Void Filler Research Articles

Doxycycline Sclerotherapy of Aneurysmal and Unicameral Bone Cysts in the Appendicular Skeleton and Pelvis: Single-Center 14-Year Experience

PurposeTo evaluate the safety, effectiveness, and patient satisfaction of doxycycline sclerotherapy for aneurysmal bone cysts (ABCs) and unicameral bone cysts (UBCs). Materials and MethodsThis was an institutional review board (IRB)–approved single-center retrospective review of all ABCs and UBCs of the appendicular skeleton and pelvis completing doxycycline sclerotherapy and having at least 2 years of follow-up from 2007 to 2021. Radiographic outcomes in a patient cohort were assessed with a modified Neer score. Patient-reported outcome (PRO) surveys were completed by a subgroup of the cohort assessing pain after treatment (Likert scale), functional outcomes (Patient-Reported Outcomes Measurement Information System), and overall patient satisfaction (adapted from the Musculoskeletal Tumor Society). ResultsSeventy-seven lesions met the inclusion criteria, with 55 (71%) receiving bone void filler in addition to doxycycline. Of the 77 lesions, 76 (99%) were successfully treated. Twelve lesions (16%) recurred but resolved with additional doxycycline treatment. One lesion failed sclerotherapy, requiring surgical excision. Of the 383 total treatments performed, 17 resulted in Society of Interventional Radiology (SIR)–classified adverse events (9 with Grade 1, 7 with Grade 2, and 1 with Grade 3). Twenty-five (32%) of the 77 cases completed PRO surveys, with 20 (80%) having little to no pain and 15 (60%) having no functional impairment after completing treatment. The PRO surveys documented high levels of satisfaction, with all patients agreeing that they would undergo doxycycline sclerotherapy again if given the option. ConclusionsDoxycycline sclerotherapy (with or without bone void filler) is a safe, effective, and well-tolerated stand-alone treatment for ABCs and UBCs.

Radiographic and Functional Outcome of Depressed Tibial Plateau Fractures Treated with Raft Plate with Bone Graft – A Prospective Study

Tibial plateau fractures are the fractures that involve the articular surface of the tibial condyles. The Schatzker and OA classifications are the most commonly used to classify these fractures. The Schatzker classification system is a widely recognized method used by orthopedic surgeons to categorize tibial plateau fractures into six distinct types. This classification helps in assessing the initial injury, planning the appropriate management strategy, and predicting the prognosis. Each type represents a different pattern of fracture, which can guide treatment decisions and expectations for recovery. These fractures typically result from the external(valgus) or internal(varus) forces on the knee with axial loading. In younger individuals, tibial plateau fractures are most commonly caused by road traffic accidents due to the high-energy impact. However, in elderly patients with osteopenic bone, even a simple fall can lead to these fractures because their bones are more fragile and susceptible to injury. The tibial plateau fractures are intra-articular fractures of the knee joint and are often difficult to treat and have a high complication rate, including early-onset osteoarthritis. Surgery is the preferred modality of treatment for these fractures, along with bone void fillers to address bone defects caused by the injury. At present, there is no consensus on the optimal method of fixation or the void filling to treat such fractures. Techniques of operative management of tibial plateau fractures have become more successful in achieving and maintaining reduction of the fracture. Still, avoiding malalignment of the limb has been shown to be at least as important as articular congruity to long-term joint viability.

Antibiotic Eluting Bone Void Filler Versus Systemic Antibiotics For Pedal Osteomyelitis

Osteomyelitis complicates 20% of patients with infected diabetic foot ulcers. In this study, two strategies for treating pedal osteomyelitis were compared in a pilot study.This was a retrospective, non-randomized, single center 2 arm cohort study, conducted between 2020-2022 involving 53 patients at a tertiary limb salvage unit. All patients were managed with debridement and proximal bone biopsy. Group A was treated with systemic antibiotics for up to 6 weeks. Group B had vancomycin or gentamycin eluting bone void filler implanted into the diseased bone medullary cavity(s) and 1 week of oral antibiotics. Patients were followed independently for the primary endpoint of osteomyelitis treatment failure and secondary endpoints of amputation free survival, wound healing, minor amputation, and treatment-limiting side-effects.Survival analysis demonstrated no significant difference in treatment failure (p=0.35) or amputation free survival (p=0.46). Limb salvage rates were 88% in Group A and 89% in Group B. Wounds healed in 85% in Group A and 89% in Group B. Minor amputations occurred in 21% in Group A and 11% in Group B. Treatment limiting side effects occurred in 6% in Group A and were absent in Group B.In conclusion, the use of antibiotic eluting bone void filler appeared safe without extended systemic antibiotics in this study. Group B had fewer intravenous lines, requirement for home nursing, and treatment limiting side effects. A larger randomized controlled trial examining longer term clinical and radiological efficacy, treatment costs and side effects is warranted. Level of Clinical EvidenceThis is a retrospective cohort study, therefore the level of clinical evidence is 2.

Development of Ductile‐Sticky Bone Fillers from Biodegradable Hydrolyzed Wool‐Keratin and Silk Fibroin

AbstractIn the present study, a method is proposed for preparing novel ductile‐sticky materials that can be used as bone void fillers using hydrolyzed wool‐keratin (WK) and silk fibroin (SF). This methodology uses citric acid as a cross‐linking agent in preparing keratin paste (KP) owing to its non‐toxicity and plasticizing properties. The Keratin paste‐silk fibroin structure (KPSF) is obtained by adding SF, which possesses biocompatible and superior mechanical properties. Methanol treatment is employed on the KPSF mixture to convert the Silk I structure in the SF to Silk II, resulting in a water‐insoluble and tightly packed proteinaceous structure. The physicochemical properties of both bioscaffolds are investigated and discussed in detail by comparison. Based on the findings, the presence of SF in the KPSF structure contributed to properties such as flexibility and porosity. In ovo CAM analysis reveals that both materials exhibit proangiogenic properties and are biocompatible. KP and KPSF bioscaffolds can be converted into ductile‐sticky forms by adding water. It believes that these forms can easily apply to bone defect areas, particularly cavitary bone defects. Furthermore, KPSF bioscaffolds, with better mechanical properties, can be considered candidates for use in non‐load‐bearing bone tissue engineering applications.

A Two-Stage Approach Integrating Provisional Biomaterial-Mediated Stabilization Followed by a Definitive Treatment for Managing Volumetric Muscle Loss Injuries.

Treatment of volumetric muscle loss (VML) faces challenges due to its unique pathobiology and lower priority in severe musculoskeletal injury management. Consequently, a need exists for multi-stage VML treatment strategies to accommodate delayed interventions owing to comorbidity management or prolonged casualty care in combat settings. To this end, polyvinyl alcohol (PVA) was used at concentrations of 5%, 7.5%, and 10% to generate provisional muscle void fillers (MVFs) of varying stiffness values (1.125 kPa, 3.700 kPa, and 7.699 kPa) to stabilize VML injuries as part of a two-stage approach. These were implanted into a rat model for a duration of 4 weeks, then explanted and either left untreated (control) or treated through minced muscle grafting (MMG). Additional benchmarks included acute MMG and unrepaired groups. At the MVF explant, the 7.5% PVA group exhibited superior neuromuscular function compared to the 5% and 10% PVA groups, the least fibrosis, and the largest median myofiber size among all groups at the 12-week endpoint. Despite the 7.5% PVA's superiority amongst the two-stage treatment groups, neuromuscular function was neither improved nor impaired relative to acute treatment benchmarks. This suggests that the future success of a two-stage VML treatment strategy will necessitate a more effective definitive intervention.

Use of shells for the mechanical stabilisation of sediments: a valuable geomechanical perspective?

The present study contributes to developing a novel eco-friendly solution for the mechanical stabilisation of dredged marine sediments by using mussel shells – another high-impact waste of marine origin – in the partial replacement of cements. What are the underlying chemo-mechanical interactions affecting the evolution of such mixtures? Can mussel shells replace cement without compromising useful geomechanical and geochemical properties of the stabilised sediments? Can such mixtures still be modelled as soils when it comes to their geotechnical design and analysis? The paper answers these questions by assessing the mechanical performance of mixtures formed by sediments stabilised with three types of cement and a mussel shell powder and comparing them with those of the same sediments treated with cement only. Multiple beneficial effects of the use of mussel shell powder, as a peculiar source of calcium carbonate from its biogenic origin, have been demonstrated: it acts as a void filler; enhances the electrolytic exchanges between sediment and cement, and increases the contact area between the mineral particles promoting the chemical hydration reactions. As a result, for fixed replacement ratios, the original mixtures still exhibit soil-like behaviour consistent with traditional geomechanics and even better performance than the control mixtures.

Ultrasonic Coating of Poly(D,L-lactic acid)/Poly(lactic-co-glycolic acid) Electrospun Fibers with ZnO Nanoparticles to Increase Angiogenesis in the CAM Assay.

Critical-size bone defects necessitate bone void fillers that should be integrated well and be easily vascularized. One viable option is to use a biocompatible synthetic polymer and sonocoat it with zinc oxide (ZnO) nanoparticles (NPs). However, the ideal NP concentration and size must be assessed because a high dose of ZnO NPs may be toxic. Electrospun PDLLA/PLGA scaffolds were produced with different concentrations (0.5 or 1.0 s of sonocoating) and sizes of ZnO NPs (25 nm and 70 nm). They were characterized by SEM, EDX, ICP-OES, and the water contact angle. Vascularization and integration into the surrounding tissue were assessed with the CAM assay in the living chicken embryo. SEM, EDX, and ICP-OES confirmed the presence of ZnO NPs on polymer fibers. Sonocoated ZnO NPs lowered the WCA compared with the control. Smaller NPs were more pro-angiogenic exhibiting a higher vessel density than the larger NPs. At a lower concentration, less but larger vessels were visible in an environment with a lower cell density. Hence, the favored combination of smaller ZnO NPs at a lower concentration sonocoated on PDLLA/PLGA electrospun meshes leads to an advanced state of tissue integration and vascularization, providing a valuable synthetic bone graft to be used in clinics in the future.

Efficacy of sintered Zinc-doped fluorapatite scaffold as an antimicrobial regenerative bone filler for dental applications

ObjectivesThe objective of this study was to assess whether zinc-doped fluorapatite (ZnFA) could serve as an effective antimicrobial dental bone filler for bone regeneration compared to autografts. MethodsFA and 2 % zinc-doped FA (2ZnFA) were synthesized and characterized in-house. Compressed and sintered FA and 2ZnFA disks were incubated with bacteria to assess antimicrobial properties. Adipose-derived stem cells were cultured on these discs to evaluate the surfaces’ ability to support cell growth and promote osteogenic differentiation. Surfaces exhibiting the highest expressions of the bone markers osteopontin and osteocalcin were selected for an in vivo study in a rat mandibular defect model. Twenty rats were divided into 5 groups, equally, and a 5 mm surgical defect of the jaw was left untreated or filled with 2ZnFA, FA, autograft, or demineralized bone matrix (DBM). At 12 weeks, the defects and surrounding tissues were harvested and subjected to microCT and histological evaluations. ResultsStandard techniques such as FTIR, ICP-MS, fluoride probe, and XRD revealed the sintered FA and ZnFA's chemical compositions and structures. Bacterial studies revealed no significant differences in surface bacterial adhesion properties between FA and 2ZnFA, but significantly fewer bacterial loads than control titanium discs (p < 0.05). Cell culture data confirmed that both surfaces could support cell growth and promote the osteogenic differentiation of stem cells. MicroCT analysis confirmed statistical similarities in bone regeneration within FA, 2ZnFA, and autograft groups. ConclusionThe data suggests that both FA and 2ZnFA could serve as alternatives to autograft materials, which are the current gold standard. Moreover, these bone fillers outperformed DBM, an allograft material commonly used as a dental bone void filler. Clinical SignificanceThe use of FA or 2ZnFA for treating mandibular defects led to bone regeneration statistically similar to autograft repair and significantly outperformed the widely used dental bone filler, DBM. Additional translational research may confirm FA-based materials as superior substitutes for existing synthetic bone fillers, ultimately enhancing patient outcomes.

Time to full weight-bearing with the use of a calcium sulfate-calcium phosphate bone substitute as a bone void filler following extended curettage in the treatment of primary benign bone tumours.

The primary objective of this study was to determine time to full weight-bearing after the use of a calcium-sulfate-calcium phosphate bone substitute (CaSO4/CaPO4) as a bone void filler in the treatment of primary benign bone tumours following intralesional curettage. The secondary objectives were to determine surgical complications and recurrence rates. Retrospective review of patients identified from a surgeon-specific orthopaedic oncology database, who underwent curettage of benign bone tumours and subsequent bone void filling with CaSO4/CaPO4. A total of 39 patients (20 males, 19 females) met inclusion criteria with an average age of 31years (range: 13 to 62years), a median follow-up of 3.7years, and a maximum follow-up of 11years. The most common tumour diagnosis was giant cell tumour of bone (GCT) (n = 19), and the most common location was the proximal tibia (n = 9). The mean volume of tumour excised was 74.1cm3 including extraosseous bone expansion due to tumour growth, with a mean of volume of 21.4mL of CaSO4/CaPO4 used to fill the intraosseous cavitary defects to restore normal bone anatomy. None of the lesions required additional internal fixation. The primary outcome measure, average time to full weight-bearing/full range of motion, was 11weeks and 6weeks for upper and lower extremity lesions, respectively. Secondary outcomes included tumour recurrence requiring reoperation in five patients and infection requiring reoperation in two patients. This study demonstrates that CaSO4/CaPO4 is a viable option as a bone void filler in the reconstruction of cavitary defects following removal of primary benign bone tumours. CaSO4/CaPO4 provides sufficient bone regeneration early in the post-operative period to allow progression to full weight-bearing within weeks without the need for internal fixation. There were no graft-specific complications noted.

Open-wedge high tibial osteotomy with and without bone void filler: Allograft leads to faster bone union and weight bearing with comparable return to work and sports rates.

To compare the clinical and radiological outcome of open-wedge high tibial osteotomy (OWHTO) with allogenous bone chips to a control group without bone void filler. The focus was on the rates and timelines of return to work (RTW) and return to sports (RTS), given the significance of these factors for the satisfaction of young and active patients. One hundred and ninety-five cases of OWHTO (112 cases with allograft vs. 83 cases without graft) with a follow-up of 17 ± 4.8 months were included in this retrospective analysis. Various metrics were investigated, including time to return to full weight bearing, RTW and RTS rates and timelines, International Knee Documentation Committee (IKDC) Score, Cincinnati-Sportsmedicine and Orthopaedic Centre Scoreand Tegner Score. The time to bone union was determined on radiographs taken at 6, 16, 28 and 53 weeks. Patients returned to full weight bearing after 8.8 ± 4.8 weeks. RTW was possible for 92.8% after 13.7 ± 12.3 weeks. 96.2% returned to sports after 22.7 ± 8.3 weeks, but the number of disciplines and workouts per week diminished (p < 0.001, p = 0.006). A shift to low-impact and recreational sports was observed. Patients with allograft filling had earlier bone union (21 ± 12.3 vs. 31.9 ± 14.2 weeks, p < 0.001) and returned faster to full weight bearing (8.2 ± 4.5 vs. 9.8 ± 5 weeks, p = 0.013). There was no difference between groups in the IKDC Score (69 ± 17.2 vs. 69.9 ± 15.2, p = 0.834), Cincinnati-Sportsmedicine and Orthopaedic Centre Score (68 ± 18.3 vs. 69.4 ± 18.2, p = 0.698) and Tegner Score (3.8 ± 1.5 vs. 4 ± 1.5, p = 0.246). Allograft filling leads to faster bone union and return to full weight bearing but showed no significant advantage in terms of RTW/RTS, overall patient satisfaction and functional scores. The decision for or against filling the osteotomy gap, therefore, remainsa case-by-case decision. Level III, Retrospective cohort study.

Intraosseous Shelf Plate Fixation for Depressed Articular Fragments in Tibial Plateau Fractures: A Technical Trick and Case Series.

Tibial plateau fractures with severely displaced articular injuries and significant deformity to the surrounding metaphyseal bone (including the hyperextension varus bicondylar pattern) can be challenging to stabilize due to resulting large bone voids uncontained by metaphyseal cortex. The purpose of this report was to describe a technique to support the plateau articular surface in these cases and report on outcomes of a small series. This technique uses a small or mini fragment plate, contoured to function as an intraosseous shelf plate, with the "shelf" portion inserted into the bone beneath the articular surface to support it. This technique provides fixed-angle support to the fragment. There are some advantages of this technique compared to structural allograft, large volume ceramic bone void filler, a spine cage, or other trabecular metal object, including the ability to remove the plate later, ability to tension the plate against the depressed articular surface, ability to place screws or other allograft near the implant, wide availability of the implant, and familiarity of orthopaedic trauma surgeons with placing plates and screws to hold reductions. The technique is particularly useful in patterns with uncontained articular depression and a large metaphyseal void.

A Mechanistic and Preclinical Assessment of BioRestore Bioactive Glass as a Synthetic Bone Graft Extender and Substitute for Osteoinduction and Spine Fusion.

Preclinical animal study. Evaluate the osteoinductivity and bone regenerative capacity of BioRestore bioactive glass. BioRestore is a Food and Drug Administration (FDA)-approved bone void filler that has not yet been evaluated as a bone graft extender or substitute for spine fusion. In vitro and in vivo methods were used to compare BioRestore with other biomaterials for the capacity to promote osteodifferentiation and spinal fusion. The materials evaluated (1) absorbable collagen sponge (ACS), (2) allograft, (3) BioRestore, (4) Human Demineralized Bone Matrix (DBM), and (5) MasterGraft. For in vitro studies, rat bone marrow-derived stem cells (BMSC) were cultured on the materials in either standard or osteogenic media (SM, OM), followed by quantification of osteogenic marker genes ( Runx2, Osx, Alpl, Bglap, Spp1 ) and alkaline phosphatase (ALP) activity. Sixty female Fischer rats underwent L4-5 posterolateral fusion (PLF) with placement of 1 of 5 implants: (1) ICBG from syngeneic rats; (2) ICBG+BioRestore; (3) BioRestore alone; (4) ICBG+Allograft; or (5) ICBG+MasterGraft. Spines were harvested 8 weeks postoperatively and evaluated for bone formation and fusion via radiography, blinded manual palpation, microCT, and histology. After culture for 1 week, BioRestore promoted similar expression levels of Runx2 and Osx to cells grown on DBM. At the 2-week timepoint, the relative ALP activity for BioRestore-OM was significantly higher ( P <0.001) than that of ACS-OM and DBM-OM ( P <0.01) and statistically equivalent to cells grown on allograft-OM. In vivo, radiographic and microCT evaluation showed some degree of bridging bone formation in all groups tested, with the exception of BioRestore alone, which did not produce successful fusions. This study demonstrates the capacity of BioRestore to promote osteoinductivity in vitro. In vivo, BioRestore performed similarly to commercially available bone graft extender materials but was incapable of producing fusion as a bone graft substitute. Level V.

Pro-angiogenic and antibacterial copper containing nanoparticles in PLGA/amorphous calcium phosphate bone nanocomposites

Large bone defects after trauma demand for adequate bone substitutes. Bone void fillers should be antibacterial and pro-angiogenic. One viable option is the use of composite materials like the combination of PLGA and amorphous calcium phosphate (aCaP).Copper stimulates angiogenesis and has antibacterial qualities. Either copper oxide (CuO) nanoparticles (NPs) were therefore added to PLGA/aCaP/CuO in different concentrations (1, 5 and 10 w/w %) or copper-doped tricalcium phosphate NPs (TCP with 2% of copper) were electrospun into PLGA/CuTCP nanocomposites.Bi-layered nanocomposites of PLGA/aCaP with different copper NPs (CuO or TCP) and a second layer of pristine PLGA were fabricated. Two clinical bacterial isolates (Staphylococcus aureus and Staphylococcus epidermidis) were used to assess antibacterial properties of the copper-containing materials. For angiogenesis, the chorioallantoic membrane (CAM) assay of the chicken embryo was performed.The higher the CuO content, the higher were the antibacterial properties, with 10 % CuO reducing bacterial adhesion most effectively. Vessel and cell densities were highest in the 5 % CuO containing scaffolds, while tissue integration was more pronounced at lower CuO content. The PLGA/aCaP/CuO (1 % CuO) behaved similar like PLGA/CuTCP in all angiogenic and antibacterial readouts, based on the same copper fraction.We conclude that CuO NPs or CuTCP NPs are useful components to increase angiogenic properties of nanocomposites and at the same time exhibiting antibacterial characteristics.

Management of Traumatic Bone Defects in Tibial Plateau Fractures with Antibiotic-Impregnated Biodegradable Calcium Sulfate Beads: A Prospective Clinical Trial

Objectives: The purpose of this study was to assess adverse events and resorption of antibiotic-impregnated calcium sulfate beads used as a nonstructural void filler in tibia plateau fractures. This device may be more adaptable to a specific bacterium than vancomycin powder as it allows the mixtures of specific bactericidal antibiotics to treat bacterium with specific sensitivities. Design: A multicenter, non-randomized, uncontrolled prospective cohort study. Setting: Five level 1 trauma centers. Participants: Thirty adults with an acute closed tibia plateau fracture, OTA 41B and 41C fractures, requiring operative fixation. Intervention: After fracture fixation, the subchondral bone void was filled with the study device. Main Outcome Measures: Local wound reaction to the device was assessed and resorption of the calcium sulfate was measured on serial x-rays. Follow-up assessments occurred at six weeks, three months, six months and one year, with a CT scan performed at six months to determine resorption of the device. Results: Thirteen male and 17 female participants were recruited with a mean age of 53.3 ± 12.8 years. The median age was 55 years with a range of 29 to 78 years of age. Two participants reported serous drainage: one resolved without treatment, the other was diagnosed as a deep infection and required plate removal and oral antibiotics. There were no local or systemic allergic reactions. Resorption of the material averaged 70% by three months, 87% at six months, and 100% at one year. Conclusions: This device performed as anticipated and completely resorbed without any unexpected adverse events. It allowed for personalizing antibiotic choice with better reported elutional characteristics than vancomycin powder over two weeks and six weeks. Surgical site drainage was low, and 97% union rate was achieved. This is a safe surgical augment for local release of a chosen antibiotic into a contained subchondral defect in a periarticular fracture.

Engineered Cell‐Laden Armor Unit‐Mimicking Bioceramic Granules for Bone Regeneration

AbstractBioceramic granules have been used as fillers for the repair of various bone defects, but structural instability leads to susceptibility to displacement or dislodgement in practice. Armor unit is a concrete block placed along the breakwater to resist waves and protect the dike. Inspired by this, an armor unit‐mimicking (AU) bioceramic granule by three‐dimentional (3D) printing is developed, and combine it with adipose‐derived stem cells (ADSCs) overexpressing fibroblast growth factor 23 (FGF23) to construct tissue‐engineered bone. In vitro results show that AU granules and FGF23 transfection synergistically promote osteogenic differentiation of ADSCs. For the repair of beagle femoral metaphyseal defects, the implanted AU granules are stacked and interlocked to form an impact‐resistant porous scaffold. With the assistance of ADSCsFGF23, AU granules exhibit enhanced new bone formation and host bone maintenance. Taken together, these findings demonstrate the potential of 3D‐printed AU granules in combination with FGF23‐overexpressing ADSCs as a novel bone void filler for ease of handling and enhanced bone regeneration.

Effect of Computerized Tomography on Assessment and Surgical Planning for Olecranon Fractures.

1) Determine effects of computed tomography (CT) on reproducibility of olecranon fracture classification. 2) Determine effects of CT utilization on inter-observer agreement regarding management of olecranon fractures. 3) Evaluate factors associated with articular impaction. Seven surgeons retrospectively evaluated radiographs of 46 olecranon fractures. Each fracture was classified according to Colton, Mayo, OTA/AO systems. Observers determined if articular impaction was present and provided treatment plans. This was repeated at minimum six weeks with addition of CT. Descriptive and comparative statistics were performed and intra-class correlation coefficients (ICC) calculated. Inter-rater agreement was near-perfect for all classifications using radiographs (ICC 0.91, 0.93, 0.89 for Colton, Mayo, OTA/AO) and did not substantially change with CT (ICC 0.91, 0.91, 0.93). Agreement was moderate regarding articular impaction using radiographs (ICC 0.44); this improved significantly with CT (ICC 0.82). Articular impaction was significantly associated with OTA/AO classification, with high prevalence of impaction in OTA/AO 2U1B1e (p<0.03). Agreement was substantial for chosen fixation construct using radiographs (ICC 0.71); this improved with CT (ICC 0.79). Utilization of CT changed fixation plans in 25% of cases. Agreement regarding need for void filler was fair using radiographs (ICC 0.37); this notably improved with CT (ICC 0.64). Utilization of CT for evaluating olecranon fractures led to significant improvements in inter-observer agreement for presence of articular impaction. Impaction was significantly associated with fracture pattern but not with patient-related factors. Addition of CT improved agreement regarding fixation construct and led to notable improvement in agreement regarding need for void filler. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

New PMMA-Based Hydroxyapatite/ZnFe2O4/ZnO Composite with Antibacterial Performance and Low Toxicity.

Polymethylmethacrylate (PMMA) is the most commonly used bone void filler in orthopedic surgery. However, the biocompatibility and radiopacity of PMMA are insufficient for such applications. In addition to insufficient biocompatibility, the microbial infection of medical implants is one of the frequent causes of failure in bone reconstruction. In the present work, the preparation of a novel PMMA-based hydroxyapatite/ZnFe2O4/ZnO composite with heterophase ZnFe2O4/ZnO NPs as an antimicrobial agent was described. ZnFe2O4/ZnO nanoparticles were produced using the electrical explosion of zinc and iron twisted wires in an oxygen-containing atmosphere. This simple, highly productive, and inexpensive nanoparticle fabrication approach could be readily adapted to different applications. From the findings, the presented composite material showed significant antibacterial activity (more than 99% reduction) against P. aeruginosa, S. aureus, and MRSA, and 100% antifungal activity against C. albicans, as a result of the combined use of both ZnO and ZnFe2O4. The composite showed excellent biocompatibility against the sensitive fibroblast cell line 3T3. The more-than-70% cell viability was observed after 1-3 days incubation of the sample. The developed composite material could be a potential material for the fabrication of 3D-printed implants.

In situ forming biomaterials as muscle void fillers for the provisional treatment of volumetric muscle loss injuries.

Volumetric muscle loss (VML) represents a devastating extremity injury which leads to chronic functional deficits and disability and is unrecoverable through normal healing pathways. When left untreated, the VML pathophysiology creates many challenges towards successful treatment, such as altered residual muscle architecture, excessive fibrosis, and contracture(s). As such, innovative approaches and technologies are needed to prevent or reverse these adverse sequelae. Development of a rationally designed biomaterial technology which is intended to be acutely placed within a VML defect - i.e., to serve as a muscle void filler (MVF) by maintaining the VML defect - could address this clinical unmet need by preventing these adverse sequelae as well as enabling multi-staged treatment approaches. To that end, three biomaterials were evaluated for their ability to serve as a provisional MVF treatment intended to stabilize a VML defect in a rat model for an extended period (28 days): polyvinyl alcohol (PVA), hyaluronic acid and polyethylene glycol combination (HA+PEG), and silicone, a clinically used soft tissue void filler. HA+PEG biomaterial showed signs of deformation, while both PVA and silicone did not. There were no differences between treatment groups for their effects on adjacent muscle fiber count and size distribution. Not surprisingly, silicone elicited robust fibrotic response resulting in a fibrotic barrier with a large infiltration of macrophages, a response not seen with either the PVA or HA+PEG. Taken together, PVA was found to be the best material to be used as a provisional MVF for maintaining VML defect volume while minimizing adverse effects on the surrounding muscle.

An Overview of Magnesium-Phosphate-Based Cements as Bone Repair Materials.

In the search for effective biomaterials for bone repair, magnesium phosphate cements (MPCs) are nowadays gaining importance as bone void fillers thanks to their many attractive features that overcome some of the limitations of the well-investigated calcium-phosphate-based cements. The goal of this review was to highlight the main properties and applications of MPCs in the orthopedic field, focusing on the different types of formulations that have been described in the literature, their main features, and the in vivo and in vitro response towards them. The presented results will be useful to showcase the potential of MPCs in the orthopedic field and will suggest novel strategies to further boost their clinical application.

The impact of bone graft type used to fill bone defects in patients undergoing ACL reconstruction with bone–patellar tendon–bone (BPTB) autograft on kneeling, anterior knee pain and knee functional outcomes

PurposeMultiple different materials are used for filling bone defects following bone–patellar tendon–bone (BPTB) graft ACL reconstruction surgery. The theoretical objective being to minimize kneeling pain, improve clinical outcomes and reduce anterior knee pain following surgery. The impact of these materials is assessed in this study.MethodsA prospective monocentric cohort study was conducted from January 2018 to March 2020. There were 128 skeletally mature athletic patients who underwent ACL reconstruction using the same arthroscopic-assisted BPTB technique, with a minimum follow-up of two years identified in our database. After obtaining approval from the local ethics committee, 102 patients were included in the study. Patients were divided into three groups based on type of bone substitute. The Bioactive glass 45S5 ceramic Glassbone™ (GB), collagen and hydroxyapatite bone void filler in sponge form Collapat® II (CP), and treated human bone graft Osteopure®(OP) bone substitutes were used according to availability. Clinical evaluation of patients at follow-up was performed using the WebSurvey software. A questionnaire completed in the 2nd post-operative year included three items: The ability to kneel, the presence of donor site pain, and the palpation of a defect. Another assessment tool included the IKDC subjective score and Lysholm score. These two tools were completed by patients preoperatively, and postoperatively on three occasions (6 months, 1 year, and 2 years).ResultsA total of 102 patients were included in this study. In terms of Kneeling pain, the percentage of GB and CP patients’ who kneel with ease were much higher than that of OP patients (77.78%, 76.5% vs 65.6%, respectively). All three groups experienced an important increase in IKDC and Lysholm scores. There was no difference in anterior knee pain between the groups.ConclusionThe use of Glassbone® and Collapat II® bone substitutes reduced the incidence of kneeling pain compared to Osteopure®. There was no influence of the bone substitute type on the functional outcome of the knee or on the anterior knee pain at two years of follow.