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D'Arienzo A, Ipponi E, Ruinato AD, De Franco S, Colangeli S, Andreani L, Capanna R. Proximal Humerus Reconstruction after Tumor Resection: An Overview of Surgical Management. Adv Orthop 2021; 2021:5559377. [PMID: 33828866 PMCID: PMC8004366 DOI: 10.1155/2021/5559377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023] Open
Abstract
Proximal humerus is one of the anatomical sites that are most frequently involved by bone and soft tissue malignant tumors. Alone or in association with adjuvant treatments, surgery represents the main therapeutic option to treat and eradicate these diseases. Once the first-line option, in the last decades, amputation lost its role as treatment of choice for the large majority of cases in favor of the modern limb sparing surgery that promises to preserve anatomy and-as much as possible-upper limb functionality. Currently, the main approaches used to replace proximal humerus after a wide resection in oncologic surgery can be summarized in biological reconstructions (allografts and autografts), prosthetic reconstructions (anatomic endoprostheses, total reverse shoulder prostheses), and graft-prosthetic composite reconstructions. The purpose of this overview is to present nowadays surgical options for proximal humerus reconstruction in oncological patients, with their respective advantages and disadvantages.
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Affiliation(s)
- Antonio D'Arienzo
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Edoardo Ipponi
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | | | - Silvia De Franco
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Simone Colangeli
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Lorenzo Andreani
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
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Abstract
Orthobiologics are a group of biological materials and substrates that promote bone, ligament, muscle, and tendon healing. These substances include bone autograft, bone allograft, demineralized bone matrix, bone graft substitutes, bone marrow aspirate concentrate, platelet-rich plasma, bone morphogenetic proteins, platelet-derived growth factor, parathyroid hormone, and vitamin D and calcium. Properties of orthobiologics in bone healing include osteoconduction, osteoinduction, and osteogenesis. This article discusses the important properties of orthobiologics in bone healing, many of the orthobiologics currently available for bone healing, the related literature, their current clinical uses in sports medicine, and systemic factors that inhibit bone healing.
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Affiliation(s)
- Jacob G Calcei
- Department of Sports Medicine and Shoulder, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA.
| | - Scott A Rodeo
- Department of Sports Medicine and Shoulder, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
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Hall DJ, Turner TM, Urban RM. Healing bone lesion defects using injectable CaSO 4 /CaPO 4 -TCP bone graft substitute compared to cancellous allograft bone chips in a canine model. J Biomed Mater Res B Appl Biomater 2018; 107:408-414. [PMID: 29663638 DOI: 10.1002/jbm.b.34132] [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] [Received: 01/19/2018] [Revised: 03/16/2018] [Accepted: 03/23/2018] [Indexed: 12/12/2022]
Abstract
CaSO4 /CaPO4 -TCP bone graft substitute has been shown to be effective for treatment of bone lesion defects, but its mechanical, histological, and radiographic characteristics have not been studied in direct comparison with a conventional treatment such as cancellous allograft bone. Thirteen canines had a critical-size axial defect created bilaterally into the proximal humerus. CaSO4 /CaPO4 -TCP bone graft substitute (PRO-DENSE™, Wright Medical Technology) was injected into the defect in one humerus, and an equal volume of freeze-dried cancellous allograft bone chips was placed in the contralateral defect. The area fraction of new bone, residual graft, and fibrous tissue and the compressive strength and elastic modulus of bone within the defects were determined after 6, 13, or 26 weeks and correlated with radiographic changes. The data were analyzed using Friedman and Mann-Whitney tests. There was more bone in defects treated with the CaSO4 /CaPO4 -TCP bone graft substitute compared to defects treated with cancellous bone allograft at all three time points, and the difference at 13 weeks was significant (p = 0.025). The new bone was significantly stronger and stiffer in defects treated with the CaSO4 /CaPO4 -TCP bone graft substitute compared to defects treated with cancellous bone allograft at 13 (p = 0.046) and 26 weeks (p = 0.025). At 26 weeks, all defects treated with CaSO4 /CaPO4 -TCP bone graft substitute demonstrated complete healing with new bone, whereas healing was incomplete in all defects treated with cancellous allograft chips. The CaSO4 /CaPO4 -TCP bone graft substitute could provide faster and significantly stronger healing of bone lesions compared to the conventional treatment using freeze-dried cancellous allograft bone. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 408-414, 2019.
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Affiliation(s)
- Deborah J Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Thomas M Turner
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Robert M Urban
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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Abstract
Orthobiologics are biologic devices or products used in orthopedic surgery to augment or enhance bone formation. The use of orthobiologics in pediatric orthopedics is less frequent than in other orthopedic subspecialties, mainly due to the naturally abundant healing potential and bone formation in children compared with adults. However, orthobiologics are used in certain situations in pediatric orthopedics, particularly in spine and foot surgery. Other uses have been reported in conjunction with specific procedures involving the tibia and pelvis. The use of bioabsorable implants to stabilize children's fractures is an emerging concept but has limited supporting data.
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Affiliation(s)
- Robert F Murphy
- Department of Orthopaedics, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 708, Charleston, SC 29492, USA.
| | - James F Mooney
- Department of Orthopaedics, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 708, Charleston, SC 29492, USA
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Abstract
Orthobiologics are biological substances that allow injured muscles, tendons, ligaments, and bone to heal more quickly. They are found naturally in the body; at higher concentrations they can aid in the healing process. These substances include autograft bone, allograft bone, demineralized bone matrix, bone morphogenic proteins, growth factors, stem cells, plasma-rich protein, and ceramic grafts. Their use in sports medicine has exploded in efforts to increase graft incorporation, stimulate healing, and get athletes back to sport with problems including anterior cruciate ligament ruptures, tendon ruptures, cartilage injuries, and fractures. This article reviews orthobiologics and their applications in pediatric sports medicine.
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Affiliation(s)
- Christopher C Bray
- Pediatric Orthopaedic Surgery and Adolescent Sports Medicine, Department of Orthopaedic Surgery, Steadman Hawkins Clinic of the Carolinas, Greenville Health System, 701 Grove Road, Greenville, SC 29605, USA; University of South Carolina School of Medicine - Greenville, Greenville, SC, USA.
| | - Clark M Walker
- Department of Orthopaedic Surgery, Greenville Health System, 701 Grove Road, Greenville, SC 29605, USA
| | - David D Spence
- Department of Orthopaedic Surgery, University of Tennessee - Campbell Clinic, 1400 South Germantown Road, Germantown, Memphis, TN 38138, USA
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Aly LAA, Hammouda NI. Evaluation of implant stability simultaneously placed with sinus lift augmented with putty versus powder form of demineralized bone matrix in atrophied posterior maxilla. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.fdj.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pennington EC, Dionigi B, Gray FL, Ahmed A, Brazzo J, Dolinko A, Calderon N, Darrah T, Zurakowski D, Nazarian A, Snyder B, Fauza DO. Limb reconstruction with decellularized, non-demineralized bone in a young leporine model. ACTA ACUST UNITED AC 2015; 10:015021. [PMID: 25668190 DOI: 10.1088/1748-6041/10/1/015021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Limb salvage from a variety of pathological processes in children is often limited by the unavailability of optimal allograft bone, or an appropriate structural bone substitute. In this study, we sought to examine a practical alternative for pediatric limb repair, based on decellularized, non-demineralized bone grafts, and to determine whether controlled recellularization prior to implantation has any impact on outcome. Growing New Zealand rabbits (n = 12) with a complete, critical-size defect on the left tibiofibula were equally divided into two groups. One group received a decellularized, non-demineralized leporine tibiofibula graft. The other group received an equivalent graft seeded with mesenchymal stem cells labeled with green fluorescent protein (GFP), at a fixed density. Animals were euthanized at comparable time points 3-8 weeks post-implantation. Statistical analysis was by the Student t-test and Fisher's exact test (P < 0.05). There was no significant difference in the rate of non-union between the two groups, including on 3D micro-CT. Incorporated grafts achieved adequate axial bending rigidity, torsional rigidity, union yield and flexural strength, with no significant differences or unequal variances between the groups. Correspondingly, there were no significant differences in extracellular calcium levels, or alkaline phosphatase activity. Histology confirmed the presence of neobone in both groups, with GFP-positive cells in the recellularized grafts. It was shown that osseous grafts derived from decellularized, non-demineralized bone undergo adequate remodeling in vivo after the repair of critical-size limb defects in a growing leporine model, irrespective of subsequent recellularization. This methodology may become a practical alternative for pediatric limb reconstruction.
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Affiliation(s)
- Elliot C Pennington
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Tarafder S, Dernell WS, Bandyopadhyay A, Bose S. SrO- and MgO-doped microwave sintered 3D printed tricalcium phosphate scaffolds: mechanical properties and in vivo osteogenesis in a rabbit model. J Biomed Mater Res B Appl Biomater 2014; 103:679-90. [PMID: 25045131 DOI: 10.1002/jbm.b.33239] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/18/2014] [Accepted: 06/05/2014] [Indexed: 11/09/2022]
Abstract
The presence of interconnected macro pores allows guided tissue regeneration in tissue engineering scaffolds. However, highly porous scaffolds suffer from having poor mechanical strength. Previously, we showed that microwave sintering could successfully be used to improve mechanical strength of macro porous tricalcium phosphate (TCP) scaffolds. This study reports the presence of SrO and MgO as dopants in TCP scaffolds improves mechanical and in vivo biological performance. We have used direct three dimensional printing (3DP) technology for scaffold fabrication. These 3DP scaffolds possessed multiscale porosity, that is, 3D interconnected designed macro pores along with intrinsic micro pores. A significant increase in mechanical strength, between 37 and 41%, was achieved due to SrO and MgO doping in TCP as compared with pure TCP. Maximum compressive strengths of 9.38 ± 1.86 MPa and 12.01 ± 1.56 MPa were achieved by conventional and microwave sintering, respectively, for SrO-MgO-doped 3DP scaffolds with 500 μm designed pores. Histomorphological and histomorphometric analysis revealed a significantly higher osteoid, bone and haversian canal formation induced by the presence of SrO and MgO dopants in 3DP TCP as compared with pure TCP scaffolds when tested in rabbit femoral condyle defect model. Increased osteon and thus enhanced network of blood vessel formation, and osteocalcin expression were observed in the doped TCP scaffolds. Our results show that these 3DP SrO-MgO-doped TCP scaffolds have the potential for early wound healing through accelerated osteogenesis and vasculogenesis.
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Affiliation(s)
- Solaiman Tarafder
- W.M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, Washington, 99164
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Tarafder S, Davies NM, Bandyopadhyay A, Bose S. 3D printed tricalcium phosphate scaffolds: Effect of SrO and MgO doping on in vivo osteogenesis in a rat distal femoral defect model. Biomater Sci 2013; 1:1250-1259. [PMID: 24729867 PMCID: PMC3979641 DOI: 10.1039/c3bm60132c] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The presence of interconnected macro pores is important in tissue engineering scaffolds for guided tissue regeneration. This study reports in vivo biological performance of interconnected macro porous tricalcium phosphate (TCP) scaffolds due to the addition of SrO and MgO as dopants in TCP. We have used direct three dimensional printing (3DP) technology for scaffold fabrication followed by microwave sintering. Mechanical strength was evaluated by scaffolds with 500 µm, 750 µm, and 1000 µm interconnected designed pore sizes. Maximum compressive strength of 12.01 ± 1.56 MPa was achieved for 500 µm interconnected designed pore size Sr-Mg doped scaffold. In vivo biological performance of the microwave sintered pure TCP and Sr-Mg doped TCP scaffolds was assessed by implanting 350 µm designed interconnected macro porous scaffolds in rat distal femoral defect. Sintered pore size of these 3D printed scaffolds were 311 ± 5.9 µm and 245 ± 7.5 µm for pure and SrO-MgO doped TCP scaffolds, respectively. These 3D printed scaffolds possessed multiscale porosity, i.e., 3D interconnected designed macro pores along with intrinsic micro pores. Histomorphology and histomorphometric analysis revealed a significant increase in osteoid like new bone formation, and accelerated mineralization inside SrO and MgO doped 3D printed TCP scaffolds as compared to pure TCP scaffolds. An increase in osteocalcin and type I collagen level was also observed in rat blood serum with SrO and MgO doped TCP scaffolds compared to pure TCP scaffolds. Our results show that these 3D printed SrO and MgO doped TCP scaffolds with multiscale porosity contributed to early healing through accelerated osteogenesis.
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Affiliation(s)
- Solaiman Tarafder
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Pullman, WA 99164, USA
| | - Neal M. Davies
- Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University, Pullman, WA 99164, USA
| | - Amit Bandyopadhyay
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Pullman, WA 99164, USA
| | - Susmita Bose
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Pullman, WA 99164, USA
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Mladenov K, Deimling UV. [Bone substitution materials in therapy of cystic tumors of the immature skeleton]. DER ORTHOPADE 2013; 42:1048-53. [PMID: 24158388 DOI: 10.1007/s00132-012-2050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The primary goal in the treatment of cystic bone tumors in children is the restoration of bone integrity and normal function. It is assumed that filling of the cavity defect after removal of the tumor will facilitate bone healing. In order to reduce the complications observed with autografts and allografts use bone graft substitutes were developed. The current literature review shows that the application of substances with potential immunogenic, toxic or cancerogenic properties should be avoided. Among the purely synthetic mineral materials, tricalcium phosphate has the biochemical properties most compatible with new bone formation and calcium phosphate cements can be used to provide immediate stability in cases of existing or imminent fractures. However, there is currently insufficient evidence that the use of bone grafts or bone graft substitutes provides a real benefit to the patient, especially in comparison with no graft at all. Prospective randomized studies are necessary in order to delineate the indications for bone grafting or use of bone graft substitutes for the treatment of cystic bone tumors in children.
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Affiliation(s)
- K Mladenov
- Abteilung für Kinderorthopädie, Asklepios Klinik Sankt Augustin, Arnold-Janssen-Str. 29, 53757, Sankt Augustin, Deutschland,
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e318280c6c2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The use of bone grafts and bone graft substitutes in pediatric orthopaedics: a molecular mechanism. J Pediatr Orthop 2012; 32:e81. [PMID: 23147637 DOI: 10.1097/bpo.0b013e318266fb1a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31826b35c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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