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Korenkov O, Sukhodub L, Kumeda M, Sukhodub L. In Vivo feature of the regenerative potential of chitosan and alginate based osteoplastic composites doped with calcium phosphates, zinc ions, and vitamin D2. Ann Anat 2024; 255:152290. [PMID: 38821427 DOI: 10.1016/j.aanat.2024.152290] [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: 11/01/2023] [Revised: 04/22/2024] [Accepted: 05/27/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE In vivo comparison of the regenerative potential of two calcium phosphate-biopolymer osteoplastic composites: а) based on alginate (Alg) and hydroxyapatite (HA) - Alg/HA/CS/Zn/D2, b) based on chitosan (CS) and brushite (DCPD) - CS/DCPD/D2. MATERIALS AND METHODS 36 white male laboratory rats aged six months were used. A defect to the bone marrow canal in the middle of the femur diaphysis was made with a dental bur of 2 mm. The bone defect healed under the blood clot (control) in the different animal groups and was filled with Alg/HA/CS/Zn/D2 and CS/DCPD/D2. The regeneration of the bone defect was studied on the 30th, 90th, and 140th days by computer tomography (CT). RESULTS On the 30th day, all groups' implantation site optical density (OD) was significantly lower than that of the adjacent maternal bone (MB). Intensity of bone formation for Alg/HA/CS/Zn/D2 exceeds CS/DCPD/D2. On the 90th day, the bone trauma site OD with Alg/HA/CS/Zn/D2 (1725.4 ± 86 HU) and CS/DCPD/D2 (1484.9 ± 69 HU) exceeded the OD of the control (942.5 ± 55 HU). On the 140th day, the OD of Alg/HA/CS/Zn/D2 and CS/DCPD/D2 implantation sites was higher than Control and MB OD. Visually, the area of the past injury with the Alg/HA/CS/Zn/D2 could be detected only by the presence of an endosteal bone callus and in the case of CS/DCPD/D2 - by the shadow of the remaining biomaterial in the bone marrow canal. CONCLUSIONS According to CT data, Alg/HA/CS/Zn/D2 and CS/DCPD/D2 contribute to the complete healing of the femoral diaphysis defect in 140 days, but the regenerative potential of Alg/HA/CS/Zn/D2 from 30 days to 140 days is higher than CS/DCPD/D2 biomaterial.
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Affiliation(s)
- Olexii Korenkov
- Sumy State University, 2, Rymskogo-Korsakova st., Sumy 40007, Ukraine
| | - Liudmyla Sukhodub
- Sumy State University, 2, Rymskogo-Korsakova st., Sumy 40007, Ukraine.
| | - Mariia Kumeda
- Sumy State University, 2, Rymskogo-Korsakova st., Sumy 40007, Ukraine
| | - Leonid Sukhodub
- Sumy State University, 2, Rymskogo-Korsakova st., Sumy 40007, Ukraine
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2
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Hoveidaei AH, Ghaseminejad-Raeini A, Esmaeili S, Sharafi A, Ghaderi A, Pirahesh K, Azarboo A, Nwankwo BO, Conway JD. Effectiveness of synthetic versus autologous bone grafts in foot and ankle surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:539. [PMID: 38997680 PMCID: PMC11245794 DOI: 10.1186/s12891-024-07676-8] [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: 04/29/2024] [Accepted: 07/09/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND All orthopaedic procedures, comprising foot and ankle surgeries, seemed to show a positive trend, recently. Bone grafts are commonly employed to fix bone abnormalities resulting from trauma, disease, or other medical conditions. This study specifically focuses on reviewing the safety and efficacy of various bone substitutes used exclusively in foot and ankle surgeries, comparing them to autologous bone grafts. METHODS The systematic search involved scanning electronic databases including PubMed, Scopus, Cochrane online library, and Web of Science, employing terms like 'Bone substitute,' 'synthetic bone graft,' 'Autograft,' and 'Ankle joint.' Inclusion criteria encompassed RCTs, case-control studies, and prospective/retrospective cohorts exploring different bone substitutes in foot and ankle surgeries. Meta-analysis was performed using R software, integrating odds ratios and 95% confidence intervals (CI). Cochrane's Q test assessed heterogeneity. RESULTS This systematic review analyzed 8 articles involving a total of 894 patients. Out of these, 497 patients received synthetic bone grafts, while 397 patients received autologous bone grafts. Arthrodesis surgery was performed in five studies, and three studies used open reduction techniques. Among the synthetic bone grafts, three studies utilized a combination of recombinant human platelet-derived growth factor BB homodimer (rhPDGF-BB) and beta-tricalcium phosphate (β-TCP) collagen, while four studies used hydroxyapatite compounds. One study did not provide details in this regard. The meta-analysis revealed similar findings in the occurrence of complications, as well as in both radiological and clinical evaluations, when contrasting autografts with synthetic bone grafts. CONCLUSION Synthetic bone grafts show promise in achieving comparable outcomes in radiological, clinical, and quality-of-life aspects with fewer complications. However, additional research is necessary to identify the best scenarios for their use and to thoroughly confirm their effectiveness. LEVELS OF EVIDENCE Level II.
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Affiliation(s)
- Amir Human Hoveidaei
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Sina Esmaeili
- Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ali Ghaderi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Pirahesh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Azarboo
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Basilia Onyinyechukwu Nwankwo
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
- Department of Orthopaedic Surgery and Rehabilitation, Howard University Hospital, Washington, DC, USA
| | - Janet D Conway
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
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He X, Lu M, Zou C, Li Z, Gong T, Kenmegne GR, Wang Y, Luo Y, Zhou Y, Min L, Tu C. Three-dimensional printed custom-made modular talus prosthesis in patients with talus malignant tumor resection. J Orthop Surg Res 2024; 19:273. [PMID: 38698477 PMCID: PMC11064297 DOI: 10.1186/s13018-024-04728-6] [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: 01/14/2024] [Accepted: 04/06/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Talar malignant tumor is extremely rare. Currently, there are several alternative management options for talus malignant tumor including below-knee amputation, tibio-calcaneal arthrodesis, and homogenous bone transplant while their shortcomings limited the clinical application. Three-dimensional (3D) printed total talus prosthesis in talus lesion was reported as a useful method to reconstruct talus, however, most researches are case reports and its clinical effect remains unclear. Therefore, the current study was to explore the application of 3D printed custom-made modular prosthesis in talus malignant tumor. METHODS We retrospectively analyzed the patients who received the 3D printed custom-made modular prosthesis treatment due to talus malignant tumor in our hospital from February 2016 to December 2021. The patient's clinical data such as oncology outcome, operation time, and volume of blood loss were recorded. The limb function was evaluated with the Musculoskeletal Tumor Society 93 (MSTS-93) score, The American Orthopedic Foot and Ankle Society (AOFAS) score; the ankle joint ranges of motion as well as the leg length discrepancy were evaluated. Plain radiography and Tomosynthesis-Shimadzu Metal Artefact Reduction Technology (T-SMART) were used to evaluate the position of prosthesis and the osseointegration. Postoperative complications were recorded. RESULTS The average patients' age and the follow-up period were respectively 31.5 ± 13.1 years; and 54.8 months (range 26-72). The medium operation time was 2.4 ± 0.5 h; the intraoperative blood loss was 131.7 ± 121.4 ml. The mean MSTS-93 and AOFAS score was 26.8 and 88.5 respectively. The average plantar flexion, dorsiflexion, varus, and valgus were 32.5, 9.2, 10.8, and 5.8 degree respectively. One patient had delayed postoperative wound healing. There was no leg length discrepancy observed in any patient and good osseointegration was observed on the interface between the bone and talus prosthesis in all subjects. CONCLUSION The modular structure of the prosthesis developed in this study seems to be convenient for prosthesis implantation and screws distribution. And the combination of solid and porous structure improves the initial stability and promotes bone integration. Therefore, 3D printed custom-made modular talus prosthesis could be an alternative option for talus reconstruction in talus malignant tumor patients.
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Affiliation(s)
- Xuanhong He
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chang Zou
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhuangzhuang Li
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Taojun Gong
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Guy Romeo Kenmegne
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yitian Wang
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Li Min
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Chongqi Tu
- Department of Orthopedics, Orthopedic Research Institute, Trauma Center West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
- Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.
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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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5
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Bolia IK, Covell DJ, Tan EW. Comparative Studies of Bone Graft and Orthobiologics for Foot Ankle Arthrodesis: A Critical Review. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00004. [PMID: 38704857 PMCID: PMC11068146 DOI: 10.5435/jaaosglobal-d-23-00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/03/2024] [Indexed: 05/07/2024]
Abstract
Graft materials available to supplement hindfoot and ankle arthrodesis procedures include autologous (autograft) or allogeneic bone graft (allograft) but also bone graft substitutes such as demineralized bone matrix, calcium sulfate, calcium phosphate, and tricalcium phosphate/hydroxyapatite. In addition, biologic agents, such as recombinant human bone morphogenetic protein-2 or recombinant human platelet derived growth factor-BB (rhPDGF-BB), and preparations, including platelet-rich plasma or concentrated bone marrow aspirate, have been used to facilitate bone healing in ankle or hindfoot arthrodesis. The purpose of this review was to summarize the available clinical evidence surrounding the utilization and efficacy of the above materials and biological agents in ankle or hindfoot arthrodesis procedures, with emphasis on the quality of the existing evidence to facilitate clinical decision making.
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Affiliation(s)
- Ioanna K Bolia
- From the Department of Orthopeadic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA (Dr. Bolia, and Dr. Tan), and the Danville Orthopeadics and Sports Medicine, Danville, KY (Dr. Covell)
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6
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Tan CY, Thevendran G. Management of non-unions of the malleolar fractures- Current Evidence. J Clin Orthop Trauma 2024; 51:102395. [PMID: 38577563 PMCID: PMC10988033 DOI: 10.1016/j.jcot.2024.102395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
Although malleolar non-union is uncommon, it is associated with significant morbidity. Managing this problem requires understanding ankle fracture biomechanics and bone healing. We present in this article the pertinent points to be considered in evaluating and managing patients with malleolar non-union. Our discussion will focus on the important risk factors contributing to this problem, and the need to carefully consider the biomechanical stability and the biological environment to ensure successful bony unions.
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Affiliation(s)
- Chin Yik Tan
- Department of Orthopaedic Surgery, National University Health System, Singapore
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7
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Wang J, Liu M, Yang C, Pan Y, Ji S, Han N, Sun G. Biomaterials for bone defect repair: Types, mechanisms and effects. Int J Artif Organs 2024; 47:75-84. [PMID: 38166512 DOI: 10.1177/03913988231218884] [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: 01/04/2024]
Abstract
Bone defects or bone discontinuities caused by trauma, infection, tumours and other diseases have led to an increasing demand for bone grafts and biomaterials. Autologous bone grafts, bone grafts with vascular tips, anastomosed vascular bone grafts and autologous bone marrow components are all commonly used in clinical practice, while oversized bone defects require the use of bone tissue engineering-related biomaterials to repair bone defects and promote bone regeneration. Currently, inorganic components such as polysaccharides and bioceramics, as well as a variety of bioactive proteins, metal ions and stem cells can be loaded into hydrogels or 3D printed scaffold materials to achieve better therapeutic results. In this review, we provide an overview of the types of materials, applications, potential mechanisms and current developments in the repair of bone defects.
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Affiliation(s)
- Jiaming Wang
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mingchong Liu
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chensong Yang
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yutao Pan
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shengchao Ji
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ning Han
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Guixin Sun
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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8
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Abdulaziz D, Anastasiou AD, Panagiotopoulou V, Raif EM, Giannoudis PV, Jha A. Physiologically engineered porous titanium/brushite scaffolds for critical-size bone defects: A design and manufacturing study. J Mech Behav Biomed Mater 2023; 148:106223. [PMID: 37976684 DOI: 10.1016/j.jmbbm.2023.106223] [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: 09/13/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
Repairing critical-size bone defects still represents a critical clinical challenge in the field of trauma surgery. This study focuses on a physiological design and manufacturing of porous composite scaffold (titanium Ti with 10 % mole iron doped brushite DCPD-Fe3+) which can mimic the biomechanical properties of natural cortical bone, specifically for the purpose of repairing critical-size defects. To achieve this, the principle of design of experiments (DOE) was applied for investigating the impact of sintering temperature, mineral ratio, and volume fraction of porosity on the mechanical properties of the fabricated scaffolds. The fabricated scaffolds had open porosity up to 60 %, with pore size approximately between 100 μm and 850 μm. The stiffness of the porous composite scaffolds varied between 3.30 GPa and 20.50 GPa, while the compressive strength ranged from approximately 130 MPa-165 MPa at sintering temperatures equal to or exceeding 1000 °C. Scaffolds with higher porosity and mineral content demonstrated lower stiffness values, resembling natural bone. Numerical simulation was employed by Ansys Workbench to investigate the stress and strain distribution of a critical size defect in mid-shaft femur which was designed to be replaced with the fabricated scaffold. The fabricated scaffolds showed flexible biomechanical behaviour at the bone/scaffold interface, generating lower stress levels and indicating a better match with the femoral shaft stiffness. The experimental and numerical findings demonstrated promising applications for manufacturing a patient-specific bone scaffold for critical and potentially large defects for reducing stress shielding and minimizing non-union risk.
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Affiliation(s)
- Dina Abdulaziz
- School of Chemical and Process Engineering, University of Leeds, Leeds, LS2 9JT, UK.
| | - Antonios D Anastasiou
- Department of Chemical Engineering, University of Manchester, Manchester, M1 3AL, UK
| | | | - El Mostafa Raif
- Faculty of Medicine and Health, School of Dentistry, University of Leeds, Leeds, LS2 9JT, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Animesh Jha
- School of Chemical and Process Engineering, University of Leeds, Leeds, LS2 9JT, UK
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9
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Hsieh YK, Liu CH, Hu CH. Optimizing Traumatic Limb Salvage: Ectopic Implantation and Staged Rotationplasty. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1879. [PMID: 37893597 PMCID: PMC10608738 DOI: 10.3390/medicina59101879] [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: 09/12/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
Rotationplasty, a limb-saving procedure involving a 180-degree ankle rotation to function as a knee joint, is now standard for treating distal femur osteosarcoma. However, challenges related to self-identification persist within the Asian population. This study presents a case involving the successful application of temporary ectopic implantation followed by staged rotationplasty after a severe traumatic amputation, resulting in a favorable outcome. Additionally, a systematic review is conducted to summarize the various difficulties and complications encountered in different studies. This approach improves the feasibility of rotationplasty in traumatic cases and enhances patient and family comprehension.
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Affiliation(s)
- Yi-Keng Hsieh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan City 333, Taiwan
| | - Chang-Heng Liu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333, Taiwan
| | - Ching-Hsuan Hu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan City 333, Taiwan
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10
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Iturregui JM, Moses AM, Shi GG, Haupt ET. Contemporary Review: Autograft Bone Use in Foot and Ankle Surgery. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231153153. [PMID: 36825255 PMCID: PMC9941600 DOI: 10.1177/24730114231153153] [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] [Indexed: 02/22/2023] Open
Abstract
Bone autografts are frequently harvested for use in foot and ankle surgery. A commonly used harvest site is the iliac crest; however, because of known morbidity with this site, the tibia and calcaneus are attractive alternatives. There remains limited understanding regarding the osteogenic potential of autografts from each of these locations. In this review, we provided an update of the known data on bone autografts from the iliac crest, tibia, and calcaneus, focusing on the total cells harvested from each site as well as the presence of osteogenic osteoprogenitor cells. Level of Evidence Level V, expert opinion.
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Affiliation(s)
- Jose M. Iturregui
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Alex M. Moses
- Department of Orthopedic Surgery, University of Florida, Jacksonville, FL, USA
| | - Glenn G. Shi
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Edward T. Haupt
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA,Edward T. Haupt, MD, Department of Orthopedic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
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11
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Case Report and Surgical Technique: Second Toe Intra-articular Proximal Phalanx Fracture Nonunion Repair. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221138241. [DOI: 10.1177/24730114221138241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Tang G, Zhu L, Wang W, Zuo D, Shi C, Yu X, Chen R. Alendronate-functionalized double network hydrogel scaffolds for effective osteogenesis. Front Chem 2022; 10:977419. [PMID: 36059871 PMCID: PMC9428824 DOI: 10.3389/fchem.2022.977419] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Development of artificial bone substitutes mimicking the extracellular matrix is a promising strategy for bone repair and regeneration. In views of the actual requirement of biomechanics, biodegradability, and bioactivity, herein, a double-network (DN) hydrogel was constructed by interspersing a methacrylated gelatin (GelMA) network into alendronate (ALN)-modified oxidized alginate (OSA) network via Schiff base reaction and photo-crosslinking process to promote in situ bone regeneration. This GelMA@OSA-ALN DN hydrogel possessed favorable network and pores, good biocompatibility, and enhanced biomechanics. Notably, the introduction of Schiff base furnished the ND hydrogel scaffold with pH-responsive biodegradation and sustained ALN drug release delivery, which could provide effective bioactivity, upregulate osteogenesis-related genes, and promote the cell viability, growth, proliferation, and osteogenesis differentiation for bone regeneration. Therefore, we provide a new insight to develop functional DN hydrogel scaffold toward governing the on-demand drug release and achieving the stem cell therapy, which will be developed into the minimally invasive gelling system to prolong local delivery of bisphosphonates for the bone-related diseases.
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Affiliation(s)
- Guoke Tang
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Liang Zhu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Weiheng Wang
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Dongqing Zuo
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Changgui Shi
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
- *Correspondence: Changgui Shi, ; Xiaojie Yu, ; Rui Chen,
| | - Xiaojie Yu
- Department of Orthopedics, Hunan Aerospace Hospital, Changsha, Hunan, China
- *Correspondence: Changgui Shi, ; Xiaojie Yu, ; Rui Chen,
| | - Rui Chen
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
- *Correspondence: Changgui Shi, ; Xiaojie Yu, ; Rui Chen,
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Imaizumi A, Toyota Y. One-stage reconstruction of the complex defects of the Achilles tendon and the adjoining calcaneus using the chimeric superolateral thigh flap: A case report. Microsurgery 2022; 42:611-616. [PMID: 35816008 DOI: 10.1002/micr.30937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 05/05/2022] [Accepted: 06/23/2022] [Indexed: 11/09/2022]
Abstract
Reconstruction of the composite defects of the Achilles tendon and the overlying skin is a great challenge. Should the tendon insertion and adjoining calcaneal defects coexist, such reconstruction becomes far more complicated. A chimeric superolateral thigh flap based on the ascending branch of the lateral circumflex femoral artery provides all the components for this complex defect. We aim to illustrate a case underwent one-stage reconstruction of such defects with this chimeric flap. A 55-year-old man presented with composite defects of Achilles tendon (11 cm), adjoining calcaneus (2 × 2 × 3 cm), and the overlying skin (15 × 3.5 cm) due to unsuccessful repair for his right chronic Achilles tendon rupture, which was complicated by infection. This complex defect was reconstructed using a chimeric superolateral thigh flap consisting of the superolateral thigh skin (8.5 × 17.5 cm), full-thickness iliac bone (4 × 3 cm), and the intervening iliotibial tract preserving the fascia-bone junction, which substituted for the lost insertion of the Achilles tendon. Bone union and full weight bearing were achieved by 11 and 24 weeks, respectively, after surgery. Two debulking procedures were performed. Isometric plantar flexion muscle strength was comparable to the healthy side, but isotonic strength was somewhat reduced at 18 months after reconstruction. This chimeric flap provided all the possible components necessary for the complex Achilles tendon defect, and led functional outcomes.
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Affiliation(s)
- Atsushi Imaizumi
- Department of Plastic Surgery, Okinawa Prefectural Chubu Hospital, Okinawa, Japan
| | - Yoshie Toyota
- Department of Plastic Surgery, Okinawa Prefectural Chubu Hospital, Okinawa, Japan
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14
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Cifaldi A, Thompson M, Abicht B. Tibiotalocalcaneal Arthrodesis with Structural Allograft for Management of Large Osseous Defects of the Hindfoot and Ankle: A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2022; 61:900-906. [PMID: 35585002 DOI: 10.1053/j.jfas.2022.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/26/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Large osseous defects of the hindfoot and ankle pose a surgical challenge. Tibiotalocalcaneal (TTC) arthrodesis utilizing a structural allograft may be required to fill the osseous void, preserve limb length and achieve fusion. Several authors have reported small case series on this topic, however outcomes have varied and no systematic review of this data has been published to date. The primary aim of this study is to report rates of osseous union, limb salvage and complications in patients undergoing TTC arthrodesis with a structural allograft. A total of 11 publications were identified that met the inclusion criteria. One hundred seventy-five patients were included with a weighted mean age of 60.5 (range 50-72) years and follow-up period of 29.7 (range 3-62) months. Femoral head allograft was the most commonly utilized structural graft and a retrograde intramedullary nail was the most common fixation construct. Results demonstrated an overall union rate of 67.4%, limb salvage rate of 92.5% and complication rate of 26.6%. Allograft-related complications were rare with an allograft fracture rate of 0.1% and allograft collapse rate of 1.2%. There was no significant difference in union rate when using a retrograde intramedullary nail versus a plate construct (p = .9148). TTC arthrodesis with use of a structural allograft is a viable treatment option for limb salvage when faced with complex hindfoot and ankle pathology involving large osseous defects. Despite high rates of radiographic nonunion, this approach can provide patients with a stable and functional limb while avoiding amputation.
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Affiliation(s)
- Andrea Cifaldi
- Podiatric Medicine and Surgery Resident, Gundersen Medical Foundation, La Crosse, WI.
| | - Mitchell Thompson
- Podiatric Medicine and Surgery Resident, Gundersen Medical Foundation, La Crosse, WI
| | - Bradley Abicht
- Department Chair and Attending Staff, Podiatry Department within Orthopaedic Center, Gundersen Health System, La Crosse, WI
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15
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Zhu W, Chen R, Wang W, Liu Y, Shi C, Tang S, Tang G. Fabrication of Naturally Derived Double-Network Hydrogels With a Sustained Aspirin Release System for Facilitating Bone Regeneration. Front Chem 2022; 10:874985. [PMID: 35419346 PMCID: PMC8995466 DOI: 10.3389/fchem.2022.874985] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/08/2022] [Indexed: 12/20/2022] Open
Abstract
Continuous efforts on pursuit of effective drug delivery systems for engineering hydrogel scaffolds is considered a promising strategy for the bone-related diseases. Here, we developed a kind of acetylsalicylic acid (aspirin, ASA)–based double-network (DN) hydrogel containing the positively charged natural chitosan (CS) and methacrylated gelatin (GelMA) polymers. Combination of physical chain-entanglement, electrostatic interactions, and a chemically cross-linked methacrylated gelatin (GelMA) network led to the formation of a DN hydrogel, which had a suitable porous structure and favorable mechanical properties. After in situ encapsulation of aspirin agents, the resulting hydrogels were investigated as culturing matrices for adipose tissue–derived stromal cells (ADSCs) to evaluate their excellent biocompatibility and biological capacities on modulation of cell proliferation and differentiation. We further found that the long-term sustained ASA in the DN hydrogels could contribute to the anti-inflammation and osteoinductive properties, demonstrating a new strategy for bone tissue regeneration.
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Affiliation(s)
- Wenfeng Zhu
- Department of Orthopedics, Shanghai Post and Telecommunication Hospital, Shanghai, China
| | - Rui Chen
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Weiheng Wang
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yi Liu
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Changgui Shi
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
- *Correspondence: Changgui Shi, ; Songjun Tang, ; Guoke Tang,
| | - Songjun Tang
- Department of Orthopedics, Shanghai Post and Telecommunication Hospital, Shanghai, China
- *Correspondence: Changgui Shi, ; Songjun Tang, ; Guoke Tang,
| | - Guoke Tang
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
- *Correspondence: Changgui Shi, ; Songjun Tang, ; Guoke Tang,
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16
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McMurtrie JT, Patch DA, Frazier MB, Wills BW, Prather JC, Viner GC, Hill MJ, Johnson MD. Union Rates of Talar Neck Fractures With Substantial Bone Defects Treated With Autograft. Foot Ankle Int 2022; 43:343-352. [PMID: 34689579 DOI: 10.1177/10711007211050032] [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: 02/01/2023]
Abstract
BACKGROUND This study evaluated the union rate of talar neck fractures with substantial bone defects treated acutely with autologous tibial bone graft during primary osteosynthesis. METHODS A case series at a level 1 trauma center was performed to identify consecutive patients who underwent operative fixation of talar neck fracture with autograft (Current Procedural Terminology codes 28445 and 20902) between 2015 and 2018. "Substantial bone defect" was defined as a gap greater than 5 mm in the sagittal plane and greater than one-third of width of the talar neck in the coronal plane. Postoperative foot computed tomographic (CT) scans were obtained for all patients. Primary outcome was union, and secondary outcomes were malunion, avascular necrosis (AVN), post-traumatic arthritis (PTA), and patient-reported outcomes (PROs). RESULTS Twelve patients with 12 fractures were included in the series, with an average length of follow-up of 26 months (range: 7-55) The average age was 34 years (17-59), and the most common mechanism of injury was motor vehicle crash. The Hawkins classification of the fractures was 4 type II (2 type IIA and 2 type IIB) (33%) and 8 type III (67%). Four fractures (33%) were open fractures. Union was achieved in 11 patients (92%). There was 1 malunion (8%). AVN was identified on postoperative CT scans in 11 patients (92%). Three of these 11 eventually showed collapse. Ten patients (83%) had radiographic evidence of some degree of ankle PTA, and 12 patients (100%) had radiographic evidence of some degree of subtalar PTA. Average Patient-Reported Outcomes Measurement Information System-Short Form score was 37 (32-45) and average Foot and Ankle Ability Measure activities of daily living and sports subscale scores were, respectively, 61 (31-87) and 31 (0-71), respectively. Average visual analog scale score was 5 (0-10), and average Foot Function Index was 49 (7-89). SF-36 scores showed fair to poor outcomes in the majority of patients. CONCLUSION In this relatively small series, tibial autograft in primary osteosynthesis of comminuted talar neck fractures with substantial bone defects is associated with excellent union rates and low malunion rates. Despite high union rates, secondary outcomes of AVN with or without collapse, ankle and subtalar PTA, and relatively low PROs were common. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - David A Patch
- UAB Orthopaedics, University of Alabama Birmingham, Birmingham, AL, USA
| | - Mason B Frazier
- Radiology, University of Alabama Birmingham, Birmingham, AL, USA
| | - Bradley W Wills
- UAB Orthopaedics, University of Alabama Birmingham, Birmingham, AL, USA
| | - John C Prather
- UAB Orthopaedics, University of Alabama Birmingham, Birmingham, AL, USA
| | - Gean C Viner
- UAB Orthopaedics, University of Alabama Birmingham, Birmingham, AL, USA
| | - Margie J Hill
- Radiology, University of Alabama Birmingham, Birmingham, AL, USA
| | - Michael D Johnson
- UAB Orthopaedics, University of Alabama Birmingham, Birmingham, AL, USA
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17
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Ferreira GF, Costa JHA, Domingues G, Lima JPBC, Sanhudo JAV, Pereira Filho MV. Low Donor Site Morbidity Associated With Tricortical Calcaneal Bone Graft. Foot Ankle Int 2022; 43:49-54. [PMID: 34330165 DOI: 10.1177/10711007211032665] [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: 02/01/2023]
Abstract
BACKGROUND Autologous grafting is widely used in orthopaedic surgery because of its high osteogenic capacity, immunologic compatibility, for the absence of risk of disease transmission, and for not requiring a bone bank. The posterior-superior calcaneal tuberosity is an option for obtaining a cortical and cancellous structural bone. This study aims to describe the operative technique and complications observed at the donor site of the posterior-superior calcaneal tuberosity. METHODS Patients who underwent graft harvesting from the posterior-superior calcaneal tuberosity were retrospectively evaluated by pain outcomes, imaging tests, and intra- and postoperative complications. RESULTS Twenty patients with a median age of 69 years (range 48-77) and follow-up of 16 months (12-26) were assessed. Median postoperative pain at the donor site was 0 (0-6), with 2 patients reporting persistent local pain. No case of Achilles tendon rupture or intra- or postoperative calcaneal fracture were identified. One patient developed a superficial infection that was quickly resolved using oral antibiotic therapy. CONCLUSION The posterior-superior calcaneal tuberosity is an alternative source of autologous graft with low donor site morbidity. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Gabriel Ferraz Ferreira
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
| | | | | | | | | | - Miguel Viana Pereira Filho
- Head of Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
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18
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Wassif RK, Elkayal M, Shamma RN, Elkheshen SA. Recent advances in the local antibiotics delivery systems for management of osteomyelitis. Drug Deliv 2021; 28:2392-2414. [PMID: 34755579 PMCID: PMC8583938 DOI: 10.1080/10717544.2021.1998246] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chronic osteomyelitis is a challenging disease due to its serious rates of mortality and morbidity while the currently available treatment strategies are suboptimal. In contrast to the adopted systemic treatment approaches after surgical debridement in chronic osteomyelitis, local drug delivery systems are receiving great attention in the recent decades. Local drug delivery systems using special carriers have the pros of enhancing the feasibility of penetration of antimicrobial agents to bone tissues, providing sustained release and localized concentrations of the antimicrobial agents in the infected area while avoiding the systemic side effects and toxicity. Most important, the incorporation of osteoinductive and osteoconductive materials in these systems assists bones proliferation and differentiation, hence the generation of new bone materials is enhanced. Some of these systems can also provide mechanical support for the long bones during the healing process. Most important, if the local systems are designed to be injectable to the affected site and biodegradable, they will reduce the level of invasion required for implantation and can win the patients’ compliance and reduce the healing period. They will also allow multiple injections during the course of therapy to guard against the side effect of the long-term systemic therapy. The current review presents different available approaches for delivering antimicrobial agents for the treatment of osteomyelitis focusing on the recent advances in researches for local delivery of antibiotics.HIGHLIGHTS Chronic osteomyelitis is a challenging disease due to its serious mortality and morbidity rates and limited effective treatment options. Local drug delivery systems are receiving great attention in the recent decades. Osteoinductive and osteoconductive materials in the local systems assists bones proliferation and differentiation Local systems can be designed to provide mechanical support for the long bones during the healing process. Designing the local system to be injectable to the affected site and biodegradable will reduces the level of invasion and win the patients’ compliance.
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Affiliation(s)
- Reem Khaled Wassif
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt
| | - Maha Elkayal
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt
| | - Rehab Nabil Shamma
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Seham A Elkheshen
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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19
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Aghali A. Craniofacial Bone Tissue Engineering: Current Approaches and Potential Therapy. Cells 2021; 10:cells10112993. [PMID: 34831216 PMCID: PMC8616509 DOI: 10.3390/cells10112993] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/16/2021] [Accepted: 10/22/2021] [Indexed: 01/10/2023] Open
Abstract
Craniofacial bone defects can result from various disorders, including congenital malformations, tumor resection, infection, severe trauma, and accidents. Successfully regenerating cranial defects is an integral step to restore craniofacial function. However, challenges managing and controlling new bone tissue formation remain. Current advances in tissue engineering and regenerative medicine use innovative techniques to address these challenges. The use of biomaterials, stromal cells, and growth factors have demonstrated promising outcomes in vitro and in vivo. Natural and synthetic bone grafts combined with Mesenchymal Stromal Cells (MSCs) and growth factors have shown encouraging results in regenerating critical-size cranial defects. One of prevalent growth factors is Bone Morphogenetic Protein-2 (BMP-2). BMP-2 is defined as a gold standard growth factor that enhances new bone formation in vitro and in vivo. Recently, emerging evidence suggested that Megakaryocytes (MKs), induced by Thrombopoietin (TPO), show an increase in osteoblast proliferation in vitro and bone mass in vivo. Furthermore, a co-culture study shows mature MKs enhance MSC survival rate while maintaining their phenotype. Therefore, MKs can provide an insight as a potential therapy offering a safe and effective approach to regenerating critical-size cranial defects.
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Affiliation(s)
- Arbi Aghali
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA;
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47908, USA
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20
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Khademi F, Erfani A, Erfani MA, Vosoughi AR. Bone Graft Harvesting From the Calcaneus Using Lateral Wall Corticotomy Technique by an Osteotome. Foot Ankle Spec 2021; 14:298-301. [PMID: 32326754 DOI: 10.1177/1938640020916269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The aim of this study was to evaluate the complications following calcaneal autologous bone graft harvesting using an osteotome in patients who underwent foot and ankle surgery with follow-up of at least 1 year. Methods: In a cohort study, all consecutive patients underwent forefoot or midfoot surgeries in conjunction with harvesting bone graft from the calcaneus using lateral wall corticotomy technique by an osteotome from 2015 till 2018 were asked to follow. The outcome and morbidity were assessed by visual analogue scale (VAS) pain, numbness in territory of the sural nerve, surgical site numbness or tenderness, infection, hematoma formation, or pathologic fracture. Also any possible restrictions on wearing desired shoes were asked. Results: Totally, 50 patients (11 males, 39 females; 29 right foot, 21 left foot) with the mean age of 48.2 ± 13.8 years (range 8-66 years) were assessed. There were no major complications on donor site such as infection, hematoma formation, or pathologic fracture. The following results were seen; 90% without any pain (VAS 0/10), 96% without numbness at the incision site, 96% without point tenderness on lateral of heel, 98% without paresthesia or numbness in the sural nerve territory, and 84% were able to wear their favorite shoes. Forty-one (82%) cases said if they need another foot surgery, they would permit to harvest bone graft from their heel. Conclusions: Autologous bone graft harvesting from the calcaneus using lateral wall corticotomy technique by an osteotome could be a useful method with very low complications.Levels of Evidence: Therapeutic, level IV: cohort, case series.
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Affiliation(s)
- Farough Khademi
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran (FK, AE).,Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran (MAE, ARV)
| | - Amirhossein Erfani
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran (FK, AE).,Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran (MAE, ARV)
| | - Mohammad Ali Erfani
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran (FK, AE).,Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran (MAE, ARV)
| | - Amir Reza Vosoughi
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran (FK, AE).,Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran (MAE, ARV)
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21
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Bansal R, Halai M, Matthews JL, Martin CR. Partial Calcaneus Reconstruction using 'Opportunistic Grafts': A Case Report. J Foot Ankle Surg 2021; 60:199-203. [PMID: 33218858 DOI: 10.1053/j.jfas.2020.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/30/2020] [Accepted: 08/27/2020] [Indexed: 02/03/2023]
Abstract
Although replantation of an amputated extremity has been successfully performed, occasionally the surgeon is forced to amputate in the case of an unsalvageable open fracture. These appendages can theoretically act as an autologous 'bone and tissue bank' for patients if they have reconstructable contralateral injuries. We present a case of an athlete who sustained a Gustilo and Anderson IIIC injury on 1 leg resulting in a below knee amputation. Her other lower leg had a traumatic amputation of the heel pad, partial amputation of the calcaneus, and complete Achilles tendon loss. Tissues from this amputated appendage were utilised to restore the anatomy of the contralateral extremity. The distal tibia and the tibialis anterior from the amputated limb were used to reconstruct the missing posterior tuberosity of the calcaneus and the Achilles tendon respectively. The soft tissue deficiency of the heel pad was restored with an anterolateral thigh free flap. At 2-year follow-up, the patient is pain free and back to playing soccer. This case highlights the opportunistic use of amputated parts to reconstruct a calcaneus and Achilles tendon. A multidisciplinary approach with plastic surgeons is required. The main advantage of this 'Spare Part Surgery' philosophy is to provide autologous graft of a similar geometry and to avoid harvesting tissues from an additional donor site.
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Affiliation(s)
- Rohit Bansal
- Clinical Fellow, Section of Orthopedic Trauma Surgery, University of Calgary, Calgary, AB, Canada.
| | - Mansur Halai
- Assistant Professor, University of Toronto, Toronto, ON, Canada; Orthopaedic Surgeon, Trauma, Foot & Ankle, St Michael's Hospital, Toronto, ON, Canada
| | - Jennifer Lk Matthews
- Section of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Christopher Ryan Martin
- Section of Orthopedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
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22
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Surgical Reconstruction of Nonunion after Iatrogenic Scarf Osteotomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115620. [PMID: 34070270 PMCID: PMC8197363 DOI: 10.3390/ijerph18115620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/02/2022]
Abstract
We present the case of a young patient, 32 years old, with nonunion in the diaphysis of the first metatarsal after scarf osteotomy for correction of hallux valgus. After removal of the failed osteosynthesis material and preparation of the bone fragments, a calcaneal bone autograft, previously extracted from the patient, was placed in the nonunion area. The new physiological position of the first metatarsal in the three planes was checked intraoperatively, and autograft and fragment fixation was performed using a combination of a low-profile plate with six screws and two interfragmentary screws. The advantage of using an autogenous graft is that it provides corticocancellous bone and great osteogenic capacity with little antigenic capacity. This makes it an excellent option in many situations in foot and ankle surgery. Regarding the fixation method, we used the two most commonly used techniques for osteosynthesis of bone grafts in cases of bone nonunion, combining plates with locking screws and two interfragmentary screws. This provides greater stability of the bone fragments in the three planes and makes it possible to bring forward when the patient starts postsurgical loading.
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23
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Tang G, Liu Z, Liu Y, Yu J, Wang X, Tan Z, Ye X. Recent Trends in the Development of Bone Regenerative Biomaterials. Front Cell Dev Biol 2021; 9:665813. [PMID: 34026758 PMCID: PMC8138062 DOI: 10.3389/fcell.2021.665813] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/01/2021] [Indexed: 12/12/2022] Open
Abstract
The goal of a biomaterial is to support the bone tissue regeneration process at the defect site and eventually degrade in situ and get replaced with the newly generated bone tissue. Biomaterials that enhance bone regeneration have a wealth of potential clinical applications from the treatment of non-union fractures to spinal fusion. The use of bone regenerative biomaterials from bioceramics and polymeric components to support bone cell and tissue growth is a longstanding area of interest. Recently, various forms of bone repair materials such as hydrogel, nanofiber scaffolds, and 3D printing composite scaffolds are emerging. Current challenges include the engineering of biomaterials that can match both the mechanical and biological context of bone tissue matrix and support the vascularization of large tissue constructs. Biomaterials with new levels of biofunctionality that attempt to recreate nanoscale topographical, biofactor, and gene delivery cues from the extracellular environment are emerging as interesting candidate bone regenerative biomaterials. This review has been sculptured around a case-by-case basis of current research that is being undertaken in the field of bone regeneration engineering. We will highlight the current progress in the development of physicochemical properties and applications of bone defect repair materials and their perspectives in bone regeneration.
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Affiliation(s)
- Guoke Tang
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Spine Surgery, The Affiliated Zhuzhou Hospital of Xiangya School of Medical CSU, Hunan, China
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhiqin Liu
- Department of Spine Surgery, The Affiliated Zhuzhou Hospital of Xiangya School of Medical CSU, Hunan, China
| | - Yi Liu
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jiangming Yu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xing Wang
- Beijing National Laboratory for Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Zhihong Tan
- Department of Spine Surgery, The Affiliated Zhuzhou Hospital of Xiangya School of Medical CSU, Hunan, China
| | - Xiaojian Ye
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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24
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Wang L, Luo D, Wu J, Xie K, Guo Y, Gan Y, Wu W, Hao Y. A clinical study on bone defect reconstruction and functional recovery in benign bone tumors of the lower extremity, treated by bone marrow mesenchymal stem cell rapid screening-enrichment-composite system. World J Surg Oncol 2021; 19:98. [PMID: 33820559 PMCID: PMC8022380 DOI: 10.1186/s12957-021-02198-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the development of medical technology, credible options for defect reconstructions after the resection of benign bone tumors of the lower extremities have become a high priority. As the current reconstructive methods commonly used in clinical practice have some flaws, new methods of reconstruction need to be explored. We aimed to prepare a new kind of bioactive scaffold for the repair of bone defects through a stem cell rapid screening-enrichment-composite technology system developed by our team. Furthermore, we aimed to investigate the curative effects of these bioactive scaffolds. METHODS Firstly, cell count, trypan blue exclusion rate, and ALP staining were used to evaluate changes in enrichment efficiency, cell activity, and osteogenic ability before and after enrichment. Then, the scaffolds were placed under the skin of nude mice to verify their osteogenic effects in vivo. Finally, the scaffolds were used for the reconstruction of bone defects after operations for benign bone tumors in a patient's lower limb. The healing status of the defect site at 1 and 3 months was assessed by X-ray, and the Musculoskeletal Tumor Society (MSTS) score was applied to reflect the recovery of patient limb function. RESULTS The system effectively enriched stem cells without affecting the activity and osteogenic abilities of the bone marrow mesenchymal stem cells (BMSCs). Meanwhile, the bioactive scaffolds obtained better osteogenic effects. In patients, the active scaffolds showed better bone integration and healing status, and the patients also obtained higher MSTS scores at 1 and 3 months after surgery. CONCLUSION As a new technique, the rapid screening-enrichment-composite technology of stem cells demonstrates a better therapeutic effect in the reconstruction of bone defects after surgery for benign bone tumors of the lower extremities, which will further improve patient prognosis.
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Affiliation(s)
- Lei Wang
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Dinghao Luo
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Junxiang Wu
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Kai Xie
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Yu Guo
- Department of Bone Oncology, Peking University People's Hospital, Peking University School of Medicine, 11 Xizhimen South Street, Beijing, 100044, People's Republic of China
| | - Yaokai Gan
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Wen Wu
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
| | - Yongqiang Hao
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
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Anastasio AT, Paniagua A, Diamond C, Ferlauto HR, Fernandez-Moure JS. Nanomaterial Nitric Oxide Delivery in Traumatic Orthopedic Regenerative Medicine. Front Bioeng Biotechnol 2021; 8:592008. [PMID: 33537289 PMCID: PMC7849904 DOI: 10.3389/fbioe.2020.592008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/10/2020] [Indexed: 11/13/2022] Open
Abstract
Achieving bone fracture union after trauma represents a major challenge for the orthopedic surgeon. Fracture non-healing has a multifactorial etiology and there are many risk factors for non-fusion. Environmental factors such as wound contamination, infection, and open fractures can contribute to non-healing, as can patient specific factors such as poor vascular status and improper immunologic response to fracture. Nitric oxide (NO) is a small, neutral, hydrophobic, highly reactive free radical that can diffuse across local cell membranes and exert paracrine functions in the vascular wall. This molecule plays a role in many biologic pathways, and participates in wound healing through decontamination, mediating inflammation, angiogenesis, and tissue remodeling. Additionally, NO is thought to play a role in fighting wound infection by mitigating growth of both Gram negative and Gram positive pathogens. Herein, we discuss recent developments in NO delivery mechanisms and potential implications for patients with bone fractures. NO donors are functional groups that store and release NO, independent of the enzymatic actions of NOS. Donor molecules include organic nitrates/nitrites, metal-NO complexes, and low molecular weight NO donors such as NONOates. Numerous advancements have also been made in developing mechanisms for localized nanomaterial delivery of nitric oxide to bone. NO-releasing aerogels, sol- gel derived nanomaterials, dendrimers, NO-releasing micelles, and core cross linked star (CCS) polymers are all discussed as potential avenues of NO delivery to bone. As a further target for improved fracture healing, 3d bone scaffolds have been developed to include potential for nanoparticulated NO release. These advancements are discussed in detail, and their potential therapeutic advantages are explored. This review aims to provide valuable insight for translational researchers who wish to improve the armamentarium of the feature trauma surgeon through use of NO mediated augmentation of bone healing.
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Affiliation(s)
| | - Ariana Paniagua
- Duke University School of Medicine, Durham, NC, United States
| | - Carrie Diamond
- Duke University School of Medicine, Durham, NC, United States
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Sallent I, Capella-Monsonís H, Procter P, Bozo IY, Deev RV, Zubov D, Vasyliev R, Perale G, Pertici G, Baker J, Gingras P, Bayon Y, Zeugolis DI. The Few Who Made It: Commercially and Clinically Successful Innovative Bone Grafts. Front Bioeng Biotechnol 2020; 8:952. [PMID: 32984269 PMCID: PMC7490292 DOI: 10.3389/fbioe.2020.00952] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022] Open
Abstract
Bone reconstruction techniques are mainly based on the use of tissue grafts and artificial scaffolds. The former presents well-known limitations, such as restricted graft availability and donor site morbidity, while the latter commonly results in poor graft integration and fixation in the bone, which leads to the unbalanced distribution of loads, impaired bone formation, increased pain perception, and risk of fracture, ultimately leading to recurrent surgeries. In the past decade, research efforts have been focused on the development of innovative bone substitutes that not only provide immediate mechanical support, but also ensure appropriate graft anchoring by, for example, promoting de novo bone tissue formation. From the countless studies that aimed in this direction, only few have made the big jump from the benchtop to the bedside, whilst most have perished along the challenging path of clinical translation. Herein, we describe some clinically successful cases of bone device development, including biological glues, stem cell-seeded scaffolds, and gene-functionalized bone substitutes. We also discuss the ventures that these technologies went through, the hindrances they faced and the common grounds among them, which might have been key for their success. The ultimate objective of this perspective article is to highlight the important aspects of the clinical translation of an innovative idea in the field of bone grafting, with the aim of commercially and clinically informing new research approaches in the sector.
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Affiliation(s)
- Ignacio Sallent
- Regenerative, Modular & Developmental Engineering Laboratory, National University of Ireland Galway, Galway, Ireland
- Science Foundation Ireland Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Galway, Ireland
| | - Héctor Capella-Monsonís
- Regenerative, Modular & Developmental Engineering Laboratory, National University of Ireland Galway, Galway, Ireland
- Science Foundation Ireland Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Galway, Ireland
| | - Philip Procter
- Division of Applied Materials Science, Department of Engineering Sciences, Uppsala University, Uppsala, Sweden
- GPBio Ltd., Shannon, Ireland
| | - Ilia Y. Bozo
- Histograft LLC, Moscow, Russia
- Federal Medical Biophysical Center of FMBA of Russia, Moscow, Russia
| | - Roman V. Deev
- Histograft LLC, Moscow, Russia
- I.I. Mechnikov North-Western State Medical University, Saint Petersburg, Russia
| | - Dimitri Zubov
- State Institute of Genetic & Regenerative Medicine NAMSU, Kyiv, Ukraine
- Medical Company ilaya, Kyiv, Ukraine
| | - Roman Vasyliev
- State Institute of Genetic & Regenerative Medicine NAMSU, Kyiv, Ukraine
- Medical Company ilaya, Kyiv, Ukraine
| | | | | | - Justin Baker
- Viscus Biologics LLC, Cleveland, OH, United States
| | | | - Yves Bayon
- Sofradim Production, A Medtronic Company, Trévoux, France
| | - Dimitrios I. Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory, National University of Ireland Galway, Galway, Ireland
- Science Foundation Ireland Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Galway, Ireland
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Dang LHN, Lee KB. Effect of bone morphogenetic protein-2/hydroxyapatite on ankle fusion with bone defect in a rabbit model: a pilot study. J Orthop Surg Res 2020; 15:366. [PMID: 32859231 PMCID: PMC7455904 DOI: 10.1186/s13018-020-01891-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/13/2020] [Indexed: 12/01/2022] Open
Abstract
Background Revision ankle-fusion surgery after a failure of total ankle arthroplasty has a problem with bone-defect management by implant removal. For the reconstruction of bone defects, autogenous bone often causes minor and major complications. Recombinant human-bone morphogenetic protein-2 (rhBMP-2) plays essential roles in bone regeneration strategies, and hydroxyapatite (HA) is beneficial as the rhBMP-2 carrier. In this study, we evaluate whether rhBMP-2/HA can replace autogenous bone in a rabbit ankle-fusion model with distal tibia bone defect. Methods The bone defect was created in the distal tibia. The ankle fusion was performed by a cannulated screw from lateral malleolus and various treatments on bone defect. Thirty male white New Zealand rabbits were divided into three groups of 10 animals on each group dependent on treatment methods as control group (no treatment into defect), auto-bone group (autogenous bone treatment), and rhBMP-2/HA group (40 μL of 1 μg/mL rhBMP-2/100 μL HA). Bone formation on defect and the union of the ankle joint were evaluated by X-ray, micro-CT, and histological analysis at 8 weeks and 12 weeks, postoperatively. Results Radiographic assessment found the control and auto-bone groups still had the bone defect present, but rhBMP-2/HA group showed complete replacement of the defect with newly formed bone at 12 weeks. Micro-CT showed significantly higher new bone formation within the defect in the rhBMP-2/HA group than in the auto-bone and control groups at 8 weeks (p > 0.05 and p < 0.01, respectively) and 12 weeks (p < 0.05, p < 0.001, respectively). Fusion rate (%) analysis of micro-CT showed a higher percentage of union in the rhBMP-2/HA group than in the auto bone and control groups at 8 weeks (p > 0.05, p < 0.001, respectively) and 12 weeks (p < 0.001 and p < 0.001, respectively). The histological showed the highest osteointegration between distal tibia and talus in the rhBMP-2/HA group at 12 weeks. Conclusions This study indicated that rhBMP-2/HA showed much better bone fusion than did the autogenous bone graft and was effective in promoting fusion rate and improving the quality of the ankle joint fusion.
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Affiliation(s)
- Le Hoang Nam Dang
- Department of Orthopedic Surgery, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Hospital, 634-18, Keumam-dong, Jeonju-shi, Jeonbuk, South Korea
| | - Kwang Bok Lee
- Department of Orthopedic Surgery, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Hospital, 634-18, Keumam-dong, Jeonju-shi, Jeonbuk, South Korea.
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Abstract
Union rates vary for arthrodesis sites and bone healing in foot and ankle surgery. The ultimate goal is to achieve complete bone healing within a reasonable time. There are many factors that surgeons cannot control, such as the patient's compliance and ability to heal. However, surgeons can control osseous preparation, stable fixation, preservation of soft tissue, and the osseous fusion initial healing environment. Modification of the healing environment can be achieved with the use of bone graft and orthobiologics. This article discusses the grafts and orthobiologics that can be used in bone healing for the foot and ankle.
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Affiliation(s)
- Sean T Grambart
- Des Moines University, College of Podiatric Medicine and Surgery, 3200 Grand Avenue, Des Moines, IA 50312, USA; Unitypoint Health - Iowa Methodist Medical Center, 1200 Pleasant Street, Des Moines, IA 50309, USA.
| | - Danika S Anderson
- Des Moines University, College of Podiatric Medicine and Surgery, 3200 Grand Avenue, Des Moines, IA 50312, USA
| | - Travis Drew Anderson
- Des Moines University, College of Podiatric Medicine and Surgery, 3200 Grand Avenue, Des Moines, IA 50312, USA
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Wan J, Ma T, Jin Y, Qiu S. The effects of morin on bone regeneration to accelerate healing in bone defects in mice. Int J Immunopathol Pharmacol 2020; 34:2058738420962909. [PMID: 33035102 PMCID: PMC7550952 DOI: 10.1177/2058738420962909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/10/2020] [Indexed: 12/29/2022] Open
Abstract
Restoring bone defects are the major challenge facing clinical trial therapy, particularly skull related problems. Morin, a naturally occurring compound, has pro-osteogenesis. This research focuses on assessing the role of morin for its pro-osteogenesis activities. We utilized in vivo and in vitro models to investigate the molecular-level mechanisms of morin's osteoblastic biological activity. The effectiveness of morin on pro-osteogenesis (100 mg/kg/day) was assessed by monitoring modifications in the bone histomorphometry score, the development of immature osteoblasts from mesenchymal stems cells and improvements in the expression of pro-osteogenic cytokines in skull defected (SD) mice. Quantitative-PCR, Western blot analysis, and immunofluorescence were studied to investigate the signaling pathways. Morin has a substantial in vivo pro-osteogenesis effect which can facilitate the development of osteoblasts, the production of osteoblast related marker genes, and in vitro protein markers for osteoblasts. From a molecular biology standpoint, morin contributes to the development of osteoblasts and stimulation of the Wnt pathway with the activation and translocation of β-catenin nuclei. Our findings from the study revealed that morin may be a beneficial substitute for helping regenerate bone defects.
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Affiliation(s)
- Jun Wan
- Department of Orthopaedics, People’s Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University For Nationalities), Yinchuan, Ningxia, China
| | - Tao Ma
- Department of Orthopaedics, People’s Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University For Nationalities), Yinchuan, Ningxia, China
| | - Yun Jin
- Department of orthopaedic trauma, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Shaodong Qiu
- Department of orthopaedic trauma, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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Zhang Y, Ding N, Zhang T, Sun Q, Han B, Yu T. A Tetra-PEG Hydrogel Based Aspirin Sustained Release System Exerts Beneficial Effects on Periodontal Ligament Stem Cells Mediated Bone Regeneration. Front Chem 2019; 7:682. [PMID: 31681732 PMCID: PMC6811605 DOI: 10.3389/fchem.2019.00682] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/01/2019] [Indexed: 01/05/2023] Open
Abstract
Bone defects, massive bone defects in particular, is still an issue clinically. Acetylsalicylic acid (ASA), also known as aspirin, has been proven to be conducive for mesenchymal stem cells osteogenic differentiation, which may be benefited for bone regeneration. In order to achieve a more appealing prognosis of bone defect, here we develop a well-defined tetra-PEG hydrogel sealant with rapid gelation speed, strong tissue adhesion, and high mechanical strength. After in-situ encapsulation of aspirin, this drug-loaded tetra-PEG hydrogel possessed a sustained release, anti-inflammation, and osteoinductive properties. In vitro experiments showed that the cell proliferation was slightly facilitated, and the osteogenic differentiation was notably augmented when periodontal ligament stem cells (PDLSCs) were co-incubating with the hydrogel materials. Moreover, in vivo study manifested that the aspirin sustained release system significantly facilitated the PDLSCs mediated bone defect regeneration. Overall, tetra-PEG hydrogel-based aspirin sustained release system is applicable not only for enhancing the osteogenesis capacity of PDLSC but also providing a new thought of bone regenerative therapy.
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Affiliation(s)
- Yunfan Zhang
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Ning Ding
- School of Life Science and Medicine, Dalian University of Technology, Panjin, China
| | - Ting Zhang
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Qiannan Sun
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Bing Han
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Tingting Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
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Abstract
Use of orthobiologics in sports medicine and musculoskeletal surgery has gained significant interest. However, many of the commercially available and advertised products are lacking in clinical evidence. Widespread use of products before fully understanding their true indications may result in unknown adverse outcomes and may also lead to increased health care costs. As more products become available, it is important to remain judicial in use and to practice evidence-based medicine. Likewise, it is important to continue advances in research in hopes to improve surgical outcomes. This article reviews clinical evidence behind common orthobiologics in the treatment of foot and ankle pathology.
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32
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Peterson JR, Chen F, Nwankwo E, Dekker TJ, Adams SB. The Use of Bone Grafts, Bone Graft Substitutes, and Orthobiologics for Osseous Healing in Foot and Ankle Surgery. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419849019. [PMID: 35097327 PMCID: PMC8500392 DOI: 10.1177/2473011419849019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Achieving fusion in osseous procedures about the foot and ankle presents unique challenges to the surgeon. Many patients have comorbidities that reduce osseous healing rates, and the limited space and high weightbearing demand placed on fusion sites makes the choice of bone graft, bone graft substitute, or orthobiologic agent of utmost importance. In this review, we discuss the essential characteristics of grafts, including their osteoconductive, osteoinductive, osteogenic, and angiogenic properties. Autologous bone graft remains the gold standard and contains all these properties. However, the convenience and lack of donor site morbidity of synthetic bone grafts, allografts, and orthobiologics, including growth factors and allogenic stem cells, has led to these being used commonly as augments.
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Affiliation(s)
- Jonathan R. Peterson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Fangyu Chen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Eugene Nwankwo
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Travis J. Dekker
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samuel B. Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Taz M, Makkar P, Imran KM, Jang D, Kim YS, Lee BT. Bone regeneration of multichannel biphasic calcium phosphate granules supplemented with hyaluronic acid. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 99:1058-1066. [DOI: 10.1016/j.msec.2019.02.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/31/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
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34
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Jiang L, Liu Z, Cui Y, Shao Y, Tao Y, Mei L. Apigenin from daily vegetable celery can accelerate bone defects healing. J Funct Foods 2019. [DOI: 10.1016/j.jff.2019.01.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Coriaty N, Pettibone K, Todd N, Rush S, Carter R, Zdenek C. Titanium Scaffolding: An Innovative Modality for Salvage of Failed First Ray Procedures. J Foot Ankle Surg 2018; 57:593-599. [PMID: 29331289 DOI: 10.1053/j.jfas.2017.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Indexed: 02/03/2023]
Abstract
Shortening of the first ray is a potential complication associated with first metatarsal procedures. Correction of this deformity conventionally has required the use of a tricortical bone graft to lengthen the bone. Graft complications, including donor site morbidity, poor graft stability, and graft resorption, have revealed a need for an alternative procedure. The present report shows that titanium cage scaffolding has lower extremity applications beyond its previous uses in the ankle and spine. Two patients underwent surgical correction for failed first ray procedures using a titanium cage apparatus with a calcaneal autograft and other biologic agents. The scaffolds were appropriately sized to fill the defect. Patients remained non-weightbearing until radiographic evidence of healing appeared. Success was determined by diminished pain, a return to activity, ambulation, and patient satisfaction. Patients exhibited faster-than-anticipated healing, including a return to protected weightbearing activities and increased stability within 6 weeks. Titanium cage implants provide long-term stability and resistance to stress and strain in the forefoot. The implant we have described, newly applied to the first ray, is analogous to a system used in salvage of failed ankle replacements. In addition to reducing reliance on the iliac crest bone graft, the titanium cage apparatus is advantageous because it is customized to fill a defect using computed tomography scanning, thereby reducing graft failure secondary to an improper shape. These cases demonstrate the potential beneficial applications for titanium cages in failed first ray reconstruction.
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Affiliation(s)
- Natalie Coriaty
- Fourth-year Student, California School of Podiatric Medicine, Oakland, CA
| | | | - Nicholas Todd
- Attending Physician, Chief of Surgical Services, Camino Division, Palo Alto Medical Foundation, Mountain View, CA.
| | - Shannon Rush
- Attending Physician, Chief of Foot and Ankle Surgery, Palo Alto Medical Foundation, Mountain View, CA
| | - Ryan Carter
- Fellow, Palo Alto Medical Foundation, Mountain View, CA
| | - Colin Zdenek
- Fellow, Palo Alto Medical Foundation, Mountain View, CA
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Magnus MK, Iceman KL, Roukis TS. Living Cryopreserved Bone Allograft as an Adjunct for Hindfoot Arthrodesis. Clin Podiatr Med Surg 2018; 35:295-310. [PMID: 29861013 DOI: 10.1016/j.cpm.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Hindfoot arthrodesis is a frequently performed procedure by foot and ankle surgeons. The relatively high nonunion rate associated with these procedures has led surgeons to use adjunctive bone graft to help augment osseous union. Cellular bone allografts are a specific type of graft that incorporates osteoconductive, osteoinductive, and osteogenic properties while also eliminating the common disadvantages of autografts and traditional allografts. This article discusses the role of cellular bone allografts in hindfoot arthrodesis procedures, a review of current literature, and a comparison of available products.
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Affiliation(s)
- Mark K Magnus
- Gundersen Medical Foundation, Mail Stop: CO3-006A, 1900 South Avenue, La Crosse, WI 54601, USA
| | - Kelli L Iceman
- Gundersen Medical Foundation, Mail Stop: CO3-006A, 1900 South Avenue, La Crosse, WI 54601, USA
| | - Thomas S Roukis
- Orthopaedic Center, Gundersen Healthcare System, Mail Stop: CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA.
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37
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Autologe matrixinduzierte Chondrogenese am Sprunggelenk. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-017-0176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Li X, Xu Y, Zhu Y, Xu X. Surgical treatment for diffused-type giant cell tumor (pigmented villonodular synovitis) about the ankle joint. BMC Musculoskelet Disord 2017; 18:450. [PMID: 29137617 PMCID: PMC5686795 DOI: 10.1186/s12891-017-1824-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/09/2017] [Indexed: 12/30/2022] Open
Abstract
Background Diffused-type giant cell tumor(Dt-GCT) is a rare, aggressive disorder of the joint synovium, bursa and tendon sheaths. Osseous erosions and subchondral cysts may develop as the result of synovium infiltration in Dt-GCT. We present a retrospective study of a series of patients who are diagnosed with Dt-GCT about the ankle joint, there clinical outcome is evaluated in this study. Material and method Fifteen patients with radiologically and histologically confirmed Dt-GCT about the ankle joint were identified in our foot and ankle department. Patients were managed with open synovectomy for the tumor tissue and bone grafting for bony erosions. X-rays and MRI scans were used for evaluation of the tumor and bony erosions pre- and post-operatively. Pre- and post-operative ankle function was assessed using the American Orthopedic Foot and Ankle Society –Ankle and Hindfoot (AOFAS-AH) score and the Muscularskeletal Tumor Society (MSTS) score. Results The mean follow-up duration was 37.4 months (range 25 to 50 months). There were 6 males and 9 females, with a mean age of 35 years old (range 18 to 65 years). All patients had talar erosion with the average size of 10.1*9.1*8.2 mm, distal tibia was affected in 5 patients with the average size of 6.2*5.6*5.8 mm. 7 patients had tendon involvement, 2 patients had recurrence and progression of ankle osteoarthritis. Both of them underwent ankle fusion. At the time of last follow-up, the mean AOFAS-AH score increased from 49 to 80 points (p < 0.05), the MSTS score increased from 12 to 22 points (p < 0.05). Conclusion For Dt-GCT with bony erosions, open synovectomy combined with bone grafting seems to be a safe and effective operation for the salvage of ankle joint. Fusion is recommended for failed and severe cartilage destruction of the ankle joint.
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Affiliation(s)
- Xingchen Li
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China
| | - Yang Xu
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China
| | - Yuan Zhu
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China
| | - Xiangyang Xu
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China.
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