Combination of bone marrow aspirate, cancellous bone allograft, and platelet-rich plasma as an alternative solution to critical-sized diaphyseal bone defect: A case series

Dwikora Novembri Utomo,Kukuh Dwiputra Hernugrahanto,Mouli Edward,Lukas Widhiyanto,Ferdiansyah Mahyudin

doi:10.1016/j.ijscr.2019.04.028

Dwikora Novembri Utomo, Kukuh Dwiputra Hernugrahanto + Show 3 more

Open Access

https://doi.org/10.1016/j.ijscr.2019.04.028

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Abstract

Introduction: Nonunion due to a critical-sized bone defect is a complicated problem. The healing process must fulfill three mandatory elements of osteogenesis, osteoinduction, and osteoconduction. One ideal source to provide an abundant number of osteogenic cells is from the process of the culture of bone marrow stem cells which demands the availability of processing facility. Unfortunately, this sophisticated option is not always feasible in every hospital in low-income to middle-income countries. We tried to fulfill the requirement of osteogenic cells by using simple and cost-effective bone marrow aspirate. We presented two cases of critical-sized diaphyseal bone defect treated with the combination of bone marrow aspirate, cancellous bone allograft, and platelet-rich plasma (PRP).Presentation of cases: The defect sizes were five and six centimeters in humerus and tibia respectively. We applied a combination of bone marrow aspirate, cancellous bone allograft, and PRP to promote bone healing in the defect sites. Both patients have achieved the good clinical and radiological outcome.Discussion: Critical-sized bone defects require the application of tissue engineering. Aspirated bone marrow can be used as a more affordable option to provide the element of osteogenic cells in bone healing. Combined with cancellous bone allograft and PRP, they fulfill the required ingredients to promote bone regeneration.Conclusion: Bone defects remain one of the most challenging conditions to treat in orthopedic. There are many options to treat the defect but the fundamental prerequisites of cells, scaffolds and growth factors for healing have developed into the concept of tissue engineering: osteogenesis, osteoinduction, and osteoconduction.

Highlights

Nonunion due to a critical-sized bone defect is a complicated problem
The ability to provide a graft for the large bone defect is hindered by the absence of osteogenesis and osteoinduction elements [4,6]
The objective of this report is to present the clinical application of the concept of tissue engineering as an alternative to treating bone defect

Summary

Introduction

Nonunion due to a critical-sized bone defect is a complicated problem. The healing process must fulfill three mandatory elements of osteogenesis, osteoinduction, and osteoconduction. One ideal source to provide an abundant number of osteogenic cells is from the process of the culture of bone marrow stem cells which demands the availability of processing facility. This sophisticated option is not always feasible in every hospital in low-income to middle-income countries. There is no agreed term on how much is a critical-sized bone defect but a “critical-sized” defect may be regarded as one that would not heal spontaneously despite surgical stabilization and requires further surgical intervention. The ability to provide a graft for the large bone defect is hindered by the absence of osteogenesis and osteoinduction elements [4,6]

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Discussion

Conclusion