Osteochondral allograft transplantation for complex distal humeral fractures assisted by 3D computer planning and printing technology: technical note

Reconstruction of the Distal Humerus in a Post-traumatic Arthritic Elbow with a Frozen Osteochondral Allograft Using CT-based Preoperative 3D Planning: A Case Report

CASE

We present a young patient with malunion of the Type IV distal humeral coronal shear fracture and post-traumatic arthritis of the elbow joint. He was treated with a frozen osteochondral allograft transplant using CT-based preoperative 3D planning. At 64 months after surgery, both the clinical and radiological results were satisfactory and no complications had been reported.

CONCLUSION

The precision of computer-aided surgical planning could assist in preoperative designing and preparation of a personalized elbow osteochondral allograft. Even in a chronic situation, a personalized treatment approach can allow for osseointegration and satisfactory clinical results.

Reconstruction of a Distal Humeral Fracture with Articular Bone Loss Using Osteochondral Allograft: A Case Report

CASE

A 31-year-old right-hand-dominant man sustained an open left distal humerus fracture resulting in a complete loss of the lateral column involving 30% of the articular surface and the lateral collateral ligament complex. Reconstructive surgery was conducted in 2 stages, beginning with articulated external elbow fixation followed by reconstruction with a fresh osteochondral allograft. Outcomes were satisfactory with no elbow pain or instability, and osseointegration was demonstrated in radiographs.

CONCLUSION

The technique described in this report can be a viable option for treating young patients with a severe distal humerus fracture complicated and can provide favorable clinical and radiological outcomes.

3D Printing for Bone-Cartilage Interface Regeneration

Due to the vasculature defects and/or the avascular nature of cartilage, as well as the complex gradients for bone-cartilage interface regeneration and the layered zonal architecture, self-repair of cartilage and subchondral bone is challenging. Currently, the primary osteochondral defect treatment strategies, including artificial joint replacement and autologous and allogeneic bone graft, are limited by their ability to simply repair, rather than induce regeneration of tissues. Meanwhile, over the past two decades, three-dimension (3D) printing technology has achieved admirable advancements in bone and cartilage reconstruction, providing a new strategy for restoring joint function. The advantages of 3D printing hybrid materials include rapid and accurate molding, as well as personalized therapy. However, certain challenges also exist. For instance, 3D printing technology for osteochondral reconstruction must simulate the histological structure of cartilage and subchondral bone, thus, it is necessary to determine the optimal bioink concentrations to maintain mechanical strength and cell viability, while also identifying biomaterials with dual bioactivities capable of simultaneously regenerating cartilage. The study showed that the regeneration of bone-cartilage interface is crucial for the repair of osteochondral defect. In this review, we focus on the significant progress and application of 3D printing technology for bone-cartilage interface regeneration, while also expounding the potential prospects for 3D printing technology and highlighting some of the most significant challenges currently facing this field.