal cartilage has many specific properties that help restore the articular surface. Costa, which can provide abundant cartilage and cylindrical corticocancellous bone, preserves permanent chondrocyte and is the largest source of hyaline cartilage. Second, in the past three decades, autologous costal cartilage-derived grafts, including cartilage, osteochondral graft(s), and chondrocyte, have expanded their indications in trauma and orthopaedic therapy from small to large joints, from the upper to lower limbs, and from non-weight-bearing to weight-bearing joints. Third, the rate of donor-site complications of ACCT or ACOT is low, acceptable, and controllable, and some skills and accumulated experience can help reduce the risks of ACCT and ACOT. Costal cartilage-derived autografting is a promising technique and could be an ideal option for articular chondral lesions with or without subchondral cysts. More high-quality clinical studies are urgently needed to help us further understand the clinical value of such technologies.
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Affiliation(s)
- Yuxuan Wei
- Department of Foot and Ankle Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Hao Guo
- Department of Foot and Ankle Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Zhuhong Chen
- Department of Foot and Ankle Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Nian Sun
- Department of Foot and Ankle Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Canjun Zeng
- Department of Foot and Ankle Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
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23
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Bonnevialle N, Baltassat A, Martinel V, Barret H, Mansat P. Arthroscopic Distal Clavicle Bone Bock Combined With Hill-Sachs Remplissage for Primary Anterior Shoulder Instability Treatment. Arthrosc Tech 2024; 13:102882. [PMID: 38584634 PMCID: PMC10995697 DOI: 10.1016/j.eats.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/02/2023] [Indexed: 04/09/2024] Open
Abstract
Arthroscopic distal clavicle transfer is an effective option to treat anterior shoulder instability with glenoid bone loss. The use of this free bone graft in an all-inside procedure, with a cortical button fixation makes the construct simpler to perform and allows to be combined with a Hill-Sachs Remplissage to address humeral bone defect. The morbidity of the donor site is low and provide the biologic capacity of an autograft. We report a step-by-step procedure, and the rationale are discussed.
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Affiliation(s)
- Nicolas Bonnevialle
- Service de Chirurgie Orthopédique et Traumatologique, CHU de Toulouse, France
- Clinique Universitaire du Sport, Toulouse, France
- Clinique Pyrénées-Ormeau, Groupe Elsan, Tarbes, France
| | - Antoine Baltassat
- Service de Chirurgie Orthopédique et Traumatologique, CHU de Toulouse, France
- Clinique Universitaire du Sport, Toulouse, France
| | | | - Hugo Barret
- Service de Chirurgie Orthopédique et Traumatologique, CHU de Toulouse, France
- Clinique Universitaire du Sport, Toulouse, France
| | - Pierre Mansat
- Service de Chirurgie Orthopédique et Traumatologique, CHU de Toulouse, France
- Clinique Universitaire du Sport, Toulouse, France
- Clinique Pyrénées-Ormeau, Groupe Elsan, Tarbes, France
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24
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Villarreal-Villarreal GA, Simental-Mendía M, Mendoza DAR, Vilchez-Cavazos F, Peña-Martínez VM, Acosta-Olivo CA. Quantitative Volumetric Measurements of Bone Grafting Sites Within the Lower Extremity on Computed Tomography Scans. J Foot Ankle Surg 2024; 63:286-290. [PMID: 38103722 DOI: 10.1053/j.jfas.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
The anterior iliac crest is one of the most used options; however, pain and other complications have been reported. Other options for bone harvest in the lower extremity, such as the proximal tibia and calcaneus, can be useful sites for bone grafting. Computed tomography angiography images of the lower extremity were analyzed using 3-D Slicer™ medical imaging software, creating an advanced 3-dimensional model. Bone volume (cm3) and bone mineral density (Hounsfield units) were measured from the cancellous bone in the anterior iliac crest, posterior iliac crest, proximal tibia, and the calcaneus. Fifteen studies were included. The total volume measured it was of 61.88 ± 14.15 cm3, 19.35 ± 4.16 cm3, 32.48 ± 7.49 cm3, 26.40 ± 7.18 cm3, for the proximal tibia, anterior and posterior iliac crest, and calcaneus, respectively. Regarding Hounsfield units, the densities were 116 ± 58.77, 232.4 ± 68.65, 214.4 ± 74.45, 170.5 ± 52.32, for proximal tibia, anterior and posterior iliac crest, and calcaneus. The intraclass correlation coefficients were in average >0.94. In conclusion, the proximal tibia has more cancellous bone than the anterior and posterior iliac crest. The calcaneus has more cancellous bone than the anterior iliac crest. Bone mineral density was highest in the anterior iliac crest and in proximal tibia was the lowest value.
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Affiliation(s)
- Gregorio Alejandro Villarreal-Villarreal
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Orthopedics and Traumatology Service, Monterrey, Nuevo León, México
| | - Mario Simental-Mendía
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Orthopedics and Traumatology Service, Monterrey, Nuevo León, México
| | - Diego Arturo Ramírez Mendoza
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina, Subdireccion de investigacion, Monterrey, Nuevo León, México
| | - Félix Vilchez-Cavazos
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Orthopedics and Traumatology Service, Monterrey, Nuevo León, México
| | - Víctor Manuel Peña-Martínez
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Orthopedics and Traumatology Service, Monterrey, Nuevo León, México
| | - Carlos Alberto Acosta-Olivo
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Orthopedics and Traumatology Service, Monterrey, Nuevo León, México.
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25
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Lun DX, Li SY, Li NN, Mou LM, Li HQ, Zhu WP, Li HF, Hu YC. Limitations and modifications in the clinical application of calcium sulfate. Front Surg 2024; 11:1278421. [PMID: 38486794 PMCID: PMC10937423 DOI: 10.3389/fsurg.2024.1278421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/29/2024] [Indexed: 03/17/2024] Open
Abstract
Calcium sulfate and calcium sulfate-based biomaterials have been widely used in non-load-bearing bone defects for hundreds of years due to their superior biocompatibility, biodegradability, and non-toxicity. However, lower compressive strength and rapid degradation rate are the main limitations in clinical applications. Excessive absorption causes a sharp increase in sulfate ion and calcium ion concentrations around the bone defect site, resulting in delayed wound healing and hypercalcemia. In addition, the space between calcium sulfate and the host bone, resulting from excessively rapid absorption, has adverse effects on bone healing or fusion techniques. This issue has been recognized and addressed. The lack of sufficient mechanical strength makes it challenging to use calcium sulfate and calcium sulfate-based biomaterials in load-bearing areas. To overcome these defects, the introduction of various inorganic additives, such as calcium carbonate, calcium phosphate, and calcium silicate, into calcium sulfate is an effective measure. Inorganic materials with different physical and chemical properties can greatly improve the properties of calcium sulfate composites. For example, the hydrolysis products of calcium carbonate are alkaline substances that can buffer the acidic environment caused by the degradation of calcium sulfate; calcium phosphate has poor degradation, which can effectively avoid the excessive absorption of calcium sulfate; and calcium silicate can promote the compressive strength and stimulate new bone formation. The purpose of this review is to review the poor properties of calcium sulfate and its complications in clinical application and to explore the effect of various inorganic additives on the physicochemical properties and biological properties of calcium sulfate.
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Affiliation(s)
- Deng-xing Lun
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang City, Shandong, China
| | - Si-ying Li
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang City, Shandong, China
| | - Nian-nian Li
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang City, Shandong, China
| | - Le-ming Mou
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang City, Shandong, China
| | - Hui-quan Li
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang City, Shandong, China
| | - Wan-ping Zhu
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang City, Shandong, China
| | - Hong-fei Li
- Department of Spinal Degeneration and Oncology, Weifang People’s Hospital, Weifang City, Shandong, China
| | - Yong-cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
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26
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Taleb Alashkar AN, Hayashi K, Ishikawa K. Lamellar Septa-like Structured Carbonate Apatite Scaffolds with Layer-by-Layer Fracture Behavior for Bone Regeneration. Biomimetics (Basel) 2024; 9:112. [PMID: 38392158 PMCID: PMC10886560 DOI: 10.3390/biomimetics9020112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/03/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
Generally, ceramics are brittle, and porosity is inversely correlated with strength, which is one of the challenges of ceramic scaffolds. Here, we demonstrate that lamellar septum-like carbonate apatite scaffolds have the potential to overcome these challenges. They were fabricated by exploiting the cellular structure of the cuttlebone, removing the organic components from the cuttlebone, and performing hydrothermal treatment. Scanning electron microscopy revealed that the scaffolds had a cellular structure with walls between lamellar septa. The interwall and interseptal sizes were 80-180 and 300-500 μm, respectively. The size of the region enclosed by the walls and septa coincided with the macropore size detected by mercury intrusion porosimetry. Although the scaffold porosity was extremely high (93.2%), the scaffold could be handled without disintegration. The compressive stress-strain curve demonstrated that the scaffolds showed layer-by-layer fracture behavior, which seemed beneficial for avoiding catastrophic failure under impact. When the scaffolds were implanted into rabbit femurs, new bone and blood vessels formed within the scaffold cells at 4 weeks. At 12 weeks, the scaffolds were almost entirely replaced with new bone. Thus, the lamellar septum-like cellular-structured carbonate apatite is a promising scaffold for achieving early bone regeneration and compression resistance.
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Affiliation(s)
- Ahmad Nazir Taleb Alashkar
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Koichiro Hayashi
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kunio Ishikawa
- Department of Biomaterials, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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27
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Andres M, Robertson E, Hall A, McBride-Gagyi S, Sell S. Controlled pore anisotropy in chitosan-gelatin cryogels for use in bone tissue engineering. J Biomater Appl 2024; 38:797-807. [PMID: 38278524 DOI: 10.1177/08853282231222324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
In tissue engineering, the development of an appropriate scaffold is crucial to provide a framework for new tissue growth. The use of cryogels as scaffolds shows promise due to their macroporous structure, but the pore size, distribution, and interconnectivity is highly variable depending on the fabrication process. The objective of the current research is to provide a technique for controlled anisotropy in chitosan-gelatin cryogels to develop scaffolds for bone tissue engineering application. A mold was developed using additive manufacturing to be used during the freezing process in order to fabricate cryogels with a more interconnected pore structure. The scaffolds were tested to evaluate their porosity, mechanical strength, and to observe cell infiltration through the cryogel. It was found that the use of the mold allowed for the creation of designated pores within the cryogel structure which facilitated cell infiltration to the center of the scaffold without sacrificing mechanical integrity of the structure.
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Affiliation(s)
- Madeline Andres
- Department of Biomedical Engineering, Saint Louis University, Saint Louis, MO, USA
| | - Eileen Robertson
- Department of Biomedical Engineering, Saint Louis University, Saint Louis, MO, USA
| | - Andrew Hall
- Department of Biomedical Engineering, Saint Louis University, Saint Louis, MO, USA
| | - Sarah McBride-Gagyi
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Scott Sell
- Department of Biomedical Engineering, Saint Louis University, Saint Louis, MO, USA
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Liu H, Li K, Guo B, Yuan Y, Ruan Z, Long H, Zhu J, Zhu Y, Chen C. Engineering an injectable gellan gum-based hydrogel with osteogenesis and angiogenesis for bone regeneration. Tissue Cell 2024; 86:102279. [PMID: 38007880 DOI: 10.1016/j.tice.2023.102279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 11/28/2023]
Abstract
Injectable hydrogels are currently a topic of great interest in bone tissue engineering, which could fill irregular bone defects in a short time and avoid traditional major surgery. Herein, we developed an injectable gellan gum (GG)-based hydrogel for bone defect repair by blending nano-hydroxyapatite (nHA) and magnesium sulfate (MgSO4). In order to acquire an injectable GG-based hydrogel with superior osteogenesis, nHA were blended into GG solution with an optimized proportion. For the aim of endowing this hydrogel capable of angiogenesis, MgSO4 was also incorporated. Physicochemical evaluation revealed that GG-based hydrogel containing 5% nHA (w/v) and 2.5 mM MgSO4 (GG/5%nHA/MgSO4) had appropriate sol-gel transition time, showed a porosity-like structure, and could release magnesium ions for at least 14 days. Rheological studies showed that the GG/5%nHA/MgSO4 hydrogel had a stable structure and repeatable self-healing properties. In-vitro results determined that GG/5%nHA/MgSO4 hydrogel presented superior ability on stimulating bone marrow mesenchymal stem cells (BMSCs) to differentiate into osteogenic linage and human umbilical vein endothelial cells (HUVECs) to generate vascularization. In-vivo, GG/5%nHA/MgSO4 hydrogel was evaluated via a rat cranial defect model, as shown by better new bone formation and more neovascularization invasion. Therefore, the study demonstrated that the new injectable hydrogel, is a favorable bioactive GG-based hydrogel, and provides potential strategies for robust therapeutic interventions to improve the repair of bone defect.
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Affiliation(s)
- Hongbin Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410000, Hunan, China
| | - Kaihu Li
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha 410000, Hunan, China
| | - Bin Guo
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410000, Hunan, China
| | - Yuhao Yuan
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410000, Hunan, China
| | - Zhe Ruan
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410000, Hunan, China
| | - Haitao Long
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410000, Hunan, China
| | - Jianxi Zhu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410000, Hunan, China
| | - Yong Zhu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410000, Hunan, China.
| | - Can Chen
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410000, Hunan, China.
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Mehta DD, Dankert JF, Buchalter DB, Kirby DJ, Patel KS, Rocks M, Hacquebord JH, Leucht P. Distinct Cell-Intrinsic Functional Differences Between Iliac Crest and Distal Radius Autografts. J Hand Surg Am 2024; 49:182.e1-182.e10. [PMID: 35933254 DOI: 10.1016/j.jhsa.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 04/13/2022] [Accepted: 06/07/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Autologous bone grafts demonstrate osteoconductive, osteoinductive, and osteogenic properties. Hand surgeons commonly augment surgical fixation with autografts to promote fracture healing. This study compared the intrinsic stem cell-like properties of 2 commonly used autograft sources in hand surgery: the iliac crest and distal radius. METHODS A total of 9 subjects who received an iliac crest bone graft and distal radius bone graft harvest as a part of the standard care of distal radius malunion or nonunion correction or scaphoid nonunion open reduction and internal fixation were enrolled in the study. Cells were isolated by serial collagenase digestion and subjected to fibroblast colony-forming units, osteogenesis, and adipogenesis assays. The expression levels of genes involved in osteogenesis and adipogenesis were confirmed using quantitative polymerase chain reaction. RESULTS The cells isolated from the iliac crest bone graft compared with those isolated from the distal radius bone graft demonstrated significantly higher mean fibroblast colony-forming unit efficiency; increased osteogenesis, as measured using alizarin red quantification; increased adipogenesis, as measured using oil red O quantification; and higher expression levels of genes involved in osteogenesis and adipogenesis under the respective differentiation conditions. CONCLUSIONS The cells isolated from the iliac crest bone graft demonstrated a higher fibroblast colony-forming unit capacity and an increased capability to undergo both osteogenesis and adipogenesis. CLINICAL RELEVANCE Limited evidence exists comparing the intrinsic stem cell-like properties of the iliac crest and distal radius despite the widespread use of each source in hand and wrist surgery. The information from this investigation may assist hand and wrist surgeons with the selection of a source of autograft.
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Affiliation(s)
- Devan D Mehta
- Department of Orthopedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY
| | - John F Dankert
- Department of Orthopedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY
| | - Daniel B Buchalter
- Department of Orthopedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY
| | - David J Kirby
- Department of Orthopedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY
| | - Karan S Patel
- Department of Orthopedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY
| | - Madeline Rocks
- Department of Orthopedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY
| | - Jacques H Hacquebord
- Department of Orthopedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY; Hansjörg Wyss Department of Plastic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY
| | - Philipp Leucht
- Department of Orthopedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY.
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Zhang J, Li S, He H, Han L, Zhang S, Yang L, Han W, Wang X, Gao J, Zhao J, Shi W, Wu Z, Wang H, Zhang Z, Zhang L, Chen W, Zhu Q, Sun T, Tang P, Zhang Y. Clinical guidelines for indications, techniques, and complications of autogenous bone grafting. Chin Med J (Engl) 2024; 137:5-7. [PMID: 37462050 PMCID: PMC10766296 DOI: 10.1097/cm9.0000000000002691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Indexed: 01/06/2024] Open
Affiliation(s)
- Jianzheng Zhang
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
- The National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100048, China
- The Trauma Orthopedic Branch of Chinese Orthopedic Association, Shijiazhuang, Hebei 050051, China
| | - Shaoguang Li
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
- The National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100048, China
| | - Hongying He
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Li Han
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Simeng Zhang
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Lin Yang
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Wenxing Han
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Xiaowei Wang
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Jie Gao
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Jianwen Zhao
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
- The National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100048, China
| | - Weidong Shi
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Zhuo Wu
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Hao Wang
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Zhicheng Zhang
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Licheng Zhang
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
- The National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100048, China
- The Trauma Orthopedic Branch of Chinese Orthopedic Association, Shijiazhuang, Hebei 050051, China
| | - Wei Chen
- The Trauma Orthopedic Branch of Chinese Orthopedic Association, Shijiazhuang, Hebei 050051, China
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China
| | - Qingtang Zhu
- Department of Microsurgical Trauma, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Tiansheng Sun
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
- The National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100048, China
| | - Peifu Tang
- Senior Department of Orthopedics, PLA General Hospital, Beijing 100048, China
- The National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100048, China
- The Trauma Orthopedic Branch of Chinese Orthopedic Association, Shijiazhuang, Hebei 050051, China
| | - Yingze Zhang
- The Trauma Orthopedic Branch of Chinese Orthopedic Association, Shijiazhuang, Hebei 050051, China
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China
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Shin SC, Kim NY, Kang HJ, Lee SW, Kim JS. Comparison of corticocancellous bone graft from the anterolateral metaphysis of the distal radius versus iliac crest for the treatment of unstable scaphoid nonunion with humpback deformity. BMC Musculoskelet Disord 2024; 25:20. [PMID: 38167040 PMCID: PMC10759349 DOI: 10.1186/s12891-023-07134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Corticocancellous bone grafting from the iliac crest is acceptable treatment for unstable scaphoid nonunion with a viable proximal pole. However, harvesting graft from the iliac crest is associated with donor site morbidity and the requirement of general anesthesia. Thus, bone grafting from the anterolateral metaphysis of the distal radius (DR) can be a treatment option. However, no study has compared the clinical effect between the two grafting techniques. METHODS From 2014 to 2019, patients with unstable scaphoid nonunion with humpback deformity underwent corticocancellous bone grafting from the anterolateral metaphysis of the DR (group DR) or iliac crest (group IC). Humpback deformity was determined by evaluating the scapholunate angle (SLA) ≥ 60°, intrascaphoid angle (ISA) ≥ 45°, and radiolunate angle (RLA) ≥ 15° from preoperative radiographs and computed tomography scans. The SLA, ISA, and RLA served to gauge carpal alignment. The operative time, grip strength, active range of motion (ROM), the Modified Mayo Wrist score (MMWS), and Disabilities of Arm, Shoulder, and Hand (DASH) score were assessed postoperatively. RESULTS Thirty-eight patients qualified for the study (group DR, 15; group IC, 23). Union rates did not differ by patient subset (group DR, 100%; group IC, 95.7%; P = .827), and grip strength, ROM, MWS, and DASH score were similar between groups at the last follow-up. The operative time (minutes) was significantly shorter in group DR (median, 98; quartiles, 80, 114) than in group IC (median, 125; quartiles, 105, 150, P < .001). The ISA, RLA, and SLA improved postoperatively in both groups (P < 0.001). The degree of restoring carpal alignment, as evaluated by SLA, showed superior correction capability in group DR (median, 25.3% quartiles, 21.1, 35.3, P < 0.05). Donor site complications were not significantly different between the groups. CONCLUSIONS Corticocancellous bone graft from the anterolateral metaphysis of the DR for unstable scaphoid nonunion is associated with a shorter operation time and comparable results with that from the iliac crest in regard to union, restoration of carpal alignment, and wrist function. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sung-Chul Shin
- Department of Orthopaedic Surgery, Catholic-Kwandong University, Incheon, South Korea
| | - Nah-Yon Kim
- Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Ho-Jung Kang
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Shin-Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Ji-Sup Kim
- Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea.
- Yonsei University College of Medicine, Seoul, Republic of Korea.
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Jiang Y, Ju W, Gai N, Qi B. A novel treatment of clavicular nonunion: Combination with PRP, autologous bone grafting, and internal plate fixation. Technol Health Care 2024; 32:545-550. [PMID: 37694321 DOI: 10.3233/thc-230336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Nonunion is a major concern for orthopedic surgeons, particularly nonunion of the clavicle, which can cause severe pain, loss of full range of motion, poor sleep quality, and loss of strength in the affected individuals. Platelet-rich plasma (PRP), an important biological agent, is widely used in orthopedics. OBJECTIVE We used a combination of three techniques - the PRP technique, autologous bone grafting technique, and internal plate fixation technique - to ensure adequate internal fixation and enable a bone growth-supportive environment at the fracture site. METHODS The surgical approach was applied to a patient with clavicle nonunion. RESULTS Based on postoperative follow-up findings and intraoperative findings at the time of re-removal of the patient's implant, the prognosis at the fracture site was considered satisfactory. CONCLUSION We observed that the patient treated with this method had favorable clinical outcomes, and we recommend that this technique be used in patients with long-bone nonunion.
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Affiliation(s)
- Ye Jiang
- Department of Orthopedic Traumatology, The First Hospital of Jilin University, Changchun, Jilin, China
- Department of Orthopedic Traumatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Weina Ju
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
- Department of Orthopedic Traumatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ning Gai
- Department of Orthopedic Traumatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Baochang Qi
- Department of Orthopedic Traumatology, The First Hospital of Jilin University, Changchun, Jilin, China
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Sedaghat F, Mahamed P, Sultani AS, Bagherian M, Biglari M, Mohammadzadeh A, Ghasemzadeh S, Barati G, Saburi E. Revisiting Recent Tissue Engineering Technologies in Alveolar Cleft Reconstruction. Curr Stem Cell Res Ther 2024; 19:840-851. [PMID: 37461350 DOI: 10.2174/1574888x18666230717152556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/06/2023] [Accepted: 06/05/2023] [Indexed: 05/15/2024]
Abstract
Tissue engineering and regenerative medicine have received significant attention in treating degenerative disorders and presented unique opportunities for researchers. The latest research on tissue engineering and regenerative medicine to reconstruct the alveolar cleft has been reviewed in this study. Three approaches have been used to reconstruct alveolar cleft: Studies that used only stem cells or biomaterials and studies that reconstructed alveolar defects by tissue engineering using a combination of stem cells and biomaterials. Stem cells, biomaterials, and tissue-engineered constructs have shown promising results in the reconstruction of alveolar defects. However, some contrary issues, including stem cell durability and scaffold stability, were also observed. It seems that more prospective and comprehensive studies should be conducted to fully clarify the exact dimensions of the stem cells and tissue engineering reconstruction method in the therapy of alveolar cleft.
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Affiliation(s)
- Faraz Sedaghat
- School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Parham Mahamed
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Mobina Bagherian
- School of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Biglari
- Faculty of Dentistry, Iran University of Medical Sciences, Tehran, Iran
| | - Anisa Mohammadzadeh
- Faculty of Dentistry, Babol University of Medical Sciences, Mazandaran, Iran
| | | | | | - Ehsan Saburi
- Medical Genetics Research center, Mashhad University of medical Sciences, Mashhad, Iran
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Bell JA, James NF, Mauck BM, Calandruccio JH, Weller WJ. The Pitfalls of Difficult Distal Radius Fractures and Provisional Reduction. Orthop Clin North Am 2024; 55:113-122. [PMID: 37980096 DOI: 10.1016/j.ocl.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Distal radius fractures are some of the most common injuries encountered in orthopedics and require careful consideration when determining the appropriate treatment options. These fractures can be difficult injuries to treat surgically based on a large variability of fracture patterns, bone quality, and anatomy. It is important to understand the potential pitfalls associated with the treatment of difficult distal radius fractures to prevent avoidable complications. Some of these pitfalls include but are not limited to appropriate surgical exposure and soft tissue handling, provisional reduction, fixation type, and augmentation of fracture fixation.
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Affiliation(s)
- Jared A Bell
- Department of Orthopedic Surgery, University of Florida Health Jacksonville, 655 8th Street West, Jacksonville, FL 32209, USA
| | - Nicholas F James
- Department of Orthopedic Surgery, University of Florida Health Jacksonville, 655 8th Street West, Jacksonville, FL 32209, USA.
| | - Benjamin M Mauck
- Campbell Clinic Department of Orthopedic Surgery, University of Tennessee Health Science Center, 7887 Wolf River Boulevard, Germantown, TN 38138, USA
| | - James H Calandruccio
- Campbell Clinic Department of Orthopedic Surgery, University of Tennessee Health Science Center, 7887 Wolf River Boulevard, Germantown, TN 38138, USA
| | - William J Weller
- Campbell Clinic Department of Orthopedic Surgery, University of Tennessee Health Science Center, 7887 Wolf River Boulevard, Germantown, TN 38138, USA
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Gordon A, Newsome F, Ahern DP, McDonnell JM, Cunniffe G, Butler JS. Iliac crest bone graft versus cell-based grafts to augment spinal fusion: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:253-263. [PMID: 37740784 DOI: 10.1007/s00586-023-07941-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION Despite successful fusion rates with iliac crest bone graft (ICBG), donor-site morbidity and increased operating time remain a considerable limitation and drive the search for alternatives. In this systematic review, grafts with additional cellular supplementation were compared with ICBG for spinal arthrodesis. We compared safety, efficacy and long-term outcomes, thus providing the current and relevant evidence for orthopaedic surgeons to make informed choices regarding this rapidly developing field. METHODS An electronic literature search was conducted according to the PRISMA guidelines by two independent reviewers for articles published up to 1st March 2023 using PubMed, EMBASE and the Cochrane Central Register of Controlled Trial. Cellular allografts were not included. The following data were extracted: Number of patients, type of graft, fusion assessment method, follow-up duration, fusion rates, clinical outcomes and complications. The methodological quality of evidence (MQOE) was assessed using the Risk of Bias 2 (RoB-2) tool and Risk of Bias In Non-Randomised Studies (ROBINS) tool developed by Cochrane for evaluating bias in randomised and non-randomised studies. RESULTS Ten studies fulfiled the inclusion criteria, including 465 patients. The mean number of patients per study was 43.8 (std dev. 28.81, range 12-100). Two studies demonstrated cell-based therapy to be significantly more successful in terms of fusion rates compared to ICBG. However, the remaining eight demonstrated equivocal results. No study found that cell-based therapy was inferior. No difference was seen between the two groups in three studies who focused on degenerative cohorts. No difference in functional outcome scores was seen between the groups. A number of different preparation techniques for cell-based grafts were used throughout the studies. CONCLUSION Cell-based therapy offers a promising alternative to ICBG in spinal fusion surgery, which could help reduce the associated morbidity to patients. This review found that cell-based therapy is non-inferior to iliac crest bone graft and may offer patients an alternative treatment option with fewer complications and reduced post-operative pain. However, the literature to date is limited by heterogeneity of the cell preparation and grafting process. Future research with a unified approach to the cell preparation process is required to fully delineate the potential advantages of this technology.
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Affiliation(s)
- Aoife Gordon
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Fiona Newsome
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Daniel P Ahern
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland.
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, Ireland.
| | - Jake M McDonnell
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Grainne Cunniffe
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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Tian Y, Sun R, Li Y, Liu P, Fan B, Xue Y. Research progress on the application of magnesium phosphate bone cement in bone defect repair: A review. Biomed Mater Eng 2024; 35:265-278. [PMID: 38728179 DOI: 10.3233/bme-230164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Bone defects arising from diverse causes, such as traffic accidents, contemporary weapon usage, and bone-related disorders, present significant challenges in clinical treatment. Prolonged treatment cycles for bone defects can result in complications, impacting patients' overall quality of life. Efficient and timely repair of bone defects is thus a critical concern in clinical practice. OBJECTIVE This study aims to assess the scientific progress and achievements of magnesium phosphate bone cement (MPC) as an artificial bone substitute material. Additionally, the research seeks to explore the future development path and clinical potential of MPC bone cement in addressing challenges associated with bone defects. METHODS The study comprehensively reviews MPC's performance, encompassing e.g. mechanical properties, biocompatibility, porosity, adhesion and injectability. Various modifiers are also considered to broaden MPC's applications in bone tissue engineering, emphasizing drug-loading performance and antibacterial capabilities, which meet clinical diversification requirements. RESULTS In comparison to alternatives such as autogenous bone transplantation, allograft, polymethyl methacrylate (PMMA), and calcium phosphate cement (CPC), MPC emerges as a promising solution for bone defects. It addresses limitations associated with these alternatives, such as immunological rejection and long-term harm to patients. MPC can control heat release during the curing process, exhibits superior mechanical strength, and has the capacity to stimulate new bone growth. CONCLUSION MPC stands out as an artificial bone substitute with appropriate mechanical strength, rapid degradation, non-toxicity, and good biocompatibility, facilitating bone repair and regeneration. Modification agents can enhance its clinical versatility. Future research should delve into its mechanical properties and formulations, expanding clinical applications to create higher-performing and more medically valuable alternatives in bone defect repair.
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Affiliation(s)
- Yongzheng Tian
- 940 Hospital of People's Liberation Army Joint Service Support Force, Lanzhou, China
- Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Ruilong Sun
- 940 Hospital of People's Liberation Army Joint Service Support Force, Lanzhou, China
- Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Yunfei Li
- 940 Hospital of People's Liberation Army Joint Service Support Force, Lanzhou, China
- Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Peng Liu
- 940 Hospital of People's Liberation Army Joint Service Support Force, Lanzhou, China
- Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Bo Fan
- 940 Hospital of People's Liberation Army Joint Service Support Force, Lanzhou, China
| | - Yun Xue
- 940 Hospital of People's Liberation Army Joint Service Support Force, Lanzhou, China
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Tahchy D, Husseini B, Ghosn N, Younes R, Khoury N, Bouserhal J, Riachi F. Three-dimensional radiographic assessment of the mandibular retromolar donor site in different vertical facial growth types. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101457. [PMID: 36972788 DOI: 10.1016/j.jormas.2023.101457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To assess volumetrically, the impact of vertical facial growth types (VGFT) on the retromolar area as a bone donor site MATERIAL AND METHODS: 60 cone beam computed tomography (CBCT) scans of adult individuals were classified in three groups according to their SN-GoGn angle: hypodivergent group (hG) (33.33%), normodivergent group (NG) (30%) and hyperdivergent group (HG) (36.67%). Total harvestable bone volume and surface (TBV and TBS respectively), total cortical and cancellous bone volume (TCBV and TcBV respectively) and the percentage of cortical and cancellous bone volume (CBV and cBV respectively) were evaluated. RESULTS The whole sample showed a mean TBV of 1220.99±448.81mm³ and a mean TBS of 940.29±259.93mm². Statistically significant differences were found between the different outcome variables and the vertical growth patterns (p<0.001). TBS differs for the different vertical growth patterns with the highest mean of TBS observed in the hG group. TBV also significantly differs between the different vertical growth patterns (p<0.001) with the highest mean observed for the hG individuals. Significant differences in percentages of cBV and CBV were present between the hyper-divergent groups and the other groups (p<0.001) with the hyper-divergent group having the lowest percentage of CBV and the highest percentage of cBV. CONCLUSION hypodivergent individuals tend to have thicker bone blocks that can be used in onlay technique while thinner bone blocks harvested from hyperdivergent and normodivergent individuals can be used in three-dimensional grafting approach.
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Affiliation(s)
- Daniel Tahchy
- Department of Oral Surgery, Faculty of Dental Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon; Cranio-Facial Research Laboratory, Faculty of Dental Medicine, Saint-Joseph, United States.
| | - Bachar Husseini
- Cranio-Facial Research Laboratory, Faculty of Dental Medicine, Saint-Joseph, United States
| | - Nabil Ghosn
- Cranio-Facial Research Laboratory, Faculty of Dental Medicine, Saint-Joseph, United States
| | - Ronald Younes
- Department of Oral Surgery, Faculty of Dental Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon; Cranio-Facial Research Laboratory, Faculty of Dental Medicine, Saint-Joseph, United States
| | - Nicolas Khoury
- Department of Oral Surgery, Faculty of Dental Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon; Cranio-Facial Research Laboratory, Faculty of Dental Medicine, Saint-Joseph, United States
| | - Joseph Bouserhal
- Cranio-Facial Research Laboratory, Faculty of Dental Medicine, Saint-Joseph, United States; Department of Orthodontics, Faculty of Dental Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon; Department of orthodontics, Henry M. Goldman School of Dental Medicine, Boston, United States
| | - Faouzi Riachi
- Department of Oral Surgery, Faculty of Dental Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
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Luo Y, Chen H, Xiu P, Zeng J, Song Y, Li T. Comparative evaluation of multi-fold rib and structural iliac bone grafts in single-segment thoracic and thoracolumbar spinal tuberculosis: clinical and radiological outcomes. J Orthop Surg Res 2023; 18:917. [PMID: 38041140 PMCID: PMC10693100 DOI: 10.1186/s13018-023-04416-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE To compare clinical and radiological outcomes of multi-fold rib and structural iliac bone grafts, the primary autologous graft techniques in anterolateral-only surgery for single-segment thoracic and thoracolumbar spinal tuberculosis. METHODS This retrospective study included 99 patients treated from January 2014 to March 2022, categorized into 64 with multi-fold rib grafts (group A) and 35 with structural iliac bone grafts (group B). Outcomes assessed included hospital stay, operation time, intraoperative blood loss, postoperative drainage, complications, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the Visual Analog Scale (VAS) for pain, the Oswestry Disability Index (ODI), bone fusion time, and the American Spinal Injury Association (ASIA) impairment scale grade. Segmental kyphotic angle and intervertebral height were measured radiologically before surgery and follow-up. RESULTS The mean follow-up was 63.50 ± 26.05 months for group A and 64.97 ± 26.43 months for group B (P > 0.05). All patients had achieved a clinical cure. Group A had a shorter operation time (P = 0.004). Within one week post-surgery, group B reported higher VAS scores (P < 0.0001). Neurological performance and quality of life significantly improved in both groups. No significant differences were observed in segmental kyphotic angle and intervertebral height between the groups pre- and postoperatively (P > 0.05). However, group A showed a greater segmental kyphotic angle at the final follow-up, while group B had better maintenance of kyphotic angle correction and intervertebral height (P < 0.05). Bone fusion was achieved in all patients without differences in fusion time (P > 0.05). CONCLUSIONS Multi-fold rib grafts resulted in shorter operation times and less postoperative pain, while structural iliac bone grafts provided better long-term maintenance of spinal alignment and stability, suggesting their use in cases where long-term outcomes are critical.
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Affiliation(s)
- Yuanrui Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, China
| | - Hua Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, China
| | - Peng Xiu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, China
| | - Jiancheng Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, China
| | - Yueming Song
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, China
| | - Tao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, China.
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Sano T, Kuraji R, Miyashita Y, Yano K, Kawanabe D, Numabe Y. Biomaterials for Alveolar Ridge Preservation as a Preoperative Procedure for Implant Treatment: History and Current Evidence. Bioengineering (Basel) 2023; 10:1376. [PMID: 38135967 PMCID: PMC10740455 DOI: 10.3390/bioengineering10121376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
In implant treatment, the reduction and structural changes in the alveolar ridge that occur after tooth extraction limit the length, width, and placement position of the implant body, impair esthetics, and, in some cases, make implant placement difficult. To solve these problems, an alveolar ridge preservation (ARP) technique, which is performed simultaneously with tooth extraction, generally aims to promote bone regeneration and prevent alveolar ridge reduction by filling the extraction socket with bone graft material and then covering it with a barrier membrane to protect against the invasion of epithelial tissue. The extraction socket provides a favorable environment for bone regeneration throughout the healing period because the blood supply is abundant, and it effectively retains the bone graft material by using the remaining bone wall of the socket. In recent years, advances in bioengineering technology have led to the development of graft materials with various biological properties, but there is currently no clear consensus regarding the selection of surgical techniques and materials depending on the condition of the alveolar ridge. This review will provide a comprehensive survey of the evidence accumulated to date on ARP, present many cases according to the clinical situation, and discuss various treatment options.
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Affiliation(s)
- Tetsuya Sano
- Department of Periodontology, The Nippon Dental University School of Life Dentistry at Tokyo, 1-9-20, Fujimi, Chiyoda-ku, Tokyo 1020071, Japan; (T.S.); (Y.M.); (Y.N.)
- Heartful Dental Clinic, 4-12-3, Mejirodai, Hachioji-shi, Tokyo 1930833, Japan
| | - Ryutaro Kuraji
- Department of Periodontology, The Nippon Dental University School of Life Dentistry at Tokyo, 1-9-20, Fujimi, Chiyoda-ku, Tokyo 1020071, Japan; (T.S.); (Y.M.); (Y.N.)
| | - Yukihiro Miyashita
- Department of Periodontology, The Nippon Dental University School of Life Dentistry at Tokyo, 1-9-20, Fujimi, Chiyoda-ku, Tokyo 1020071, Japan; (T.S.); (Y.M.); (Y.N.)
| | - Kosei Yano
- Lotus Dental Clinic, 3-13-11, Nishigotanda, Shinagawa-ku, Tokyo 1410031, Japan;
| | - Dai Kawanabe
- Kawanabe Dental Clinic, T Building 1F, 4-21-4, Nishikojiya, Ota-ku, Tokyo 1440034, Japan;
| | - Yukihiro Numabe
- Department of Periodontology, The Nippon Dental University School of Life Dentistry at Tokyo, 1-9-20, Fujimi, Chiyoda-ku, Tokyo 1020071, Japan; (T.S.); (Y.M.); (Y.N.)
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Lee W, Prat D, Chao W, Farber DC, Wang C, Wapner KL. The Efficiency of Highly Porous β-Tricalcium Phosphate With Bone Marrow Aspirate Concentrate in Midfoot Joint Arthrodesis. Foot Ankle Spec 2023:19386400231213177. [PMID: 38018529 DOI: 10.1177/19386400231213177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND Nonunion is one of the most common and devastating complications following midfoot joint arthrodesis. Many different types of bone grafts and bone substitutes have been used to promote osseous fusion. However, there is no consensus on the gold standard bone grafting material and whether biologic materials should be used alone or in combination. The purpose of this study is to investigate the efficiency of highly porous β-tricalcium phosphate (β-TCP) with bone marrow aspirate concentrate (BMAC) in midfoot joint arthrodesis. METHODS This retrospective comparative study included patients who underwent midfoot joint arthrodesis using compression screws. Patients were classified into 2 groups: arthrodesis with highly porous β-TCP and BMAC (group A) and arthrodesis without them (group B). The osseous union rate was compared between the 2 groups. A total of 44 patients (46 feet) including 89 joints were included in this study. RESULTS There was a significant difference in the union rate between the 2 groups: 91.5% (43/47 joints) in arthrodesis with highly porous β-TCP and BMAC (group A) and 76.2% (32/42 joints) in arthrodesis without highly porous β-TCP and BMAC (group B; P = .048). CONCLUSION This study investigated the efficiency of highly porous β-TCP and BMAC to promote bony healing in midfoot joint arthrodesis. A significantly higher union rate was shown when arthrodesis was performed with highly porous β-TCP and BMAC, compared with arthrodesis performed without them. We suggest that highly porous β-TCP and BMAC can be a viable and effective adjunct to the fixation in midfoot joint arthrodesis. LEVEL OF EVIDENCE Level III: Retrospective comparative analysis.
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Affiliation(s)
- Wonyong Lee
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Orthopaedic Surgery, Guthrie Medical Group, Sayre, Pennsylvania
| | - Dan Prat
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wen Chao
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel C Farber
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carol Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith L Wapner
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Lai Y, Chuanqing M, Zhiyu C, Chengyong W, Meng L, Jing L, Chen WH. Comparison of two preserved cartilage iliac crest cortical-cancellous bone blocks graft harvesting techniques in children: A prospective, double-blind, randomized clinical trial. J Craniomaxillofac Surg 2023; 51:716-722. [PMID: 37821308 DOI: 10.1016/j.jcms.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/06/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To compare donor-site morbidity for alveolar bone grafting results following cartilage-preserving outer and inner cortico-cancellous iliac crest (OCIC and ICIC) bone block grafting in children. MATERIALS AND METHODS Patients were randomly divided into two groups and prospectively reviewed. In the OCIC and ICIC groups, cortico-cancellous bone blocks were harvested at outer and inner iliac crest respectively. Patient characteristics and surgical parameters were compared; pain intensity and duration, lateral femoral cutaneous nerve (LFCN) injury, gait disturbance, scar and contour satisfaction were analysed postoperatively. RESULTS Forty-nine consecutive patients (OCIC, 24; ICIC, 25) were included. There were no significant differences in patient characteristics or donor-site surgical parameters. The mean pain score on the first post-operative day was significantly lower in the OCIC group (3.75±1.70) than in the ICIC group (5.20±2.08) (p=0.012). The pain duration was similar in the two groups (median: 5 days). Temporary LFCN injury only occurred in 3 patients in the ICIC group. Postoperatively, the duck and circle gaits were observed in the OCIC and ICIC groups, respectively. There were no significant differences in the claudication duration, scar and contour satisfaction between the groups. CONCLUSION OCIC bone graft harvesting is marginally advantageous in children due to less early postoperative donor-site pain and a lower risk of nerve damage.
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Affiliation(s)
- Yongzhen Lai
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China; Stomatological Key Laboratory of Fujian College and University, Fuzhou, China
| | - Mao Chuanqing
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Cai Zhiyu
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Wang Chengyong
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Lu Meng
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Liu Jing
- Department of Stomatology, Fujian Maternal and Child Health Hospital, No 18 Dao Shan Road, Fuzhou City, 350001, Fujian Province, China
| | - Wei Hui Chen
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China.
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Sahasrabhojanee AA, Mehendale AM, Gupta D, Gupta P, Kakar G. Malunion of a Clavicle Fracture in a Young Adult: A Case Report and Surgical Intervention. Cureus 2023; 15:e48202. [PMID: 38050501 PMCID: PMC10693678 DOI: 10.7759/cureus.48202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
This case study examines the medical complexity of managing a neglected clavicle in a young patient, resulting in a complicated interstitial non-union. Despite initial therapeutic efforts, the fracture was not treated, resulting in significant pain as well as functional and aesthetic disabilities. This case outlines accurate clinical presentation and diagnostic methods. In addition, malunion clavicle fractures require multifaceted therapeutic approaches including surgical interventions, rehabilitation programs, and psychological support. Through comprehensive research and long-term follow-up, this report reveals the complexity of traumatic fractures, highlighting the importance of early recognition and intervention. To address the issue effectively, it is essential to follow a multidisciplinary approach that includes physical assessment, pharmacotherapy, and physiotherapy. This case report aims to highlight the critical role of comprehensive individual care in improving the patient's condition and emphasizes the importance of vigilant healthcare practices.
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Affiliation(s)
- Abhiram A Sahasrabhojanee
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashok M Mehendale
- Preventive and Social Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dhananjay Gupta
- Orthopedics, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, IND
| | - Pranav Gupta
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gauri Kakar
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Al Tobing SD, Malau VD. Anterior and posterior fusion via a posterior and costotransversectomy approach for thoracic spinal tuberculosis: A case report. Int J Surg Case Rep 2023; 111:108698. [PMID: 37757733 PMCID: PMC10539854 DOI: 10.1016/j.ijscr.2023.108698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Left untreated, spinal tuberculosis can lead to irreversible neurological deficit in patients, lowering quality of life. Combination of antitubercular drugs and surgical approach is important in managing spinal tuberculosis. We report a case of thoracic spinal tuberculosis treated by anterior and posterior fusion via a posterior and costotransversectomy approach. PRESENTATION OF CASE A 38 years-old woman diagnosed with paraplegia due to spinal tuberculosis of the thoracic vertebra (Th8) with Frankel A grade for spinal function. Pre-op kyphotic angle was 27.2°. Antitubercular drugs prescribed did not improve paraplegia symptom. Thoracal X-ray and MRI showed pathological fracture on Th8 and paravertebral abscess along anterior corpus of the Th6-9. We performed Sapardan's alternative VI approach that consists of debridement and abscess evacuation, decompression by laminectomy of the Th8, flavectomy and costotransversectomy of the Th8, posterior stabilization of the Th6-7 and Th9-10, and interbody fusion of the Th8. One month postoperative follow up showed improvement on motor function and sensory function. Post op kyphotic angle was 26.7°. CLINICAL DISCUSSION Adequate debridement followed by costotransversectomy, interbody fusion and surgical stabilization relieves pain, improves neurologic function, and prevents deformity of spinal tuberculous patient. CONCLUSION Although costotransversectomy approach is rarely used in surgical management of spinal TB, it is beneficial in cases with massive abscess involvement since it provides better view to collect and drain massive abscess.
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Affiliation(s)
- S Dohar Al Tobing
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia
| | - Vino Daniel Malau
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia.
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deMeireles AJ, Czerwonka N, Levine WN. Clavicle Nonunion and Malunion: Surgical Interventions for Functional Improvement. Clin Sports Med 2023; 42:663-675. [PMID: 37716729 DOI: 10.1016/j.csm.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Clavicle nonunion and malunion are relatively uncommon but, when symptomatic, can result in pain and dysfunction that requires surgical intervention. Various reconstructive and grafting techniques are available to achieve stable fixation and union. In the setting of persistent nonunion, vascularized bone grafting may be necessary. A thorough understanding of the patient's type of nonunion and potential for healing is crucial for achieving satisfactory results because is thoughtful preoperative planning and surgical fixation.
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Affiliation(s)
- Alirio J deMeireles
- Department of Orthopedic Surgery, Columbia University Irving Medical Center-NewYork Presbyterian Hospital, New York, NY, USA
| | - Natalia Czerwonka
- Department of Orthopedic Surgery, Columbia University Irving Medical Center-NewYork Presbyterian Hospital, New York, NY, USA
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Irving Medical Center-NewYork Presbyterian Hospital, New York, NY, USA.
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Yu Q, Hu X, Pan X, Kong X, Zhang J, Yu Y, Chen J, Ren P, Lu H. "Early Efficacy and Safety of Unilateral Biportal Endoscopic Lumbar Interbody Fusion Versus Minimal Invasive in the Treatment of Lumbar Degenerative Diseases". Clin Spine Surg 2023; 36:E390-E396. [PMID: 37448192 DOI: 10.1097/bsd.0000000000001470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 05/09/2023] [Indexed: 07/15/2023]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE To compare the early clinical efficacy and radiologic outcomes between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). SUMMARY OF BACKGROUND DATA Along with the continuous development of endoscopic technology, the early safety and effectiveness of ULIF technology are still unknown. MATERIALS AND METHODS This retrospective study included 61 patients who underwent fusion surgery through ULIF or MIS-TLIF in 2021. Twenty-nine patients underwent ULIF (group A), and 32 underwent MIS-TLIF (group B). Fusion rate, bone graft volume, hidden blood loss (HBL), C-reactive protein level, operative time, Oswestry Disability Index , Visual Analog Scale score, and MacNab criteria were assessed in both groups. RESULTS The Visual Analog Scale score for back pain in the early postoperative period was significantly lower in group A than in group B ( P <0.05). All other clinical scores showed improvement, with no significant difference between the 2 groups ( P >0.05). There was no statistically significant difference in postoperative C-reactive protein levels and fusion rates between the 2 groups ( P >0.05). However, HBL was higher and operative time was longer in group A than in group B ( P <0.05). Most importantly, there were no statistically significant differences between groups A and B in fusion rate, length of stay and bone graft volume ( P >0.05). No serious surgical complications occurred in our study. CONCLUSIONS ULIF is a new option for lumbar fusion. Despite the drawbacks of longer operation time and higher HBL, ULIF may be a viable alternative to MIS-TLIF as technology advances.
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Affiliation(s)
- Qi Yu
- Bengbu Medical College, Bengbu, China
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Xuqi Hu
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Xuekang Pan
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Xiangjia Kong
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jianqiao Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yefeng Yu
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jiayi Chen
- Bengbu Medical College, Bengbu, China
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Peng Ren
- Bengbu Medical College, Bengbu, China
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Huigen Lu
- Bengbu Medical College, Bengbu, China
- Department of Orthopedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
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Kubiak J, Farng E, Gust M, Sharpe F. Treatment of an Ulnar Fracture Bone Defect Using Heterotopic Bone Autograft: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00046. [PMID: 38096335 DOI: 10.2106/jbjs.cc.23.00477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
CASE Autologous bone grafting has wide applications for the treatment of bony defects. Generally, cancellous or corticocancellous bone grafts are used depending on the characteristics and size of the bony defect and wound bed. The use of heterotopic bone as a potential source of bone graft has not been widely reported. We present a 56-year-old right-hand-dominant male victim of dog mauling who sustained a right ulnar fracture with a 5-cm bony defect, treated with the use of heterotopic bone autograft. CONCLUSION Heterotopic bone can be successfully used as an autograft in the treatment of bony defects.
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Affiliation(s)
- Jeremy Kubiak
- Department of Plastic Surgery, Loma Linda University, Loma Linda, California
| | - Eugene Farng
- Department of Orthopedic Surgery, Kaiser Permanente Fontana, Fontana, California
| | - Madeleine Gust
- Department of Plastic Surgery, Kaiser Permanente Ontario, Ontario, California
| | - Frances Sharpe
- Department of Orthopedic Surgery, Kaiser Permanente Fontana, Fontana, California
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Pei B, Hu M, Wu X, Lu D, Zhang S, Zhang L, Wu S. Investigations into the effects of scaffold microstructure on slow-release system with bioactive factors for bone repair. Front Bioeng Biotechnol 2023; 11:1230682. [PMID: 37781533 PMCID: PMC10537235 DOI: 10.3389/fbioe.2023.1230682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
In recent years, bone tissue engineering (BTE) has played an essential role in the repair of bone tissue defects. Although bioactive factors as one component of BTE have great potential to effectively promote cell differentiation and bone regeneration, they are usually not used alone due to their short effective half-lives, high concentrations, etc. The release rate of bioactive factors could be controlled by loading them into scaffolds, and the scaffold microstructure has been shown to significantly influence release rates of bioactive factors. Therefore, this review attempted to investigate how the scaffold microstructure affected the release rate of bioactive factors, in which the variables included pore size, pore shape and porosity. The loading nature and the releasing mechanism of bioactive factors were also summarized. The main conclusions were achieved as follows: i) The pore shapes in the scaffold may have had no apparent effect on the release of bioactive factors but significantly affected mechanical properties of the scaffolds; ii) The pore size of about 400 μm in the scaffold may be more conducive to controlling the release of bioactive factors to promote bone formation; iii) The porosity of scaffolds may be positively correlated with the release rate, and the porosity of 70%-80% may be better to control the release rate. This review indicates that a slow-release system with proper scaffold microstructure control could be a tremendous inspiration for developing new treatment strategies for bone disease. It is anticipated to eventually be developed into clinical applications to tackle treatment-related issues effectively.
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Affiliation(s)
- Baoqing Pei
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable and Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Mengyuan Hu
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable and Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xueqing Wu
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable and Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Da Lu
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable and Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Shijia Zhang
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable and Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Le Zhang
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable and Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Shuqin Wu
- School of Big Data and Information, Shanxi College of Technology, Taiyuan, Shanxi, China
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Destrez A, Colin E, Testelin S, Devauchelle B, Dakpé S, Naudot M. Evaluation of a Granular Bone Substitute for Bone Regeneration Using an Optimized In Vivo Alveolar Cleft Model. Bioengineering (Basel) 2023; 10:1035. [PMID: 37760137 PMCID: PMC10525109 DOI: 10.3390/bioengineering10091035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Alveolar cleft is a common congenital deformity that requires surgical intervention, notably using autologous bone grafts in young children. Bone substitutes, in combination with mesenchymal stem cells (MSCs), have shown promise in the repair of these defects. This study aimed to evaluate the regenerative capabilities of a granular bone substitute using an optimized alveolar cleft model. Thirty-six rats underwent a surgical procedure for the creation of a defect filled with a fragment of silicone. After 5 weeks, the silicone was removed and the biomaterial, with or without Wharton's jelly MSCs, was put into the defect, except for the control group. The rats underwent μCT scans immediately and after 4 and 8 weeks. Analyses showed a statistically significant improvement in bone regeneration in the two treatment groups compared with control at weeks 4 and 8, both for bone volume (94.64% ± 10.71% and 91.33% ± 13.30%, vs. 76.09% ± 7.99%) and mineral density (96.13% ± 24.19% and 93.01% ± 27.04%, vs. 51.64% ± 16.51%), but without having fully healed. This study validates our optimized alveolar cleft model in rats, but further work is needed to allow for the use of this granular bone substitute in the treatment of bone defects.
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Affiliation(s)
- Alban Destrez
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France; (A.D.); (S.T.); (B.D.); (S.D.); (M.N.)
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
| | - Emilien Colin
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France; (A.D.); (S.T.); (B.D.); (S.D.); (M.N.)
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
- Institut Faire Faces, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
| | - Sylvie Testelin
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France; (A.D.); (S.T.); (B.D.); (S.D.); (M.N.)
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
- Institut Faire Faces, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
| | - Bernard Devauchelle
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France; (A.D.); (S.T.); (B.D.); (S.D.); (M.N.)
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
- Institut Faire Faces, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
| | - Stéphanie Dakpé
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France; (A.D.); (S.T.); (B.D.); (S.D.); (M.N.)
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
- Institut Faire Faces, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
| | - Marie Naudot
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France; (A.D.); (S.T.); (B.D.); (S.D.); (M.N.)
- Institut Faire Faces, Rond-point du Pr Christian Cabrol, 80054 Amiens, France
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DeMitchell-Rodriguez EM, Shen C, Nayak VV, Tovar N, Witek L, Torroni A, Yarholar LM, Cronstein BN, Flores RL, Coelho PG. Engineering 3D Printed Bioceramic Scaffolds to Reconstruct Critical-Sized Calvaria Defects in a Skeletally Immature Pig Model. Plast Reconstr Surg 2023; 152:270e-280e. [PMID: 36723712 PMCID: PMC11310574 DOI: 10.1097/prs.0000000000010258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Three-dimensional printed bioceramic scaffolds composed of 100% β-tricalcium phosphate augmented with dipyridamole (3DPBC-DIPY) can regenerate bone across critically sized defects in skeletally mature and immature animal models. Before human application, safe and effective bone formation should be demonstrated in a large translational animal model. This study evaluated the ability of 3DPBC-DIPY scaffolds to restore critically sized calvarial defects in a skeletally immature, growing minipig. METHODS Unilateral calvarial defects (~1.4 cm) were created in 6-week-old Göttingen minipigs ( n = 12). Four defects were filled with a 1000 μm 3DPBC-DIPY scaffold with a cap (a solid barrier on the ectocortical side of the scaffold to prevent soft-tissue infiltration), four defects were filled with a 1000 μm 3DPBC-DIPY scaffold without a cap, and four defects served as negative controls (no scaffold). Animals were euthanized 12 weeks postoperatively. Calvariae were subjected to micro-computed tomography, 3D reconstruction with volumetric analysis, qualitative histologic analysis, and nanoindentation. RESULTS Scaffold-induced bone growth was statistically greater than in negative controls ( P ≤ 0.001), and the scaffolds with caps produced significantly more bone generation compared with the scaffolds without caps ( P ≤ 0.001). Histologic analysis revealed woven and lamellar bone with haversian canals throughout the regenerated bone. Cranial sutures were observed to be patent, and there was no evidence of ectopic bone formation or excess inflammatory response. Reduced elastic modulus and hardness of scaffold-regenerated bone were found to be statistically equivalent to native bone ( P = 0.148 for reduced elastic modulus of scaffolds with and without caps and P = 0.228 and P = 0.902 for hardness of scaffolds with and without caps, respectively). CONCLUSION 3DPBC-DIPY scaffolds have the capacity to regenerate bone across critically sized calvarial defects in a skeletally immature translational pig model. CLINICAL RELEVANCE STATEMENT This study assessed the bone generative capacity of 3D-printed bioceramic scaffolds composed of 100% β-tricalcium phosphate and augmented with dipyridamole placed within critical-sized calvarial defects in a growing porcine model.
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Affiliation(s)
| | - Chen Shen
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine
| | - Vasudev Vivekanand Nayak
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering
- Department of Biomaterials, New York University College of Dentistry
| | - Nick Tovar
- Department of Biomaterials, New York University College of Dentistry
| | - Lukasz Witek
- Department of Biomaterials, New York University College of Dentistry
- Department of Biomedical Engineering, New York University Tandon School of Engineering
| | - Andrea Torroni
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine
| | - Lauren M. Yarholar
- DeWitt Daughtry Family Department of Surgery, Division of Plastic Surgery, University of Miami Miller School of Medicine
| | | | - Roberto L. Flores
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine
| | - Paulo G. Coelho
- DeWitt Daughtry Family Department of Surgery, Division of Plastic Surgery, University of Miami Miller School of Medicine
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine
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50
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Olevsky LM, Anup A, Jacques M, Keokominh N, Holmgren EP, Hixon KR. Direct Integration of 3D Printing and Cryogel Scaffolds for Bone Tissue Engineering. Bioengineering (Basel) 2023; 10:889. [PMID: 37627774 PMCID: PMC10451777 DOI: 10.3390/bioengineering10080889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
Cryogels, known for their biocompatibility and porous structure, lack mechanical strength, while 3D-printed scaffolds have excellent mechanical properties but limited porosity resolution. By combining a 3D-printed plastic gyroid lattice scaffold with a chitosan-gelatin cryogel scaffold, a scaffold can be created that balances the advantages of both fabrication methods. This study compared the pore diameter, swelling potential, mechanical characteristics, and cellular infiltration capability of combined scaffolds and control cryogels. The incorporation of the 3D-printed lattice demonstrated patient-specific geometry capabilities and significantly improved mechanical strength compared to the control cryogel. The combined scaffolds exhibited similar porosity and relative swelling ratio to the control cryogels. However, they had reduced elasticity, reduced absolute swelling capacity, and are potentially cytotoxic, which may affect their performance. This paper presents a novel approach to combine two scaffold types to retain the advantages of each scaffold type while mitigating their shortcomings.
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Affiliation(s)
- Levi M. Olevsky
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA; (L.M.O.); (A.A.)
| | - Amritha Anup
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA; (L.M.O.); (A.A.)
| | - Mason Jacques
- College of Engineering and Physical Sciences, University of New Hampshire, Durham, NH 03824, USA; (M.J.); (N.K.)
| | - Nadia Keokominh
- College of Engineering and Physical Sciences, University of New Hampshire, Durham, NH 03824, USA; (M.J.); (N.K.)
| | - Eric P. Holmgren
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA;
| | - Katherine R. Hixon
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA; (L.M.O.); (A.A.)
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA;
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