Abstract
Long bone defects represent a clinical challenge. Bone tissue engineering (BTE) has been developed to overcome problems associated with conventional methods. The aim of this study was to assess the BTE strategies available in preclinical and clinical settings and the current evidence supporting this approach. A systematic literature screening was performed on PubMed database, searching for both preclinical (only on large animals) and clinical studies. The following string was used: “(Scaffold OR Implant) AND (Long bone defect OR segmental bone defect OR large bone defect OR bone loss defect).” The search retrieved a total of 1573 articles: 51 preclinical and 4 clinical studies were included. The great amount of preclinical papers published over the past few years showed promising findings in terms of radiological and histological evidence. Unfortunately, this in vivo situation is not reflected by a corresponding clinical impact, with few published papers, highly heterogeneous and with small patient populations. Several aspects should be further investigated to translate positive preclinical findings into clinical protocols: the identification of the best biomaterial, with both biological and biomechanical suitable properties, and the selection of the best choice between cells, GFs, or their combination through standardized models to be validated by randomized trials.
Highlights
Traumatic long bone defects still represent a clinical challenge for orthopaedic surgeons
Other options could be the treatment with allografts or xenografts, but some disadvantages have been reported for these methods, such as immune rejection, slow and only partial integration, absorption and substitution with new bone, graft sequestration, and failures [9]
autologous bone grafting (ABG) has been widely used for the treatment of long bone defects with a high success rate reported to range between 70 and 95%, a 50% failure rate has been reported [74, 75]
Summary
Traumatic long bone defects still represent a clinical challenge for orthopaedic surgeons. A critical size defect requires invasive surgical procedures to reconstitute the structural integrity of the collapsed bone. This does not provide fully satisfactory results entailing a significant socioeconomic burden [1, 2]. Despite all recent innovations in bone repair techniques, autologous bone grafting (ABG) is still considered the “gold standard” treatment for long bone defects. Other options could be the treatment with allografts or xenografts, but some disadvantages have been reported for these methods, such as immune rejection, slow and only partial integration, absorption and substitution with new bone, graft sequestration, and failures [9]
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