1
|
Tao Y, Jia M, Shao-Qiang Y, Lai CT, Hong Q, Xin Y, Hui J, Qing-Gang C, Jian-Da X, Ni-Rong B. A novel fluffy PLGA/HA composite scaffold for bone defect repair. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2024; 35:16. [PMID: 38489121 PMCID: PMC10943150 DOI: 10.1007/s10856-024-06782-2] [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: 08/26/2023] [Accepted: 01/24/2024] [Indexed: 03/17/2024]
Abstract
Treatment of bone defects remains crucial challenge for successful bone healing, which arouses great interests in designing and fabricating ideal biomaterials. In this regard, the present study focuses on developing a novel fluffy scaffold of poly Lactide-co-glycolide (PLGA) composites with hydroxyapatite (HA) scaffold used in bone defect repair in rabbits. This fluffy PLGA/HA composite scaffold was fabricated by using multi-electro-spinning combined with biomineralization technology. In vitro analysis of human bone marrow mesenchymal stem cells (BMSCs) seeded onto fluffy PLGA/HA composite scaffold showed their ability to adhere, proliferate and cell viability. Transplant of fluffy PLGA/HA composite scaffold in a rabbit model showed a significant increase in mineralized tissue production compared to conventional and fluffy PLGA/HA composite scaffold. These findings are promising for fluffy PLGA/HA composite scaffolds used in bone defects.
Collapse
Affiliation(s)
- Yuan Tao
- Department of Orthopaedics, Jinling Hospital, Nanjing university, School of Medicine, Nanjing, China
| | - Meng Jia
- Department of Orthopaedics, Jinling Hospital, Nanjing university, School of Medicine, Nanjing, China
| | - Yang Shao-Qiang
- Department of Orthopaedics, Jinling Hospital, Nanjing university, School of Medicine, Nanjing, China
| | - Cheng-Teng Lai
- Department of Orthopaedics, Jinling Hospital, Nanjing university, School of Medicine, Nanjing, China
| | - Qian Hong
- Department of Orthopaedics, Jinling Hospital, Nanjing university, School of Medicine, Nanjing, China
| | - Yu Xin
- Department of Orthopaedics, Jinling Hospital, Nanjing university, School of Medicine, Nanjing, China
| | - Jiang Hui
- Department of Orthopaedics, Jinling Hospital, Nanjing university, School of Medicine, Nanjing, China
| | - Cao Qing-Gang
- Department of Orthopaedics, Jinling Hospital, Nanjing university, School of Medicine, Nanjing, China
| | - Xu Jian-Da
- Department of Orthopaedics, Changzhou Traditional Chinese medical hospital, Changzhou hospital affiliated to Nanjing University of Chinese Medicine, Changzhou, China.
| | - Bao Ni-Rong
- Department of Orthopaedics, Jinling Hospital, Nanjing university, School of Medicine, Nanjing, China.
| |
Collapse
|
2
|
Westrick ER, Bernstein M, Little MT, Marecek GS, Scolaro JA. Orthopaedic Advances: Use of Three-Dimensional Metallic Implants for Reconstruction of Critical Bone Defects After Trauma. J Am Acad Orthop Surg 2023; 31:e685-e693. [PMID: 37384878 DOI: 10.5435/jaaos-d-22-00676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/26/2023] [Indexed: 07/01/2023] Open
Abstract
Multiple successful strategies exist for the management of critical-sized bone defects. Depending on the location and etiology of an osseous defect, there are nuances that must be considered by the treating surgeon. The induced membrane technique and various modifications of the Ilizarov method (bone transport by distraction osteogenesis) have been the most common methods for biologic reconstruction. Despite the versatility and high union rates reported, they may not be practical for every patient. The rapid expansion of three-dimensional printing of medical devices has led to an increase in their use within orthopaedic surgery, specifically in the definitive treatment of critical bone defects. This article proposes indications and contraindications for implementation of this technology and reviews the available clinical evidence on the use of custom nonresorbable implants for the treatment of traumatic bone loss. Clinical cases are presented to illustrate the scenarios in which this approach is viable.
Collapse
Affiliation(s)
- Edward R Westrick
- From the Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA (Westrick), the Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada (Bernstein), the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Little), the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Marecek), and the Department of Orthopaedic Surgery, University of California Irvine, Orange, CA (Scolaro)
| | | | | | | | | |
Collapse
|
3
|
Sheridan GA, Pang A, Page BJ, Greenstein MD, Cardoso GS, Amorim R, Rozbruch SR, Fragomen AT. The Management of Tibial Bone Defects: A Multicenter Experience of Hexapod and Ilizarov Frames. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202308000-00002. [PMID: 37535816 PMCID: PMC10402980 DOI: 10.5435/jaaosglobal-d-23-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/09/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Bone defects may be managed with bone transport or acute shortening and lengthening using circular external fixation devices. We performed a multicenter retrospective cohort study to compare the outcomes between the Ilizarov frames and hexapod frames for the management of bone defects. METHODS Patients treated for bone defects using either Ilizarov or hexapod frames were included for analysis in two specialist institutions. Primary outcomes were time to consolidation, bone healing index (BHI), and external fixator index (EFI). Radiographic parameters included the medial proximal tibial angle, lateral distal tibial angle, posterior proximal tibial angle, and anterior distal tibial angle. RESULTS There were 137 hexapods and 90 Ilizarov frames in total. The mean time to follow-up was 3.7 years in the hexapod group and 4.0 years in the Ilizarov group. Hexapods had a significantly lower time to consolidation (253 days versus 449 days) (P < 0.0001) and BHI (59.1 days/cm versus 87.5 days/cm) (P < 0.0001). Hexapods had a significantly better EFI (72.3 days/cm versus 96.1 days/cm) (P = 0.0009). CONCLUSION Hexapods may confer a significant advantage over Ilizarov frames in the management of bone defects. Time to consolidation, radiographic parameters, BHI, and EFI are all superior in hexapods.
Collapse
Affiliation(s)
- Gerard A Sheridan
- From the Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY (Dr. Sheridan, Dr. Pang, Dr. Page, Greenstein, Dr. Rozbruch, and Dr. Fragomen), and the Serviço de Ortopedia e Traumatologia, Hospital Governador Celso Ramos, Florianópolis, Brazil (Dr. Cardoso and Dr. Amorim)
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Jianmongkol S, Vinitpairot C. The 3D-Printed Titanium Truss Cage for the Treatment of Concurrent Complex Malunion, Synostosis and Large Bone Defect Following Forearm Injuries: A Case Report. J Hand Surg Asian Pac Vol 2023; 28:292-296. [PMID: 37120300 DOI: 10.1142/s2424835523720098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A 28-year-old man sustained a complex forearm injury from high-energy trauma, causing ulnar nerve injury, a bone defect, forearm malunion and synostosis. A 3D-printed titanium truss cage was used to solve these problems. This patient achieved union of the bone defect, was pain-free and had no recurrent synostosis 2 years after reconstructive surgery. The advantages of the 3D-printed titanium truss cage included anatomical fit, immediate mobilisation and low morbidity of the donor side of the bone graft. This study reported a promising result from using 3D-printed titanium truss cages to manage complex forearm bony problems. Level of Evidence: Level V (Therapeutic).
Collapse
Affiliation(s)
- Surut Jianmongkol
- Hand and Reconstructive Unit, Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chaiyos Vinitpairot
- Hand and Reconstructive Unit, Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| |
Collapse
|
5
|
Valderrama-Molina CO, Pesántez R. Fracture-Related infection - the role of the surgeon and surgery in prevention and treatment. J Orthop Surg (Hong Kong) 2022; 30:10225536221118520. [PMID: 36545936 DOI: 10.1177/10225536221118520] [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: 12/24/2022] Open
Abstract
Fracture-related infection (FRI) is a complication that impacts care costs, quality of life, and patient function. Great strides have been made in the last decade to obtain a common language for definition and diagnosis with the contribution of the Fracture-Related Infection Consensus. Although FRI treatment requires the participation of clinical specialists in infectious diseases for the management of antibiotics, it is necessary to understand that this complication is an eminently surgical pathology. The orthopedic surgeon must play a leadership role in the prevention and treatment of this complex disease. In this review, the most relevant aspects of prevention are updated, and a strategy for a sequential and comprehensive approach to the patient with this complication is presented.
Collapse
Affiliation(s)
| | - Rodrigo Pesántez
- Department of Orthopedics and Traumatology, 173061Fundación Santa Fe de Bogotá, Bogotá, Colombia
| |
Collapse
|
6
|
Huang EE, Zhang N, Ganio EA, Shen H, Li X, Ueno M, Utsunomiya T, Maruyama M, Gao Q, Su N, Yao Z, Yang F, Gaudillière B, Goodman SB. Differential dynamics of bone graft transplantation and mesenchymal stem cell therapy during bone defect healing in a murine critical size defect. J Orthop Translat 2022; 36:64-74. [PMID: 35979174 PMCID: PMC9357712 DOI: 10.1016/j.jot.2022.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 10/24/2022] Open
Abstract
Background A critical size bone defect is a clinical scenario in which bone is lost or excised due to trauma, infection, tumor, or other causes, and cannot completely heal spontaneously. The most common treatment for this condition is autologous bone grafting to the defect site. However, autologous bone graft is often insufficient in quantity or quality for transplantation to these large defects. Recently, tissue engineering methods using mesenchymal stem cells (MSCs) have been proposed as an alternative treatment. However, the underlying biological principles and optimal techniques for tissue regeneration of bone using stem cell therapy have not been completely elucidated. Methods In this study, we compare the early cellular dynamics of healing between bone graft transplantation and MSC therapy in a murine chronic femoral critical-size bone defect. We employ high-dimensional mass cytometry to provide a comprehensive view of the differences in cell composition, stem cell functionality, and immunomodulatory activity between these two treatment methods one week after transplantation. Results We reveal distinct cell compositions among tissues from bone defect sites compared with original bone graft, show active recruitment of MSCs to the bone defect sites, and demonstrate the phenotypic diversity of macrophages and T cells in each group that may affect the clinical outcome. Conclusion Our results provide critical data and future directions on the use of MSCs for treating critical size defects to regenerate bone.Translational Potential of this article: This study showed systematic comparisons of the cellular and immunomodulatory profiles among different interventions to improve the healing of the critical-size bone defect. The results provided potential strategies for designing robust therapeutic interventions for the unmet clinical need of treating critical-size bone defects.
Collapse
Affiliation(s)
- Elijah Ejun Huang
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Ning Zhang
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Edward A. Ganio
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Huaishuang Shen
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Xueping Li
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Masaya Ueno
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Takeshi Utsunomiya
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Masahiro Maruyama
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Qi Gao
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Ni Su
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Zhenyu Yao
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Fan Yang
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Brice Gaudillière
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| |
Collapse
|