Abstract
The Masquelet technique is used to treat large bone defects; it is a two-stage procedure based on an induced membrane. To improve the induced membrane process, demineralized bone matrix in granular (GDBM) and fibrous form (f-DBM) was tested with and without bone marrow mononuclear cells (BMC) as filling of the membrane against the gold standard filling with syngeneic cancellous bone (SCB). A total of 65 male Sprague–Dawley rats obtained a 5 mm femoral defect. These defects were treated with the induced membrane technique and filled with SCB, GDBM, or f-DBM, with or without BMC. After a healing period of eight weeks, the femurs were harvested and submitted for histological, radiological, and biomechanical analyses. The fracture load in the defect zone was lower compared to SCB in all groups. However, histological analysis showed comparable new bone formation, bone mineral density, and cartilage proportions and vascularization. The results suggest that f-DBM in combination with BMC and the induced membrane technique cannot reproduce the very good results of this material in large, non-membrane coated bone defects, nevertheless it supports the maturation of new bone tissue locally. It can be concluded that BMC should be applied in lower doses and inflammatory cells should be removed from the cell preparation before implantation.
Highlights
Bone defects of critical size due to tumor resections, osteomyelitis, or trauma are a huge challenge for surgeons and patients [1]
Bars represent 5 mm, dotted line defect zone, Cor = corticalis. In this animal experimental study, the effect of fibrous bone marrow mononuclear cells (BMC)-populated demineralized bone matrix (f-DBM) in combination with the induced membrane technique (Masquelet technique) on bone defect healing after 8 weeks of healing time using the 5 mm femoral defect of the SD rat was analyzed in comparison to DBM granules and syngeneic cancellous bone
Histological analysis showed comparable new bone formation, bone mineral density, and cartilage proportions and vascularization in all groups compared with the cancellous bone group
Summary
Bone defects of critical size due to tumor resections, osteomyelitis, or trauma are a huge challenge for surgeons and patients [1]. The critical size in a bone defect is defined as either a bone loss greater than “50% of the circumference of the particular bone” [2] or a defect in a bone that “will not heal during the lifetime [ . ] or a defect that shows less than. To treat these defects correctly, different surgical and biomedical approaches are available. Restricted bone volume at the donor site and donor site morbidity such as long-lasting pain are described [5]. To avoid these limitations, various procedures have been developed.
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