Diaphyseal Bone Research Articles

The etiology and pattern distribution of closed long bone diaphyseal fractures: A prospective survey in a regional trauma center Enugu, Nigeria

Extremity injuries have attained a significant position in musculoskeletal trauma. This study aims to describe the pattern of closed long bone diaphyseal fractures in acute trauma setting. A prospective study of patients who presented at the trauma unit of National Orthopaedic Hospital Enugu over a 6months period was undertaken. Sixty two patients with closed long bone diaphyseal fractures of femur, tibia and humerus who consented and met the study inclusion criteria were prospectively included and evaluated. Data was analyzed using the Statistical Package for the Social Sciences version 20. A total of 2880 patients presented during the period of study out of which, 62 (37 males and 25 females) presented with closed long bone diaphyseal fractures giving an incidence of 21.5/1000 trauma unit attendance (and occurring mostly in males 32.1/1000). The 21-30years age group distribution were the mostly affected (35.5%) with closed long bone diaphyseal fracture at presentation. Motor vehicular accident was the leading cause of closed long bone diaphyseal fractures (66.7%) followed by tricycle accident (19.4%) and assault (1.9%), the least. Transverse fractures (40.3%) were the most common fracture pattern followed by the comminuted fracture (27.4%), The anatomic location of fractures in diaphyseal long bones of the humerus, femur and tibia did not show any significant difference (p<0.05). With transverse and comminuted fracture being the commonest fracture patterns distribution and motor vehicular accidents the leading cause, these could be of a guide for orthopaedic surgeons to decide on the best interventional approach and to improve functional outcome.

Clinical characteristics and identification of a novel TGFB1 variant in three unrelated Chinese families with Camurati-Engelmann disease.

BackgroundTo investigate the clinical characteristics and molecular diagnosis of Camurati‐Engelmann disease (CAEND) in Chinese individuals.MethodsWe recruited six patients aged 14 to 45 years in three unrelated families with CAEND, including five females and one male. Clinical manifestations, biochemical tests, and radiographic examinations were analyzed. The TGFB1 gene variants were further identified by Sanger sequencing. In addition, one female patient was followed up for 5 years.ResultsThe onset age of the patients ranged from 1 to 6 years. All of them had family histories and consisted of an autosomal dominant inheritance pattern. Gait disturbance, fatigue, progressive bone pain, muscle atrophy, and weakness were the main complaints. Laboratory examinations revealed that the inflammatory markers were at high levels, in addition to the increased bone metabolism indicators. The thickened diaphysis of long bones and the narrowed medullary cavity was observed by radiography. Furthermore, bone scintigraphy detected abnormal symmetrical radioactive concentrations in the affected regions of bone. Sanger sequencing identified a missense heterozygous variant in exon 4 of the TGFB1 gene in families 1 and 2, resulting in Arg218Cys, which confirmed CAEND. Moreover, one novel variant c.669C > G in exon 4 of the TGFB1 gene harboring Cys223Trp was detected in family 3. Subsequent bioinformatics software predicted that the novel variant was pathogenic. Of interest, III:2 in family 3 experienced heart valve defects and tachycardia at birth, which had never been reported in CAEND patients before. Moreover, the response to drug treatment is also full of contradictions and is worthy of further study.ConclusionBesides the typical CAEND manifestations, the new phenotypic characteristics of tachycardia and heart valve defects were first reported in one woman carrying the novel variant p.Cys223Trp in TGFB1 the gene. In addition, we demonstrated that increased bone metabolism indicators and inflammatory markers may possess auxiliary diagnosis for CAEND.

A Comparative study between Different Treatment Modalities of Floating Knee injury At Aswan University Hospital

Purpose: The study aimed at presenting a comparison between the modalities of treatment different of floating knee injury at Aswan University Hospital. Materials and Methods: This study is a prospective study including all of our 20 cases of floating knee injuries who were treated utilizing various treatment modalities at Aswan University Hospital between December 2018 and September 2019 with a follow-up period of 12 months Results: Based on the data analysis, nailing is a better modality in floating knee injury (especially with diaphyseal long bone). Moreover, plating is a good choice for distal fractures, the external fixator is considered a choice for limb saving(as in popliteal ischemia, open fractures(OG3), and compartment syndrome). Conclusion: Management of floating knee injury is critical as floating knee injury is not like other fractures. Floating knee injuries are serious injuries with a high rate of complications. Besides being caused by high-energy trauma with extensive skeletal and soft tissue damage, they are also associated with potentially life-threatening injuries of the head, chest, and abdomen. There are multiple controversies in surgical management starting from choosing suitable fixation for each patient according to variable conditions. Floating knee injury remains a challenging orthopedic problem in which regaining good knee function outcome is a major concern. Stable osteosynthesis to achieve rigid fixation and early mobilization should always be attempted.

Ageing attenuates bone healing by mesenchymal stem cells\xa0in a microribbon hydrogel\xa0with a murine long bone critical-size defect model

BackgroundDespite the high incidence of fractures and pseudoarthrosis in the aged population, a potential role for the use of mesenchymal stem cells (MSCs) in the treatment of bone defects in elderly patients has not been elucidated. Inflammation and the innate immune system, including macrophages, play crucial roles in the differentiation and activation of MSCs. We have developed lentivirus-transduced interleukin 4 (IL4) over-expressing MSCs (IL4-MSCs) to polarize macrophages to an M2 phenotype to promote bone healing in an established young murine critical size bone defect model. In the current study, we explore the potential of IL4-MSCs in aged mice.MethodsA 2 mm femoral diaphyseal bone defect was created and fixed with an external fixation device in 15- to 17-month-old male and female BALB/c mice. Microribbon (µRB) scaffolds (Sc) with or without encapsulation of MSCs were implanted in the defect sites. Accordingly, the mice were divided into three treatment groups: Sc-only, Sc + MSCs, and Sc + IL4-MSCs. Mice were euthanized six weeks after the surgery; subsequently, MicroCT (µCT), histochemical and immunohistochemical analyses were performed.ResultsµCT analysis revealed that bone formation was markedly enhanced in the IL4-MSC group. Compared with the Sc-only, the amount of new bone increased in the Sc + MSCs and Sc + IL4-MSC groups. However, no bridging of bone was observed in all groups. H&E staining showed fibrous tissue within the defect in all groups. Alkaline phosphatase (ALP) staining was increased in the Sc + IL4-MSC group. The Sc + IL4-MSCs group showed a decrease in the number of M1 macrophages and an increase in the number of M2 macrophages, with a significant increase in the M2/M1 ratio.DiscussionIL4 promotes macrophage polarization to an M2 phenotype, facilitating osteogenesis and vasculogenesis. The addition of IL4-MSCs in the µRB scaffold polarized macrophages to an M2 phenotype and increased bone formation; however, complete bone bridging was not observed in any specimens. These results suggest that IL4-MSCs are insufficient to heal a critical size bone defect in aged mice, as opposed to younger animals. Additional therapeutic strategies are needed in this challenging clinical scenario.

Staged correction trajectory with hexapod external fixator for the satisfactory reduction of long bone shaft fracture

BackgroudWhen the reduction of long bone shaft fracture fragments is performed by a hexapod external fixator, the collision and interference between bony ends often results in an incomplete reduction and a time-consuming procedure. The purpose of this study was to present and determine the clinical effectiveness of staged correction trajectory with hexapod external fixator in the reduction of a long bone shaft fracture.MethodsA total of 57 patients with tibial shaft fractures treated by hexapod external fixator were retrospectively analyzed from June 2016 to February 2020. Thirty-one cases (Group I) underwent a conventional one-step reduction trajectory from June 2016 to July 2018. Starting in September 2018, the other twenty-six patients (Group II) underwent staged correction trajectory (three key points reduction trajectory of “distraction-derotation-reduction”). The demographic data, residual deformities before and after correction, number of repeated X-rays after the first postoperative X-ray, duration of deformity correction process, and external fixation time were analyzed. Johner-Wruhs criteria were used to evaluate the final clinical outcomes.ResultsAll the 57 patients achieved satisfactory fracture reduction and bone union. There were no significant differences between the two groups in demographic data, residual deformities before and after correction, external fixation time, and final clinical outcomes (p > 0.05). The average number of repeated X-rays after the first postoperative X-ray and mean duration of deformity correction process in Group II (1.3 times, 2.9 days) were all less than those in Group I (2.3 times, 5.1 days) (p < 0.05).ConclusionCompared with the conventional one-step reduction trajectory, there is no differences in final clinical outcomes, but the staged correction trajectory provides less repeated X-rays and shorter reduction process duration.

A Pain in the Neck: An Adolescent with Neck Pain.

A Pain in the Neck: An Adolescent with Neck Pain.

The role of Meteorin-like in skeletal development and bone fracture healing.

Meteorin-like protein (Metrnl), homologous to the initially identified neurotrophic factor Meteorin, is a secreted, multifunctional protein. Here we used mouse models to investigate Metrnl's role in skeletal development and bone fracture healing. During development Metrnl was expressed in the perichondrium and primary ossification center. In neonates, single cell RNA-seq of diaphyseal bone demonstrated strongest expression of Metrnl transcript by osteoblasts. In vitro, Metrnl was osteoinductive, increasing osteoblast differentiation and mineralization in tissue culture models. In vivo, loss of Metrnl expression resulted in no change in skeletal metrics in utero, at birth, or during postnatal growth. Six-week-old Metrnl-null mice displayed similar body length, body weight, tibial length, femoral length, BV/TV, trabecular number, trabecular thickness, and cortical thickness as littermate controls. In 4-month-old mice, lack of Metrnl expression did not change structural stiffness, ultimate force, or energy to fracture of femora under 3-point-bending. Last, we investigated the role of Metrnl in bone fracture healing. Metrnl expression increased in response to tibial injury, however, loss of Metrnl expression did not affect the amount of bone deposited within the healing tissue nor did it change the structural parameters of healing tissue. This work identifies Metrnl as a dispensable molecule for skeletal development. However, the osteoinductive capabilities of Metrnl may be utilized to modulate osteoblast differentiation in cell-based orthopedic therapies.

Forearm Plate Fixation: Should Plates Be Removed?

Refracture after both bone forearm fracture fixation may vary with or without plate removal. We tested the null hypothesis that there is no difference in the rate of refracture in patients who have undergone open reduction and internal fixation of a diaphyseal forearm bone who have retained implants versus removed implants. We also studied factors associated with plate removal. We retrospectively identified 645 adult patients with a total of 925 primary fractures that underwent primary plate fixation of an ulnar or radial shaft fracture between 2002 and 2015 at a single institutional system. Patients with nonunion, pathological fracture or infection were excluded. Independent factors associated with refracture and plate removal were identified using multivariable analysis. Refractures occurred in 6.3% of the fractures that had forearm implant removal, compared to 2.1% of the fractures with retained plates. Refractures were independently associated with plate removal (OR: 3.7, 95% CI: 1.2-11.7, P=0.023) and was more frequent in the radius (OR: 2.4, 95% CI: 1.0-5.8, P=0.06). A refracture after implant removal occurred within 3 months after removal. Ulnar plates were removed more often compared to radial plates (OR: 2.6, 95% CI: 1.4-4.7, P=0.002) as were plates used for type A fractures compared to type C fractures (OR: 3.2, 95% CI: 1.1-9.2, P=0.032). The rate of refracture is higher after plate removal compared to patients who did not have plates removed. Although uncommon, refractures of the radius tend to be more common than a refracture of the ulna. If the implant is symptomatic on the ulnar side, it may be preferable to remove the ulnar implant and retain the radius implant rather than remove both plates when possible. Furthermore, limiting strenuous activity for three months after implant removal is a consideration.

Treatment of Posttraumatic Tibial Diaphyseal Bone Defects: A Systematic Review and Meta-Analysis.

To describe evidenced-based treatment options for patients who sustained trauma and/or posttraumatic osteomyelitis of the tibia resulting in diaphyseal bone defects and to compare outcomes between patients treated with nonvascularized bone grafts (NBGs), bone transport (BT), or vascularized bone grafts (VBGs). The Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data and Cochrane guidelines were followed. PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, and CINAHL were searched from inception to June 2020. Patients who were ≥18 years, had sustained trauma to the tibia resulting in fracture and/or osteomyelitis with measurable diaphyseal bone defects, and were treated by interventions such as NBGs, BT, or VBGs were eligible. Excluded studies were non-English, reviews, nonreviewed literature, cadavers, animals, unavailable full texts, nondiaphyseal defects, atrophic nonunions, malignancy, and replantations. A total of 108 studies were included with 826 patients. Two reviewers systematically/independently screened titles/abstracts, followed by full texts to ensure quality, accuracy, and consensus among authors for inclusion/exclusion of studies. A third reviewer addressed disagreements if investigators were unable to reach a consensus. Studies were quality assessed using "Methodological Quality and Synthesis of Case Series and Case Reports". Analyses were performed with IBM SPSS version 25.0 (IBM Corporation, Armonk, NY) and G*Power3.1.9.2. NBGs may be considered first line for trauma defect sizes ≤ 10 cm or posttraumatic osteomyelitis defect sizes <5 cm. BT may be considered first line for posttraumatic osteomyelitis defect sizes <5 cm. VBGs may be considered first line for trauma and posttraumatic osteomyelitis defect sizes ≥5 cm. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

THE DOG FEMORAL OSTEOBLAST NUMBER POST TRANSPLANTATION OF DEMINERALIZED PORCINE CORTICAL BONE XENOGRAFT

The xenograft function in fracture healing is as osteoinduction. Osteoinduction is stimulated by factors present in the graft material including proteins and growth factors. Proteins and growth factors contained in the graft material are related to the process of osteoblast formation. This study aims to determine the amount of osteoblasts in bone fractures post-transplantation demineralized porcine cortical bone xenograft. Eight males dog aged 3-4 months were used in this study, which was divided into 2 groups at random. Group I is 2 dogs is used as a control, the dog on the diaphysis of the femur bone is drilled with a diameter of 1 cm without graft material. Group II is 6 dog on diaphisis femur bone drilled with a diameter of 1 cm and given Demineralized Porcine Cortical Bone Xenograft. Femoral bone was biopsied at 4th and 8th weeks postoperative for histologically processed and stained with hematoxylin-Eosin. The results showed that the number of osteoblasts in the group given demineralized porcine cortical bone xenograft was higher than the control group. There was no statistically significant difference in the number of osteoblasts between groups (P&gt; 0.05). In conclusion, demineralized porcine cortical bone xenograft can increase the number of osteoblast cells in the bone healing process but the increase is not significant.

Cemented Versus Hybrid Technique of Fixation of the Stemmed Revision Total Knee Arthroplasty: A Literature Review.

Stems are required during revision total knee arthroplasty to bypass damaged periarticular bone and transfer stress to healthier diaphyseal bone. The mode of stem fixation, whether fully cemented or hybrid, remains controversial. Improvements in surgical technique and implant and instrument technology have improved our ability to deal with many of the challenges of revision total knee arthroplasty. Recent publications that reflect contemporary practice has prompted this review of literature covering the past 20 years to determine whether superiority of one fixation mode over the other can be demonstrated. We reviewed single studies of each type of fixation, studies directly comparing both types of fixation, systematic reviews, international registry data, and studies highlighting the pros and cons of each mode of stem fixation. Based on the available literature, we conclude that using both methods of fixation carries comparable outcomes with marginal superiority of the hybrid fixation method, which is of nonstatistical significance, although on an individual case basis, all fixation methods should be kept in mind and the appropriate method implemented when suitable.

Recurrent Bilateral Lower Motor Neuron Type of Facial Palsy with Hearing Impairment: Hyperphosphatemic Familial Tumoral Calcinosis.

Hyperphosphatemic familial tumoral calcinosis (HFTC) presents with varied neurological manifestations that have been reported in the literature like facial palsy, vision and hearing impairment, stroke, and headache. In this article, we reported a 12-year-old girl child patient with recurrent facial weakness with bilateral hearing impairment and multiple ulcerative lesions on lower limbs and elbows. On examination, she had lower motor neuron (LMN) facial palsy with conductive hearing loss. The investigations showed hyperphosphatemia (9.3 mg/dL) with normal serum calcium (10.4 mg/dL), alkaline phosphatase (147.9 U/L), parathyroid hormone (23.12 pg/mL), and renal function tests. Elevated serum calcium and phosphorus product (96.72 mg 2 /mL 2 ) and elevated renal tubular reabsorption of phosphate (TMPxGFR) value (9.16) were noted. Skeletal survey showed hyperostosis in the long bone diaphysis, vertebrae, ribs, pelvic bone, skull, and facial bones with narrowing of cranial ostium, characteristically without any peri-articular soft tissue calcifications. An angiogram showed multiple intravascular calcifications. She was managed with a low-phosphate diet, sevelamer, niacinamide, acetazolamide, sucroferric oxyhydroxide to lower serum phosphate level, and topical sodium thiosulfate ectopic cutaneous calcification. Exome sequencing showed novel homozygous inframe deletion of ACG in FGF23 gene exon 3 at c.374_376 delins position (p. Asp125del) in the proband and a mutation in the heterozygous state in the mother and elder sibling, thus confirming a molecular diagnosis of HFTC. Our case had a unique neurological presentation of recurrent bilateral lower motor nerve facial palsy, hearing loss, multiple ectopic cutaneous calcifications without peri-articular deposits, multiple intravascular, intracranial, and vertebral endplate calcification, which has not been reported earlier. The proband showed a novel pathogenic variant suggesting an expanding phenotype of HFTC.

“Ewing's Sarcoma of Calcaneum” an uncommon tumor in an unusual site with skip metastasis: An enigma

Ewing's sarcoma (EWS) is an uncommon primary malignant tumor of the bone, mostly affects 5–25 years of age with male predominance. Diaphysis of the long bone is usual site of origin with occasional extraskeletal extension. However, it is extremely rare (3%–5%) in the small bones of the hand and feet, hence often misinterpreted as osteomyelitis, aneurysmal bone cyst, giant cell tumor, cartilagenous tumor and osteosarcoma; delaying definitive treatment. Metastasis of calcaneal EWS is common, and prognosis is dismal. Multimodality treatment approach is the standard care rendered for it. Herein, we report such a case of EWS in a 12-year-old girl child at an unusual site of calcaneum with skip metastasis for which the diagnosis and treatment was deferred by 5 months. Only after histopathology and immunohistochemistry confirmation, the definitive chemotherapy was provided and surgery was scheduled after five cycles of chemotherapy. The patient is now on chemotherapy and followed up till today.

Epithelioid Hemangioma of Bone: A Rare Vascular Neoplasm. A Case Report and Literature Review

Epithelioid hemangioma (EH) of bone is a rare benign, albeit locally aggressive vascular neoplasm. It is usually solitary and involves the metaphysis or diaphysis of long tubular bones, especially in the lower extremities. Rarely it may present as multifocal lesions. The differential diagnosis includes malignant vascular bone tumors such as epithelioid hemangioendothelioma and epithelioid angiosarcoma. Clinical presentation and radiographic and histological findings are not specific and diagnosis is based mostly on immunohistochemical and molecular studies. There is no consensus regarding the optimal treatment. Curettage and bone grafting or en bloc resection are the current treatment options, however local recurrence have been reported. We present a case of multifocal EH of the distal tibia, distal fibula and hindfoot in a 38 year-old male managed with curettage, radiofrequency ablation and cement osteoplasty. The imaging features, histological findings and treatment options of this rare vascular tumor are discussed.

Salmonella Osteomyelitis and Septic Arthritis in Children

Salmonella infections of the bone and joints are very rare. They are common in hemoglobinopathies and immunocompromised children. The diaphysis and metaphysis of the long bones are common sites. The spine pelvis, ribs, and cranium are rare sites. The clinical course is indolent compared to acute osteomyelitis. Serological tests and culture can be used for the diagnosis. Radiographs are frequently negative early in the disease. CT scans and MRI scans can be used in certain cases. The majority of cases can be managed with antibiotics. In this review, we describe the etiology, clinical features, investigations, and management of Salmonella bone and joint infections. We have described the features of Salmonella bone and joint infections in normal and sickle disease patients. We also present an illustrative case of Salmonella septic arthritis of the shoulder in an immunocompetent infant one month after COVID-19 infection.

Mechanics and morphology of destruction of the diaphysis of long tubular bones of the lower extremities under various types of external influences by blunt solid objects

The purpose of the study is to develop forensic criteria for determining the mechanisms of fractures of long tubular bones of the lower extremities subjected to dynamic (impact) and static (compression) impacts with blunt objects, in relation to road traffic injury and falling from a height. The morphological characteristics of damages to the long tubular bones of the lower extremities under shock and compression loading of the extremities of biomannequins at various structural levels were studied. Objective morphological qualitative and quantitative criteria for fractures under various types of loading are revealed based on the analysis of the morphological characteristics of a fracture and in the depth of the compact bone layer. Based on the data obtained, models for diagnosing the type of external influence were developed.

Outcome of Plate Augmentation in Management of Tibial Nonunion After Intramedullary Nailing

<i>Background:</i> Despite the multitude of studies on non union no clear criterion has been established for declaring a fracture as non united. A diagnosis of non union is unjustified, however, until clinical or radiographic evidence shows that healing has ceased and that union is highly improbable. A fracture of the shaft of a long bone should not be considered a non union until at least 6 months after the injury. The incidence of non union in the long bone varies with each bone and with methods of treating acute fractures. More recently, the tibia probably is the most frequent site of non union. Nonunion following intramedullary fixation of tibial fractures is a challenge. Although reamed exchange nailing results are encouraging with union rates, exchange nailing could be extremely challenging due to situations when nail removal is difficult. Augmentation plates gained popularity in management of femoral nonunion with few reports in tibial nonunion. The aim of the current study is to present our results in augmentation plate in management of tibial nonunion with intramedullary nail. <i>Patient and methods:</i> From 2017 till 2021, 20 cases of nonunited tibial fractures fixed by IM nails was included. Augmentation plate without removing the nail in addition of autogenous iliac graft. <i>Results:</i> Union was obtained in all the cases (20 cases) in an average time of about 6.22 months (range 3-12 months). Complications are few included 3 casea of superficial infection and parasthesia at iliac graft site. <i>Conclusion:</i> Plate augmentation without removal of IM nail is a good option in management of aseptic nonunion tibia with excellent results and few complications.

Universal Long Bone Defect Classification

Introduction: Treatment of long bone defects is a challenging problem in orthopedics that requires a robust and comprehensive classification system to guide diagnosis and management. The Universal Long Bone Defect Classification (ULBDC) is an alphanumeric system detailing the size and location of the defect. It is designed to describe the bone defect and indicate the appropriate treatment for both diaphyseal and articular long bones defects. Methods: The location, size, and morphology of the bone defect are the main criteria used in the treatment of both extra-articular and intra-articular bone defects. The proposed classification system utilizes the following nomenclature for both periarticular defects and diaphyseal defects: location (bone and segment) and morphology (type, group, and subgroup). Discussion: The ULBDC is based the same principles of coding as the “gold standard” AO/OTA Fractures Classification system with alpha-numeric coding “from simple to complex.” The choice of treatment method depends on the type, group, and subgroup of the defect as described. The principles of treatment of diaphyseal defects, as well as the principles of treatment of extra-articular fractures, are based on the restoration of the alignment, length, and rotation of the segment. Bone shortening and deformity are considered bone defects because their treatment requires the use of the same principles (osteotomies, bone grafting, bone transport, or combination of these methods) as treating real bone defects. Conclusion: The proposed classification is an attempt to classify all types of long bone defects and its use in clinical practice and research will allow for optimal and standardized treatments for the various types of bone defects to improve the treatment outcomes.

Induced Membrane Technique for Reconstruction of a 25 cm Humerus Diaphyseal Defect Secondary to Chronic Osteomyelitis in an Adolescent

The surgical treatment of long bone defects in septic environments remains a challenge for any orthopedic surgeon. The two-stage reconstruction technique described by Masquelet AC is a better alternative in our regions where expertise in microsurgical techniques is rare. We report our first experience with this technique through the reconstruction of the humeral diaphyseal bone defect. We presented a 12-year-old boy diagnosed with chronic osteomyelitis of the left humerus with sequestrum, a pathologic fracture with overly joint involvement. The first stage consisted of a sequestrectomy removing the entire humerus shaft (25 cm) with conservation of the humerus paddle followed by the implantation of cement spacer into the bone defect and stabilization with 2 Kirschner wires (22/10th) and a thoraco-brachial cast. Eleven months later, we performed a cancellous autograft associated with a free non-vascularised fibula graft (12 cm). The bone corticalisation was obtained after 11 months. At the 43-month follow-up, despite joint stiffness and unequal length of brachial segments, the patient and his parents were satisfied.

Decellularized xenogenic bone graft for repair of segmental bone defect in rabbits.

Bone grafting is a preferred treatment option for the healing of large diaphyseal bone defects and is useful in the management of nonunion, delayed union, and tumor resection. To investigate a decellularization protocol of bovine cancellous bone for xenogenic implantation in radial bone defects in rabbits. Bovine bone scaffolds fabricated with various decellularization protocols viz phosphate buffer saline (PBS), 1% sodium dodecyl sulfate (SDS), and rapid freeze and thaw technique. The manufactured scaffolds were characterized by biomechanical testing, histological staining, and scanning electron microscopy. A 10 mm rabbit radius bone defect was repaired with autograft and SDS treated and rapid freeze and thaw in groups A, B, and C respectively. Healing was evaluated by radiography and histopathology at 0, 30, 60, and 90 days. The grafts were also checked for host tissue reaction and incorporation into the defect. The freeze and thaw group showed complete elimination of all cellular nuclei, regular arrangement of collagen fiber, and no significant difference in tensile strength compared to 1% SDS treated and native groups. The in vivo radiographic and histopathological study showed that the rapid freeze and thaw group had complete bridging of the bone gap defect with new bone formation and they were immunologically less reactive compared to group B. The in vitro and in vivo evaluation of the grafts suggested that freeze and thaw technique was most superior to all other techniques for effective decellularization and augmentation of bone healing with better integration of the graft into the host.