Abstract
The Masquelet induced-membrane technique for the treatment of segmental bone defects includes a two-stage surgical procedure, and polymethylmethacrylate (PMMA) plays a major role in the treatment. However, the PMMA spacer must be surgically removed. Here, we investigated the potential of poly(lactic-co-glycolic acid) (PLGA) nanofibers, a biodegradable material to replace the PMMA spacer, allowing the bioactive membrane to be induced and the spacer to degrade without the additional surgery on a rabbit femoral segmental bone defect model. PLGA nanofibers were shown to degrade completely six weeks after implantation in the investigated animals, and a thick membrane was found to circumferentially fold around the segmental bone defects. Results from image studies demonstrated that, in the group without the bone graft, all studied femurs exhibited either nonunion or considerable malunion. In contrast, the femurs in the bone graft group had a high union rate without considerable deformities. Histological examinations suggested that the membranous tissue in this group was rich in small blood vessels and the expression of BMP2 and VEGF increased. Our results demonstrate that the biodegradable PLGA nanofibers may be useful for replacing the PMMA spacer as the bioactive-membrane inducer, facilitating the process of healing and removing the need for repeated surgeries.
Highlights
Segmental bone defects may be a result of trauma, tumor resection, or the sequelae of osteomyelitis, and their management remains challenging for orthopedic surgeons [1, 2]
We examined the effectiveness of the poly(lactic-co-glycolic acid) (PLGA) nanofibers used in the Masquelet technique for the induction of a periosteum-like bioactive membrane and the reparation of the segmental bone defects
Our results demonstrated that the bioactive membrane can be successfully induced by the application of the biodegradable material tested here, PLGA, which was shown to be accompanied by the expression of growth factors such as BMP2 and VGEF
Summary
Segmental bone defects may be a result of trauma, tumor resection, or the sequelae of osteomyelitis, and their management remains challenging for orthopedic surgeons [1, 2]. Two approaches have been commonly employed for the treatment of segmental bone defects. The transplantation of vascularized autologous bone graft [2,3,4] has been commonly used; the donor site morbidity from the autologous fibula graft, including infection and stress fracture, remains as the main concern. The second approach is the bone transport with distraction osteogenesis by the Ilizarov ring fixator, which is a standard procedure for the management of segmental bone defect applied by experienced surgeons in some medical institutes [5,6,7]. Various complications, including pin tract infection, failure of the transported bone consolidation, and nonunion at the docking site, have been reported [8, 9]
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