Allogeneic Bone Grafts Research Articles

The effect of radiotherapy, chemotherapy, and immunotherapy on fusion rate in spinal surgery using osteobiologics for patients with metastatic spinal disease: a systematic review.

To evaluate the impact that adjuvant therapies like radiotherapy, chemotherapy, and immunotherapy have on osteobiologic properties and bony regeneration in patients with metastatic spine disease (MSD) undergoing spinal fusion surgery. PubMed and ClinicalTrials.gov searches were performed. MSD patients undergoing fusion surgery with an osteobiologic and radiotherapy, chemotherapy and/or immunotherapy were included. Demographics, primary tumor, surgery, adjuvant treatments, osteobiologic type, fusion rates with scoring criteria, hardware failure, reoperation rates, follow-up, and survival were extracted. 1487 studies were screened, 20 included. 585 patients (464 with MSD) had fusion rates ranging from 17.9 to 100%. In the setting of radiotherapy, fusion rates of 10 studies using autologous bone graft (autograft), 5 studies using allogenic bone graft (allograft), 5 studies using combination autograft/allograft, 4 studies using biomaterial scaffolds (BMS), 3 studies using demineralized bone matrices (DBM), and 1 study using growth factors (GF), were 50-100%, 17.9-100%, 57.8-100%, 52.9-100%, 20-100%, and 100%, respectively. A higher incidence of fusion in patients with autograft or allograft receiving stereotactic body radiotherapy (SBRT) at lower biologically effective doses (BED) and at least 1-month postoperatively was noted. Chemotherapy had no impact on fusion. No studies evaluated the impact of immunotherapy on fusion. SBRT at lower doses given greater than 1-month postoperatively may enhance bony fusion in patients receiving autograft, allograft, or autograft/allograft. Chemotherapy may delay bony fusion without affecting overall fusion rates. Preclinical studies suggest immunotherapy may prevent osteolysis and promote osteogenesis, but no studies have yet evaluated the clinical impact of these findings on spinal fusion. Further research is needed on osteobiologics in bony regeneration in the MSD population.

Enhanced alveolar ridge preservation with hyaluronic acid-enriched allografts: a comparative study of granular allografts with and without hyaluronic acid addition

PurposeRidge preservation is essential to restore alveolar ridge volume and to enhance esthetic and functional outcomes for dental implants. The addition of hyaluronic acid to allogeneic bone substitute materials might enhance these outcomes. This clinical study evaluated the efficacy of ridge preservation after tooth extraction using granular allografts with and without hyaluronic acid addition.MethodsIn this retrospective study, 40 patients with compromised extraction sockets were enrolled. Among them, 19 received particulate allogeneic bone substitutes (Allo), 21 received allogeneic bone substitutes with hyaluronic acid (AlloHya). Vertical and horizontal graft stability, graft shrinkage rate, and bone mineral density were assessed using radiographic measurements on CBCT scans conducted before tooth extraction, directly after ridge preservation and after four months. Patients were followed up 12 months post-implantation.ResultsVertical height loss after 4 months was significantly greater in the Allo group (-0.82 ± 0.95 mm) compared to the AlloHya group (-0.19 ± 0.51 mm; p = 0.011). Graft shrinkage rate was 16.9 ± 11.5% (Allo) and 10.3 ± 7.7% (AlloHya) (p = 0.038). After four months, average bone density was significantly higher in the AlloHya compared to the Allo group (p = 0.004). Nearly all implants (39 out of 40) were classified as “Success” according to the ICOI scheme, with no differences in implant quality between the two study groups.ConclusionsImproved graft stability, reduced resorption, and increased bone density were observed in hyaluronic acid-enriched allografts compared to pure allografts. Adding hyaluronic acid to allogeneic bone grafts significantly enhanced outcomes in ridge preservation.

Use of tricortical iliac crest allograft for augmentation of depressed lateral tibial plateau fracture: a surgical technique.

Lateral tibial plateau fractures with significant articular depression and metaphyseal comminution in the setting of osteoporosis are challenging to manage. The subchondral bone defect and capacious cancellous void after surgical elevation of the articular surface is usually filled with nonstructural graft such as autologous cancellous bone graft, allogenic cancellous bone graft, or bone graft substitutes. Reports have shown a high rate of subsidence with these grafts when patients start to bear weight and ultimately failure of the construct. Structural grafts demonstrated stronger mechanical properties and lower subsidence rates. The purpose of this note is to describe a novel surgical technique using structural tricortical iliac crest allograft for the treatment of osteoporotic depressed lateral tibia plateau fracture.

THE ROLE OF PERICYTES IN BONE TISSUE REGENERATION AND THERAPEUTIC APPLICATIONS

The regeneration of massive bone defects poses a significant challenge in traumatology and orthopedics, often requiring bone grafting procedures following tumor resection, surgery, or severe injury. Current treatment methods include autologous and allogeneic bone grafts, as well as bone substitutes. While autologous transplantation is considered the standard, it is limited by donor site morbidity and availability. Allogeneic transplantation presents risks such as graft rejection and disease transmission. Bone substitutes may not fully restore bone defects. Tissue-engineered biomaterials offer promise for effective regeneration, utilizing stem cells, growth factors, and scaffolds. Adipose tissue, rich in mesenchymal stem cells and perivascular stem cells (pericytes), is a promising cell source for tissue engineering. This thesis explores the therapeutic potential of pericytes combined with various biological carriers and stimulating factors to enhance bone tissue regeneration. Pericytes, contractile cells surrounding small blood vessels, are crucial for vessel integrity and blood flow regulation. They express markers like α-SMA and PDGFR-β and participate in angiogenesis, immune function, and tissue repair. Interactions with endothelial cells via signaling pathways involving molecules like VEGF and TGF-β are vital for vessel formation and stability. With their multipotent nature, pericytes show promise for regenerative medicine. Ongoing research is essential to address challenges in pericyte biology, including identification and understanding their roles in tissue regeneration. Studies highlight the potential of adipose tissue-derived pericytes in bone regeneration, particularly CD146+ pericytes, showing efficacy in spinal fusion and nonunion fracture treatment when combined with DBM. Preclinical studies confirm their effectiveness, especially when incorporated into various scaffold materials. Clinical studies using adipose-derived stem cells and autologous microfragmented adipose tissue have shown promise, with pericyte-enriched fractions holding potential for improved outcomes. Future research into pericyte application, combined with growth factors and scaffolds, could significantly advance bone tissue regeneration and regenerative medicine. Human pericytes show promise for bone tissue regeneration due to their mesenchymal stem cell properties and role in vascular stabilization. Injectable hydrogels are crucial for bone tissue engineering, with various biomaterials developed for this purpose. Studies using injectable hydrogels with pericytes have demonstrated their efficacy in accelerating bone regeneration in different models. Further advancements in injectable hydrogel technology incorporating stem cells and osteoinductive factors are needed for more efficient bone tissue restoration.

Radiologic and Histological Evaluation of Allogenic Bone graft Blocks in Bounded Anterior Maxillary Alveolar Ridge Defects

Radiologic and Histological Evaluation of Allogenic Bone graft Blocks in Bounded Anterior Maxillary Alveolar Ridge Defects

Biomechanical Evaluation of the Osseointegration Levels of Implants Placed Simultaneously With Tibia, Femur, and Jaw Allogeneic Bone Grafts.

In implant-supported prosthetic treatments, the jaw bones may not always have enough bone to accommodate implants. Allogeneic grafts can also be preferred as an alternative to autogenous grafts in cases of vertical and horizontal bone deficiencies. The aim of this study is to evaluate the osseointegration levels of lathe-faced titanium implants placed together with allogeneic bone tissue transplants obtained from tibia, femur, and mandible bones using a biomechanical method. Twenty-eight female Sprague Dawley rats were included in the study. The subjects were divided into groups where bone transplantations were performed together with implant placement from the tibia (n=7), femur (n=7), and lower jaw (n=7) regions. Four rats (left and right) were used as donors. Grafts, along with implants, were surgically placed in the corticocancellous part of the metaphyseal parts of the tibia bones of rats. At the end of the 2-week experimental setup, all rats were killed, and the implants and surrounding bone tissues were subjected to biomechanical reverse torque analysis (N/cm), no statistical difference was detected in terms of bone-implant fusion between the groups in which the femur and tibia bones were transplanted (P>0.05), while the bone-implant fusion value in the group in which the lower jaw bone was transplanted was found to be statistically higher than the femur and tibia bones (P<0.05). Based on the limited results of this study, it can be thought that the lower jaw allogeneic jawbone has a higher osseointegration potential than allogeneic grafts obtained from the femur and tibia.

MgO-enhanced β-TCP promotes osteogenesis in both in vitro and in vivo rat models

Allogeneic bone grafts are used to treat bone defects in orthopedic surgery, but the osteogenic potential of artificial bones remains a challenge. In this study, we developed a β-tricalcium phosphate (β-TCP) formulation containing MgO, ZnO, SrO, and SiO2 and compared its bone-forming ability with that of β-TCP without biological elements. We prepared β-TCP discs with 60% porosity containing 1.0 wt% of these biological elements. β-TCP scaffolds were loaded with bone marrow-derived mesenchymal stem cells (BMSC) from 7-week-old male rats and cultured for 2 weeks. ALP activity and mRNA expression of osteogenic markers were evaluated. In addition, scaffolds were implanted subcutaneously in rats and analyzed after 7 weeks. In vitro, the MgO group showed lower Ca concentrations and higher osteogenic marker expression compared to controls. In vivo, the MgO group showed higher ALP activity compared to controls, and RT-qPCR analysis showed significant expression of BMP2 and VEGF. Histopathology, fluorescent immunostaining, and micro-CT also showed relatively better bone formation in the MgO group. β-TCP with MgO may enhance bone morphology in vitro and in vivo and improve the prognosis of patients with substantial and refractory bone defects.

Clinical and Histological Efficacy of Digitally Designed CAD CAM Allogenic Bone Blocks. A Prospective Cohort.

The growth in bone reconstructive surgery has been unsurpassed in recent decades. However, most bone regenerative products lack any potential for delivering site-specific morphologically driven augmentation. It was therefore the purpose of this study to evaluate the histological and clinical incorporation of a novel CAD CAM allogenic block bone graft for the reconstruction of complex 3- dimensional alveolar defects. In addition the clinical outcome of dental implants subsequently placed and loaded within these grafts was assessed with up to 5 years in function. Results demonstrated that 4 of the initial 17 blocks failed (23.5%). The remaining 13 blocks plus an additional two replacement blocks were fully or partially incorporated within the recipient bone site (79%). Of the 29 implants placed within the integrated blocks, no failures occurred with up to 5 years in function, with a recorded mean marginal bone loss by implant of -0.5mm.

Establishing a bone bank within a hospital setting in India: early insights from a tertiary care center in Northern India-a review article.

When addressing bone defects resulting from trauma, infection, or tumors, the use of allogenic bone is often necessary. While autografts are considered the standard, they have limitations and can lead to donor site morbidity. Consequently, there has been exploration into the feasibility of utilizing allogenic bone and bone graft replacements. Allogenic bone transplants are acquired from donors following rigorous procurement, sterile processing, and donor screening procedures. To ensure the safe storage and effective utilization of allograft material, a bone banking system is employed. Establishing and managing an orthopedic bone bank, entails navigating complex legal and medical organizational aspects. This paper examines the establishment and operation of bone banks in India, drawing upon our first-hand experience in managing one at a tertiary care center in Northern India.Level of evidence: Level IV.

Impression fracture of the lateral condyle of tibial plateau complicated by acute peri-implant infection: a case report

Introduction. Deep infection after open osteosynthesis of tibial plateau fractures occurs in 9.9%. This rate is significantly higher than in surgical treatment of closed injuries of other localizations. Many authors consider it necessary to improve management protocols for patients with complex plateau fractures in order to minimize or prevent the development of infectious complications. Aims of the study: 1) to discuss the treatment tactics of a patient with an intraarticular fracture of the tibial plateau after osteosynthesis complicated by the development of early deep surgical site infection (SSI), using clinical case as an example; 2) to carry out the analysis of medical care defects. Case description. A 71-year-old patient with compromised somatic status underwent osteosynthesis with a buttress plate and allogeneic bone grafting of the metaphyseal defect on the 12th day after injury. In 7 days after the occurrence of signs of infection, a revision surgery was performed. Later, a number of consecutive revisions were performed due to recurrences of the infectious process. The complex of measures against SSI included the use of vacuum drainage systems and antibacterial spacers. As a result, the wounds had healed. Two years after the injury, the patient had a good functional result. Conclusion. The presented clinical case has shown that even if the treatment tactic for early peri-implant infection is chosen correctly, there are several defects in our routine practice. First of all, inaccurate sampling of material for bacteriological study and inadequate duration of antibacterial therapy are to be mentioned. To successfully treat infectious complications of osteosynthesis, a team of like-minded specialists including traumatologists as well as physicians, microbiologists and clinical pharmacologists is needed. Undoubtedly, surgical treatment of fractures might develop into infectious complications. Their diagnosis and treatment are often accompanied by a number of various mistakes. The most important points are early radical revision of the postoperative wound, etiotropic antibacterial therapy, maintaining stability of fixation after primary osteosynthesis. If these standards are complied with, the outcome of surgical treatment might be satisfying even with such a severe complication as peri-implant infection. At the same time, we are planning further researches aimed at improving algorithms and tactics for surgical treatment of infectious complications, reducing surgery trauma level and upgrading quality of primary osteosynthesis.

Assessment of Autogenous Tooth Dentin Graft with Allogenic Bone Graft in the Preservation of Alveolar Ridge: A Clinicoradiographic Study

Abstract Background: Alveolar ridge is dynamic in nature. Preservation of residual alveolar ridge is always desirable. Bone grafts and platelet concentrates can be used for socket preservation. Maintenance of bone volume is essential and various ridge augmentation techniques are used for desirable functional and esthetic outcomes. Aim: Evaluation and comparison of the efficacy of autogenous dentin block versus allograft block in preserving alveolar ridge dimension with 6-month follow-up. Materials and Methods: Twenty subjects indicated for tooth extraction were randomly divided into three groups. In Group I, autogenous dentin graft with platelet-rich fibrin (PRF) membrane was used as socket filling material, Group II: allogenic bone graft with PRF membrane, or Group III: control group (socket left ungrafted). Clinical and radiographic examinations were done using periodontal probe and cone-beam computed tomography. Results: On intragroup comparison of socket size, the mean for Group I was found to be 33.270 mm2 at baseline and 25.358 mm after 12 months for Group II was found to be 53.250 mm2 at baseline and socket fill was 41.875 mm2 at 12 months. Group III was found to be 43.483 mm2 at baseline, and socket fill was 15.063 mm2 at 12 months. On intergroup comparison, the values were found to be statistically nonsignificant both at baseline (12 months postoperatively. The crestal bone loss was 0.975 for Group I, 1.075 for Group II, and 2.925 mm for Group III. Crestal bone loss was seen highest in Group III and lowest for Group I. The mean percentage of socket fill was found to be 80.01% for Group I, 76.13% for Group II, and 34.03% for Group I. Conclusion: A significant amount of radiographic socket fill was appreciated over 12 months in all the three groups. The percentage of socket fill in Group I was 80.01% and in Group II was 76.13% and the difference between them was statistically nonsignificant. Statistically significant socket fill was seen for both Group 1 and Group 2.

Recent Advances in 3D Printing of Smart Scaffolds for Bone Tissue Engineering and Regeneration.

The repair and functional reconstruction of bone defects resulting from severe trauma, surgical resection, degenerative disease, and congenital malformation pose significant clinical challenges. Bone tissue engineering (BTE) holds immense potential in treating these severe bone defects, without incurring prevalent complications associated with conventional autologous or allogeneic bone grafts. Three-dimensional (3D) printing technology enables control over architectural structures at multiple length scales and has been extensively employed to process biomimetic scaffolds for BTE. In contrast to inert and functional bone grafts, next-generation smart scaffolds possess remarkable ability to mimic the dynamic nature of native extracellular matrix (ECM), thereby facilitating bone repair and regeneration. Additionally, they can generate tailored and controllable therapeutic effects, such as antibacterial or antitumor properties, in response to exogenous and/or endogenous stimuli. This review provides a comprehensive assessment of the progress of 3D-printed smart scaffolds for BTE applications. It begins with an introduction to bone physiology, followed by an overview of 3D printing technologies utilized for smart scaffolds. Notable advances in various stimuli-responsive strategies, therapeutic efficacy, and applications of 3D-printed smart scaffolds are discussed. Finally, the review highlights the existing challenges in the development and clinical implementation of smart scaffolds, as well as emerging technologies in this field. This article is protected by copyright. All rights reserved.

Guided Bone Regeneration for the Treatment of Peri-Implantitis: Clinical Case Report

Periodontal disease is characterized as an inflammatory process that damages the periodontal lining and/or support tissues. Peri-implantitis is among the periodontal alterations, being caused by bacterial biofilm causing loss of underlying bone insertion, leading to modifications in its architecture that form intraosseous defects of various types. For the treatment of peri-implantitis there are non-surgical, surgical, resective, regenerative, combined techniques and the decision-making will depend on the degree of the bone defect. Therefore, guided bone regeneration (GBR) is an efficient and simple technique for bone augmentation, which is widely used to restructure bone defects that occur in the alveolar ridge and in the peri-implant region. Biomaterials are alternatives to be used in guided bone regeneration due to their excellent biocompatibility, osteoinductive properties, low degradation rate and their hydrophilicity, which collaborates with the absorption of blood cells and proteins that will help in osseointegration. Female, 58-year-old normosistemic patient, attended a private dental office complaining of pain, bad smell, bleeding and bad taste in the peri-implant region referring to element 25, on its distal face to the mesial face of the element tooth 26. After imaging exams, periodontal probing and the patient's past history, extraction of element 26 was performed, decontamination protocol of the implant surface of 25 through mechanical, chemical and physical means performing antimicrobial photodynamic therapy and finally, a guided bone regeneration was performed, using the allogeneic bone grafting technique associated with a polytetrafluoroethylene membrane in its expanded form (e-PTFE) for recovery of the bone defect and alveolar preservation. Thus, guided bone regeneration has shown high success rates and greater predictability when well indicated and performed, making it important for the maintenance of periodontal and peri-implant health.

Comparative Studies of Bone Graft and Orthobiologics for Foot Ankle Arthrodesis: A Critical Review.

Graft materials available to supplement hindfoot and ankle arthrodesis procedures include autologous (autograft) or allogeneic bone graft (allograft) but also bone graft substitutes such as demineralized bone matrix, calcium sulfate, calcium phosphate, and tricalcium phosphate/hydroxyapatite. In addition, biologic agents, such as recombinant human bone morphogenetic protein-2 or recombinant human platelet derived growth factor-BB (rhPDGF-BB), and preparations, including platelet-rich plasma or concentrated bone marrow aspirate, have been used to facilitate bone healing in ankle or hindfoot arthrodesis. The purpose of this review was to summarize the available clinical evidence surrounding the utilization and efficacy of the above materials and biological agents in ankle or hindfoot arthrodesis procedures, with emphasis on the quality of the existing evidence to facilitate clinical decision making.

The effect of cannabinoids on single-level lumbar arthrodesis outcomes in a rat model

BACKGROUND CONTEXTThe opioid epidemic is a public health crisis affecting spine care and pain management. Medical marijuana is a potential nonopioid analgesic yet to be studied in the surgical setting since its effects on bone healing are not fully understood. Studies have demonstrated analgesic and potentially osteoinductive properties of cannabinoids with endocannabinoid receptor expression in bone tissue. PURPOSEWe hypothesize that tetrahydrocannabinol (THC) and cannabidiol (CBD) will not decrease bone healing in spinal fusion. STUDY DESIGNSeventy-eight adult Sprague-Dawley rats were used for this study. Utilizing allogenic bone grafts (6 donor rats), posterolateral inter-transverse lumbar fusion at the L4–L5 level was performed. The animals were equally divided into four treatment groups, each receiving 0.1 ml intraperitoneal injections weekly as follows: placebo (saline), 5 mg/kg THC, 5 mg/kg CBD, and a combination of 5 mg/kg THC and 5mg/kg CBD (Combo). METHODSCallus tissue was harvested 2- and 8-weeks postsurgery for qPCR assessment to quantify changes in the expression of osteogenic genes. Manual palpation was done to assess the strength of the L4–L5 arthrodesis on all rats. μCT image-based callus analysis and histology were performed. One-way ANOVA followed by post hoc comparisons was performed. RESULTSμCT demonstrated no significant differences. Treatment groups had slightly increased bone volume and density compared to control. qPCR at 2 weeks indicated downregulated RANKL/OPG ratios skewing towards osteogenesis in the CBD group, with the THC and CBD+THC groups demonstrating a downward trend (p>.05). ALPL, BMP4, and SOST were significantly higher in the CBD group, with CTNNB1 and RUNX2 also showing an upregulating trend. The CBD group showed elevation in Col1A1 and MMP13. Data at eight weeks showed ALPL, RUNX2, BMP4, and SOST were downregulated for all treatment groups. In the CBD+THC group, RANK, RANKL, and OPG were downregulated. OPG downregulation reached significance for the THC and CBD+THC group compared to saline. Interestingly, the RANKL/OPG ratio showed upregulation in the CBD and CBD+THC groups. RANKL showed upregulation in the CBD group. At 2 and 8 weeks, the CBD treatment group showed superior histological progression, increasing between time points. CONCLUSIONThis study demonstrates that CBD and THC have no adverse effect on bone healing and the rate of spinal fusion in rats. Osteogenic factors were upregulated in the CBD-treated groups at 2 weeks, which indicates a potential for bone regeneration. In this group, compared to control, the RANKL/OPG ratio at the early healing phase demonstrates the inhibition of osteoclast differentiation, enhancing bone formation. Interestingly, it shows promoted osteoclast differentiation at the later healing phase, enhancing bone remodeling. This aligns with the physiological expectation of a lower ratio in the early phases and a higher ratio in the later remodeling phases. CLINICAL SIGNIFICANCECBD and THC showed no inhibitory effects on bone healing in a spinal fusion model. Moreover, histologic and gene expression analysis demonstrated that CBD may, in fact, enhance bone healing. Further research is needed to confirm the safe usage of THC and CBD in the postoperative setting following spinal fusions.

Faster Bone Gap Union in Medial Opening Wedge High Tibial Osteotomy With 3D-Printed Synthetic Bioresorbable Polycaprolactone and Tricalcium Phosphate Osteotomy Gap Fillers Compared to Allogeneic Osteotomy Gap Fillers: A Retrospective Matched-Pair Cohort Study.

The use of synthetic bone substitute material (BSM) as osteotomy gap fillers have been reported to improve outcomes in medial opening wedge high tibial osteotomy (MOWHTO). This study aims to evaluate the early radiological outcomes (bone union) and complication rates of the novel patient-specific 3D-printed honeycomb-structured polycaprolactone and tricalcium phosphate (PCL-TCP) synthetic graft compared to allogeneic bone grafts as an osteotomy gap filler in MOWHTO. A retrospective matched-pair analysis of patients who underwent MOWHTO with either PCL-TCP synthetic graft or allogenic femoral head allograft as osteotomy gap filler was performed. The osteotomy gap was split into equal zones (Zone 1-5), and bone union was evaluated on anteroposterior radiographs based on the van Hemert classification at 1, 3, 6, and 12 months postoperatively. Postoperative complications including infection, lateral hinge fractures, and persistent pain was measured. The study and control group were matched for age, smoking status, diabetes mellitus, and osteotomy gap size. Significantly greater bone union progression was observed in the PCL-TCP group than in the allograft group at 1 month (Zones 1-3), 3 months (Zones 1-4), 6 months (Zones 1-2, 4), and 12 months (Zones 2-3, 5) postoperatively (P < 0.05). No significant difference in complications rates was noted between the two groups at 1 year. Bone union rates observed in patients who underwent MOWHTO with the PCL-TCP synthetic graft osteotomy gap filler were superior to those in the allograft group at 1 year postoperatively, with no significant difference in complication rates (postoperative infection, lateral hinge fractures, and persistent pain).

Laser-assisted synthesis of nano-hydroxyapatite and functionalization with bone active molecules for bone regeneration

The main goal of bone tissue engineering research is to replace the allogenic and autologous bone graft substitutes that can promote bone repair. Owing to excellent biocompatibility and osteoconductivity, hydroxyapatite is in extensive research and high demand for both medical and non-medical applications. Although various methods have been developed for the synthesis of hydroxyapatite, in the present study we have shown the use of nanosecond laser energy in the wet precipitation method of nano-hydroxyapatite (nHAP) synthesis without using ammonium solution or any other chemicals for pH maintenance. Here, the present study aimed to fabricate the nanohydroxyapatite using a nanosecond laser. The X-ray diffraction and Fourier transform infrared spectroscopy have confirmed the hydroxyapatite formation under laser irradiation in less time without aging. A transmission electron microscopy confirmed the nano size of synthesized nHAP, which is comparable to conventional nHAP. The length and width of the laser-assisted nHAP were found to be in the range of 50–200 nm and 15–20 nm, respectively, at various laser parameters. The crystallite size obtained by Debye Scherrer formulae was found to be in the range of ∼ 16–36 nm. In addition, laser-assisted nHAP based composite cryogel (nanohydroxyapatite/gelatin/collagen I) was synthesized and impregnated with bioactive molecules (bone morphogenic protein and zoledronic acid) that demonstrated significant osteogenic potential both in vitro in cell experiment and in vivo rat muscle pouch model (abdomen and tibia muscles). Dual-energy X-ray analysis, micro-CT, and histological analysis confirmed ectopic bone regeneration. Micro-CT based histomorphometry showed a higher amount (more than 10-fold) of mineralization for animal groups implanted with composite cryogels loaded with bioactive molecules compared to only composite cryogels groups. Our findings thus demonstrate a controlled and rapid synthetic method for the synthesis of nHAP with various physical, chemical, and biological properties exhibited as comparable to conventionally synthesized nHAP.

Bone-Regeneration Therapy Using Biodegradable Scaffolds: Calcium Phosphate Bioceramics and Biodegradable Polymers.

Calcium phosphate-based synthetic bone is broadly used for the clinical treatment of bone defects caused by trauma and bone tumors. Synthetic bone is easy to use; however, its effects depend on the size and location of the bone defect. Many alternative treatment options are available, such as joint arthroplasty, autologous bone grafting, and allogeneic bone grafting. Although various biodegradable polymers are also being developed as synthetic bone material in scaffolds for regenerative medicine, the clinical application of commercial synthetic bone products with comparable performance to that of calcium phosphate bioceramics have yet to be realized. This review discusses the status quo of bone-regeneration therapy using artificial bone composed of calcium phosphate bioceramics such as β-tricalcium phosphate (βTCP), carbonate apatite, and hydroxyapatite (HA), in addition to the recent use of calcium phosphate bioceramics, biodegradable polymers, and their composites. New research has introduced potential materials such as octacalcium phosphate (OCP), biologically derived polymers, and synthetic biodegradable polymers. The performance of artificial bone is intricately related to conditions such as the intrinsic material, degradability, composite materials, manufacturing method, structure, and signaling molecules such as growth factors and cells. The development of new scaffold materials may offer more efficient bone regeneration.

Early posterior column internal fixation: A staged treatment of type C3 tibial pilon fracture

Pilon fractures represent a challenging subset of tibial fractures. The management of AO/OTA Type C3 fractures remains complex due to associated complications and lack of clear guidelines for surgical timing and methods. A prospective cohort study was conducted to evaluate two staged treatment strategies for AO/OTA Type C3 tibial pilon fractures. The study focused on assessing surgical difficulty, complications, and patient prognosis. One group of patients received early internal fixation of the fibula and tibial posterior column combined with external fixation, while the other group received external fixation alone in the first stage. Patients who received early internal fixation of the fibula and tibial posterior column combined with external fixation had better outcomes, including lower rate of allogeneic bone grafting (67.74 % versus 94.64 %), reduced incidence of wound delay and skin necrosis (3.23 % versus 21.43 %), shorter surgical time (133.06 ± 23.99 min versus 163.04 ± 26.83 min), shorter hospital stay (13.77 ± 2.53 days versus 18.25 ± 3.67 days), and higher AOFAS (83.05 ± 8.68 versus 79.36 ± 8.92). Additionally, avoiding fibular shortening was shown to be crucial in preventing prolonged surgery and improving patient function. The study demonstrated that the staged treatment approach with early internal fixation led to shorter operative times, improved ankle function, and reduced complications, including a lower risk of infection. The findings support the use of this treatment to optimize outcomes in AO/OTA Type C3 pilon fractures.

Results of Allografts and Synthetic Grafts in Humeral Simple Bone Cysts.

Simple bone cysts (SBCs) are the most common benign bone lesions in childhood. There are many different methods in the treatment of SBCs. There is no consensus on which method to use in the treatment. In this study, we compared the results of allogeneic bone graft or synthetic bone graft in addition to fl exible intramedullary nail (FIN) for SBC located in the humerus. This retrospective study comparing the data of 19 (group 1: 8 curettage, allograft and FIN; group 2: 11 curettage, synthetic graft and FIN) patients with a mean age of 11.4 (6 to 26; seven female, twelve male) who were surgically treated in our hospital for humeral SBC between April 2014 and January 2020. Patient data included age, sex, anatomical side, stage of the cyst, pathological fracture, previous treatments and complications. The mean follow-up period was 33.7 months (12 to 61). The average last follow-up Musculoskeletal Tumor Society functional scores for groups 1 and 2 were 27.8 (20 to 30) and 28.6 (21 to 30) (P > 0.05). Complete or signifi cant partial radiographic healing rates were achieved in group 1 (75%) compared with group 2 (81.9%). The reoperation rates for groups 1 and 2 were 62.5% (5/8; three for nails removed, two for recurrence) and 36.3% (4/11; two for nails removed, two for recurrence). One patient in group 2 had a 15° varus deformity due to recurrence. No other complications were observed. The combination of curettage-grafonage FIN is a common treatment method in recent years, as it provides early cyst healing and limb mobilization in SBCs located in the upper extremity. For defects after curettage of the bone cysts, allogeneic or synthetic grafts (granule b-tricalcium phospate) which have similar results in terms of healing can be used as an alternative to each other. allografts, bone cysts, bone nails, synthetic grafts, humerus.