Autogenous bone grafting is a widely used technique in orthopaedic and reconstructive surgeries. The anterior superior iliac crest (AIC) and proximal tibia (PT) are common sources for bone grafts. While, AIC is the gold standard, PT is popular for lower extremity procedures due to its proximity. The research investigates early complications associated with these donor sites in a tertiary orthopaedic centre in Nigeria.

This randomized controlled study was conducted from July 2020 to December 2021. It includes 66 patients randomized into AIC and PT groups. Pain score analysis and the incidence of surgical site infections were compared between both groups.

There was no statistical difference in the incidence of surgical site infections (SSI) in both groups. The study also reveals that patients in the AIC group experienced more significant pain in the immediate postoperative period and up to two weeks after surgery, with the severity particularly pronounced on the first postoperative day. (p < 0.001).

The PT had less pain severity than the AIC bone graft donor sites. The authors recommend that surgeons consider PT if bone grafting is required.

Eden-Hybinette procedure can maximize the restoration of the glenoid defect by harvesting a proper size of iliac bone block. We developed an arthroscopic "double-inlay" Eden-Hybinette procedure to achieve better bone union of the graft. The aim of this study was to evaluate the clinical and radiological mid-term outcomes of the arthroscopic "double-inlay" Eden-Hybinette procedure for bone defects exceeding 20%.

A retrospective case series was conducted. The inclusion criterion was a bone defect exceeding 20%, especially failed Bristow-Latarjet procedure or recurrent anterior shoulder instability among patients with epilepsy. An arthroscopic "double-inlay" Eden-Hybinette procedure was carried out. Recurrence and apprehension, the American Shoulder and Elbow Surgeons, University of California at Los Angeles, Subjective Shoulder Value, Rowe, and visual analog scale pain scores and rate of return to sports were obtained at final follow-up. Graft position, healing, and resorption were evaluated via 3D computerized tomography scan. Moreover, postoperative complications and the incidence of osteoarthritis were recorded.

The study cohort included 15 patients, with a mean age of 34.9 ± 13.2 years (range, 19-59 years) and a mean follow-up duration of 5 ± 1.7 years (range, 2.0-8.0 years). No patients experienced recurrent dislocation, and the visual analog scale pain and instability scores during shoulder range of motion decreased from a mean 6.5 ± 2.3 and 9.6 ± 0.9 preoperatively to 1.9 ± 1 and 2 ± 1.7 at the last follow-up (P < .001). The Rowe, American Shoulder and Elbow Surgeons, University of California at Los Angeles, and Subjective Shoulder Value scores of the patients increased from 18.7 ± 10.6, 71.8 ± 5, 22.9 ± 3.5, and 49.3 ± 16.2 preoperatively to 90.3 ± 6.2, 90.1 ± 4.2, 30.1 ± 2.4 (P < .001) and 81.1 ± 15.7 (P = .001) postoperatively. At the final follow-up, the bone graft healing rate was 100%, and there was no severe bone resorption. All patients returned to work, and 73.3% of patients (11 of 15) returned to sports at their preinjury or higher level.

The arthroscopic "double-inlay" Eden-Hybinette procedure has demonstrated reliability and efficacy, yielding excellent mid-term clinical and radiological outcomes for bone defects exceeding 20%, particularly in cases of failed Bristow-Latarjet procedures or in patients with epilepsy.

This systematic review and proportional meta-analysis aims to evaluate the postoperative complication rate (CR%) of ceramic-based 3D-printed bone grafts based on the reported scientific articles conducted with human individuals.

MEDLINE and SCOPUS were used as information sources. The synthesis of the study was carried out from studies with human individuals and the use of 3D-printed bone graft-ceramic as inclusion criteria. Cohen's kappa (κ) was calculated for interrater reliability. Qualitative analysis was performed based on the characteristics and outcomes of the individual study, and quantitative analysis was performed using proportional meta-analysis for CR%.

A total of 1352 records were identified through databases and resulted in 11 included studies (κ = 0.81-1.00) consisting of prospective clinical trials (64.63%), case series (16.67%), and case reports (18.18%). The overall postoperative complication rate was 14.3% (95% Cl: 0.19-53.6). The postoperative complication rate for studies conducted on the cranial defect, the maxillofacial-zygomatic defect, and the tibial-femoral defect was 2.7%, 11.1%, and 15.6%, respectively. This review also highlights common 3D printing techniques, materials, and grafs' characteristics, as well as their clinical applications.

Ceramic-based 3D-printed bone grafts show potential as alternatives for bone tissue reconstruction.

Describe the use, indications, and outcomes of iliac crest bone graft (ICBG) with concomitant anterolateral thigh fascia lata (ALTFL) rescue flap for the management of mandibular osteoradionecrosis (ORN).

Retrospective chart review.

Single institution.

Retrospective chart review of patients who underwent ICBG with ALTFL rescue flap for mandibular ORN between 2011 and 2023.

Twenty-three patients (mean age 66.5 years, 73.9% male) with mandibular ORN underwent ICBG at the time of ATLFL. Patients failed prior antibiotic therapy (78.3%), hyperbaric oxygen therapy (39.1%), and/or pentoxifylline/tocopherol (34.8%). The most common mandibular subsites included the body (91.3%) and the angle (60.9%). All patients underwent concurrent ICBG with ALTFL to augment cortical height of retained mandible (<1 cm following debridement of ORN to healthy, bleeding bone). Following the ALTFL rescue flap with ICBG, the median length of stay was 3 days. There was 1 episode of flap failure noted at follow-up, requiring additional ALTFL procedure. No other major complications were reported at the reconstructed site. There were no complications associated with ICBG harvest, with all patients ambulating at the time of discharge. The mean clinical follow-up length was 20 months. Mandibular stability, based on radiographic features and clinical symptoms, was maintained in the majority of patients. Mandibular height was restored to an average of 1.9 cm, with a mean radiographic follow-up length of 16.8 months. A subset of patients (n = 4, 17.4%) experienced a flare in ORN symptoms following this procedure and required additional mandibular debridement with antibiotic therapy. One such patient required segmental mandibulectomy with osteocutaneous free flap reconstruction; however, all other patients exhibited radiographic and clinical arrest of symptoms for the follow-up period of 6.5 to 61.7 months.

In patients undergoing ALTFL rescue flap for mandibular ORN, ICBG appears to supplement mandibular height and strength in patients with limited remaining mandibular bone height following debridement, with successful arrest of clinical and radiographic disease progression, low morbidity, and abbreviated hospital stays.

Level 4.

Evidence was reviewed to assess the decrease in compressive strength postoperatively. The PRISMA guidelines were followed. PubMed, Embase, Web of Science, Google Scholar, and ProQuest were searched. Five cadaver studies met the inclusion criteria (49 cadavers). Three reported force leading to fracture (FLF), which ranged between 1034 N and 9962 N consistently higher than three times cadaver body weight. Only one reported statistically significant lower FLF in decancellated tibias compared to the contralateral tibias (mean 3766.9 N vs 5126.4; stability reduction 26.5%). The overall estimate of FLF in decancellated tibias was 4321.6 N (95% confidence interval 3434.4-5208.8 N. Meta-analysis estimated a significant difference in force leading to fracture (ΔFLF) 1098.1 N, 95% confidence interval 547.8-1648.5 N. While mean FLF in all studies and the pooled data was above a force three times the body weight of an average adult (70 kg x 3 = 2100 N), three cadavers showed FLF values below this threshold. Increasing the threshold to 2400 N (roughly relating to a body weight of 80 kg, increased this number to six. Normal weight-bearing after decancellation seems to be statistically safe. Clinically, however, the authors are not able to generalize this assumption.

Glenoid bone defects play a significant role in anterior shoulder instability. Their management is controversial, and the use of anterior bone grafting is one appealing option. The purpose of this study is to assess the clinical and radiologic outcomes at a 5-year follow-up of an arthroscopic bone block procedure with iliac crest allograft for the management of subcritical glenoid bone loss in subjects with recurrent anterior shoulder instability.

Prospective longitudinal study of a consecutive case series of subjects with anterior glenohumeral instability and subcritical (between 8% and 17%) glenoid bone defects managed with an arthroscopic bone block procedure with iliac crest allograft fixed with a double-button system associated with a Bankart repair and, when necessary, a remplissage. Preoperative computed tomographic (CT) scans were used to quantify the dimensions of the glenoid and the humeral bone defects. Postoperative CT scans 1 month after surgery and at 1-year follow-up were used to assess the graft's positioning, integration, and resorption. Clinical assessment was performed using the Constant-Murley (CS) and Rowe (RS) scores preoperatively and at a minimum 3-year follow-up.

Fourteen subjects were included (all male, median age 27 years, interquartile range [IQR] = 5.75), with a median of 8 (IQR = 14) dislocation episodes before surgery and a median preoperative glenoid bone defect of 13% (IQR = 14%, range: 9.3%-15.4%). A remplissage was added in 12 of 14 cases (85.7%). Graft position was excellent in all cases (100%) in the axial plane and in 12 of 14 (85.7%) in the sagittal plane. The median reconstructed glenoid surface in the postoperative CT scan was 99.4% (IQR 2.1%, range: 96.6%-100%). One-year postoperative CT scans showed bone resorption of ≥20% of volume in 13 of 14 cases (93%), with a median resorption of 80.3% (IQR = 40.8%) of the graft volume. Graft integration was observed in 6 of 14 cases (42.8%). The median reconstructed glenoid surface decreased to 93.6% (IQR = 2%, range: 87.5%-97.3%) (P < .0001). At the latest follow-up (58.9 months [IQR = 11.2]: range: 39.6-67.8), 2 subjects (14.3%) presented with recurrence of instability. There were substantial improvements in the RS (from 25 [5] to 95 [6.2], P < .0001) and in the CS (from 84 [5] to 94.5 [4.2] points, P < .0001) at the final follow-up.

Arthroscopic bone block procedure employing an iliac crest allograft achieves accurate graft positioning and good clinical outcomes with low recurrence rates at a mean of 5-year follow-up. However, early graft resorption and low consolidation rates are worrisome issues that must be considered.

Symptomatic malunion following a distal radius fracture (DRF) is commonly treated with a corrective osteotomy. Such osteotomy is traditionally fixed with a palmar plate in combination with autogenous bone graft in the osteotomy gap. However, bone grafting prolongs surgery and may result in comorbidity. Recent studies suggest that filling the osteotomy gap may not be necessary. An alternative is to fill the gap with an injectable bone substitute (IBS). However, there is limited data on inter-fragmentary micromotion in osteotomies utilizing IBS. This study aims to assess micromotion and outcomes in patients undergoing corrective osteotomy for malunited DRFs, comparing outcomes between those treated with and without IBS.

Patients undergoing distal radius osteotomy for symptomatic malunion were randomized to either an IBS (hydroxyapatite, HA) group or control group (where the osteotomy gap was left unfilled) in combination with palmar plate fixation. Radiostereometric Analysis (RSA) markers were placed in the radius, and RSA assessments were conducted immediately postoperatively and at 6 weeks, 3, 6, and 12 months. The primary outcome of the study was dorsal/palmar tilt, while the secondary outcomes were radial shortening, radial inclination, radial shift, as well as clinical and Patient Reported Outcomes (PROMs).

42 patients (24 control, 18 HA-group) were included in the analysis. Significantly less micromotions were noted in the HA-group at multiple follow-ups (p ≤ 0.05) in X-axis rotation and Y-axis translation, however they were in the subclinical scale. Both groups showed functional improvements over time, but there were no differences between the groups in clinical outcomes or PROMs.

Hydroxyapatite bone substitute does not offer additional benefits in terms of stability or outcomes in extra-articular corrective osteotomy for malunited DRFs when a palmar plate is used for fixation and palmar cortical bone contact is maintained.

Free bone graft transfer (FBGT) and the Latarjet procedure are 2 competing techniques for the treatment of anterior shoulder instability with glenoid bone loss. In the current literature, there are no mid- to long-term prospective randomized comparative studies comparing both surgical methods.

This prospective, twin-center, randomized study enrolled 60 patients with anterior shoulder instability and more than 15% glenoid bone loss. The study cohort was randomly assigned in a 1:1 ratio to either an open FBGT surgery (J-bone graft technique) or an open Latarjet procedure. Clinical data, including Western Ontario Shoulder Index (WOSI), Rowe Score, Subjective Shoulder Value, visual analog scale, satisfaction with the operation, sports and work limitations, range of motion and strength, as well as the extent of instability arthropathy were collected preoperatively and at 6, 12, 24, and 60 months postoperatively. The 5-year follow-up rate was 63.3% for the FBGT group and 66.6% for the Latarjet group.

The primary outcome parameter (ie, WOSI) showed no significant differences at the 5-year follow-up (J-Span 221 ± 186, Latarjet 201 ± 239; P = .529) and other time points. The secondary clinical scores also showed no significant differences between the 2 groups (Rowe Score, P = .596; Subjective Shoulder Value, P = .368; visual analog scale, P = .238; and Athletic Shoulder Outcome Scoring System, P = .594). Comparable results were observed regarding strength and motion, except for significantly better internal rotation in the FBGT group at all time points, including the 5-year follow-up (P = .004). A single recurrence of instability was observed in 3 patients of the FBGT group and 1 patient of the Latarjet group (P = .342). Postoperative hypesthesia at the iliac crest was reported in 3.3% of the FBGT patients. The degree of instability arthropathy showed a comparable increase in both cohorts (P = .154).

Neither of the 2 surgical methods showed clinical superiority at the 5-year follow-up, except for statistically better internal rotation in the FBGT group. Both cohorts showed comparable success in joint stabilization, but neither could prevent the progression of instability arthropathy.

Osteogenic differentiation is a complex process, and its analysis requires several biomarkers. Allied with this, there are no standardized bioassays to monitor the activity of simvastatin in osteogenesis in vitro. Therefore, identifying the most efficient and sensitive bioassays may enhance the quality of in vitro studies, bridging the gap with in vivo findings, saving time and resources, and benefiting the community. This systematic review aimed to determine the most efficient bioassay for simvastatin's osteogenic activity in vitro, in terms of sensitivity.

In vitro studies evaluating undifferentiated mesenchymal cells treated with simvastatin were considered eligible. References were selected in a two-phase process. Electronic databases and the grey literature were screened up to September 2023. The Office of Health Assessment and Translation (OHAT) tool was used to assess the risk of bias. Certainty in cumulative evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Data were analyzed considering extracellular matrix mineralization, alkaline phosphatase, and the expression of potential target genes, such as bone morphogenetic protein-2 (BMP-2), collagen type I, Runt-related transcription factor 2, osterix, osteocalcin, and osteopontin.

Fourteen studies were included. A "probably low" or a "definitely low" risk of bias was assigned to the included studies. The simvastatin concentration ranged from 0.1 nM to 10 µM. Considering a minimum 4-fold increase, simvastatin caused robust mineralization of the extracellular matrix in four studies (4.0-, 4.4-, 5.0-, and 39.5-fold). Moreover, simvastatin substantially increased BMP-2 expression in mesenchymal cells in three studies (4-, 11-, and 19-fold).

Therefore, mineralization of the extracellular matrix and BMP-2 expression in mesenchymal cells are the most efficient bioassays for determining the osteogenic activity of simvastatin in vitro (high certainty level). These findings provide a standardized approach that can enhance the reliability and comparability of in vitro studies, bridging the gap with in vivo research and optimizing resources in the field of bone regeneration.

Between July 2021 and February 2024, 6 patients with biopsy-confirmed benign pathologic lesions had mandibular defects reconstructed using a reamer-irrigator-aspirator at the University of Cincinnati Medical Center. Patients' ages ranged from 34 to 73, 5 of which were males and one female. Primary end points were bony continuity of the mandible, recovery time, and ability of the graft to receive implants. The reamer-irrigator-aspirator obtained 40 to 100 cm3 of uncompressed bone from donor sites. All patients ambulated on the day of surgery or postoperative day one. No neurosensory disturbances were reported at the donor site. Five patients achieved radiographic continuity of the mandible postoperatively. Of the patients with continuity, 4 received implants, and one received a removable prosthesis. The patient without mandibular continuity declined further intervention and received a removable prosthesis. The findings lend support to the possibility of harvesting medullary bone from the femur for mandibular defect reconstruction.

The management of segmental bone defects presents a complex reconstruction challenge for orthopedic surgeons. Current treatment options are limited by efficacy across the spectrum of injury, morbidity, and cost. Regional gene therapy is a promising tissue engineering strategy for bone repair, as it allows for local implantation of nucleic acids or genetically modified cells to direct specific protein expression. In cell-based gene therapy approaches, a variety of different cell types have been described including mesenchymal stem cells (MSCs) derived from multiple sources-bone marrow, adipose, skeletal muscle, and umbilical cord tissue, among others. MSCs, in particular, have been well studied, as they serve as a source of osteoprogenitor cells in addition to providing a vehicle for transgene delivery. Furthermore, MSCs possess immunomodulatory properties, which may support the development of an allogeneic "off-the-shelf" gene therapy product. Identifying an optimal cell type is paramount to the successful clinical translation of cell-based gene therapy approaches. Here, we review current strategies for the management of segmental bone loss in orthopedic surgery, including bone grafting, bone graft substitutes, and operative techniques. We also highlight regional gene therapy as a tissue engineering strategy for bone repair, with a focus on cell types and cell sources suitable for this application.

The Masquelet induced membrane technique is a surgical procedure that allows the reconstruction of segmental bone defects using a relatively simple approach that requires minimal resources from both the healthcare facility and the patient. Historically applied to the lower limb, this technique is gaining increasing attention in the literature for its use in the upper limb.

A systematic review of the literature was conducted using the PubMed and Google Scholar databases to identify all studies reporting the outcomes of the Masquelet induced membrane technique in the long bones of the upper limb (humerus, radius, and ulna) with a sample size of at least 3 patients. The papers had to include the length of the bone defect, a description of the protocol used for treatment, the complications of each case, and the anatomical location of the defect. The studies that did not meet the above inclusion criteria were excluded.

The search identified 1044 studies, of which 15 met the inclusion criteria. These studies described a total of 156 patients with a mean age of 42 years. The affected bone segments included the humerus in 22 cases and the forearm in 134 cases. In 108 cases, the bone defect was septic. The average defect length was 4.5 cm. PMMA was used as a spacer in all cases, with antibiotics added in 77% of them. The average time interval between the first and second phases of the procedure was 9.5 weeks, and bone union took an average of 5.5 months. The mean follow-up duration was 48 months, and the complication rate was 21%, ranging from 0% to 75%.

The Masquelet induced membrane technique is a viable surgical option for managing segmental bone defects of the upper limb. However, the complication rate remains significant. Further research is needed to identify strategies to improve the outcomes of this technique.

Level 2.

Nonunion following a long bone fracture has gained a lot of attention due to the dreadful impact on the life quality of tremendous patients. Recent data have demonstrated the important involvement of angiogenesis in improving fracture healing. Tetramethylpyrazine (TMP) is an active component of Chinese herbal medicine with various biological activities including pro-angiogenesis property. However, the activity and mechanism of action of TMP in osteo-angiogenesis during bone fracture repair bone fracture healing remain unknown. In this study, TMP was tested for its specific activities in rat aortic endothelial cells (RAECs) and fractured rat model.

The effect of TMP on angiogenesis and migration in RAECs was detected by conducting matrigel tubulogenesis assay and transwell assay. Histopathological changes were observed in the rats from each group using H&E staining. The levels of inflammation and coagulation markers in rats were evaluated by ELISA. The expression of osteogenesis-related genes in rats was assessed by RT-qPCR and western blotting.

TMP promoted angiogenesis processes and migratory ability in RAECs. TMP improved histopathological changes in fractured rat model. The concentration of inflammatory markers (IL-2, IL-6, IL-1beta) in the serum of fractured rats were suppressed by TMP treatment. TMP also had the potential to inhibit blood coagulation in rat tibia fracture model. In addition, the expression and protein levels of osteogenesis-related markers (ALP, Runx2, and OPN-1) were elevated by TMP in the tissues from the fractured rats. In mechanism, TMP significantly promoted the activation of VEGF/FLK1 pathway in vitro and in vivo.

TMP accelerated the repair of bone fracture by promoting angiogenesis and osteogenesis.

Bone tissue engineering is a promising field that aims to rebuild the bone tissue using biomaterials, cells, and signaling molecules. Materials like natural and synthetic polymers, inorganic materials, and composite materials are used to create scaffolds that mimic the hierarchical microstructure of bone. Stem cells, particularly mesenchymal stem cells (MSCs), play a crucial role in bone tissue engineering by promoting tissue regeneration and modulating the immune response. Growth factors like bone morphogenetic proteins (BMPs), vascular endothelial growth factor (VEGF), and platelet-derived growth factor (PDGF) are utilized to accelerate bone regeneration. Clinical applications include treating nonunion and mal-union fractures, osteonecrosis, orthopedic surgery, dental applications, and spinal cord injuries. Recent advances in the field include nanotechnology, 3D printing, bioprinting techniques, gene editing technologies, and microfluidic devices for drug testing. However, challenges remain, such as standardization of protocols, large-scale biomaterial production, personalized medicine approaches, cost-effectiveness, and regulatory issues. Current clinical trials are investigating the safety and efficacy of various bone tissue engineering approaches, with the potential to modernize patient care by providing more adequate treatments for bone defects and injuries.

The use of a distal tibial allograft (DTA) for reconstruction of a glenoid defect in anterior shoulder instability has grown significantly over the past decade. However, few large-scale clinical studies have investigated the clinical and radiographic outcomes of the DTA procedure.

To conduct a systematic review and meta-analysis of clinical studies with data on outcomes and complications in patients who underwent the DTA procedure for recurrent anterior shoulder instability with glenoid bone loss.

Systematic review and meta-analysis; Level of evidence, 4.

A comprehensive search of major bibliographic databases was conducted for articles pertaining to the use of a DTA for the management of anterior shoulder instability with associated glenoid bone loss. Postoperative complications and outcomes were extracted and compiled in a meta-analysis.

Of the 8 included studies with 329 total participants, the mean patient age was 28.1 ± 10.8 years, 192 (83.8%) patients were male, and the mean follow-up was 38.4 ± 20.5 months. The overall complication rate was 7.1%, with hardware complications (3.8%) being the most common. Partial graft resorption was observed in 36.5% of the participants. Recurrent subluxation was reported in 1.2% of the participants, and recurrent dislocation prompting a reoperation was noted in 0.3% of the participants. There were significant improvements in clinical outcomes, including American Shoulder and Elbow Surgeons score (40.9-point increase; P < .01), Single Assessment Numeric Evaluation (47.2-point increase; P < .01), Western Ontario Shoulder Instability Index (49.4-point decrease; P < .01), Disabilities of the Arm, Shoulder and Hand (20.0-point decrease; P = .03), and visual analog scale (2.1-point decrease; P = .05). Additionally, postoperative shoulder range of motion significantly increased from baseline values.

The DTA procedure was associated with a low complication rate, good clinical outcomes, and improved range of motion among patients with anterior shoulder instability and associated glenoid defects.

Osteoarthritis is a widespread and debilitating condition, particularly affecting the medial compartment of knee joint due to varus knee deformities. Medial opening wedge high tibial osteotomy (MOWHTO) has emerged as an effective treatment, but it comes with challenges like fractures, correction loss, and nonunion, leading to unsatisfactory results in up to 26 % of patients. In response, our study explores the potential of a bioabsorbable magnesium-based bulk metallic glass composite (Mg67Zn28Ca5 BMGC) enriched with molybdenum particles as an innovative solution for MOWHTO.

Our comprehensive study includes composite fabrication, mechanical property evaluations, in vitro degradation tests, cell viability assessments, cell migration assays, calcium deposition analyses, and osteoblast differentiation investigations. In vivo experiments were commenced for assessing biological effects and bone growth of the Mg67Zn28Ca5 BMGC in an animal model. Finite element analysis was utilized for assessing the mechanical impact of the composite wedge in human MOWHTO.

The findings indicate that the Mg67Zn28Ca5 BMGC closely matches human cortical bone's mechanical properties, with controlled degradation and superior cellular responses. In vivo experiments reveal progressive degradation and bone integration. Finite element analysis confirms the composite's mechanical effectiveness in MOWHTO.

In conclusion, our research introduces an innovative Mg67Zn28Ca5 BMGC enriched with molybdenum particles, showing promising mechanical and degradation characteristics. It has the potential to improve MOWHTO surgeries by matching cortical bone properties, controlled degradation, and promoting beneficial ion release for bone health. Successful tissue integration suggests suitability for high tibial osteotomy surgeries, offering hope for better outcomes in knee osteoarthritis patients.

This article focuses on meeting the advantages of a novel magnesium-based BMGC with the clinical unmet need of MOWHTO surgeries. If properly developed, the results of this article have significant potential of translation to other temporary orthopedic implants under load-bearing conditions.

BACKGROUND  : The use of bone morphogenic protein (BMP-2) in adult spine deformity (ASD) surgery remains controversial more than two decades following its approval for clinical application in spine surgery. This study was performed to assess outcomes in patients undergoing ASD surgery with BMP application compared with a combination of bone marrow aspirate, cancellous bone chips and i-Factor.

This was a retrospective cohort study. ASD patients were stratified by use of intra-operative BMP (BMP +) or not (BMA + I) and surveyed for the development of complications and mechanical failure. Quality of life gained following the procedure was evaluated using quality-adjusted life years (QALYs). Cost was calculated using the PearlDiver database and CMS definitions. Multivariable analyses (ANCOVA) and logistic regression were used to adjust for confounding.

512 patients were included (60% BMP +). At baseline, BMP + patients were older (62.5 vs 60.8 years, p < 0.010). Radiographic and quality-of-life metrics did not differ at follow up timepoints (all p > 0.05). BMP use was associated with higher supplemental rod use (OR: 7.0, 1.9 - 26.2, p = 0.004), greater number of levels fused (OR: 1.1, 1.03 - 1.17, p = 0.003) and greater neurological complications (OR: 5.0, 1.3 - 18.7, p = 0.017). Controlling for rod use and levels fused, BMP use was not associated with a lower risk of mechanical complications (OR 0.3, 95% CI: 0.2 - 3.0, p = 0.353), rod breakage (OR: 3.3, 0.6 - 18.7, p = 0.182) or implant failure (OR: 0.3, 0.04 - 1.51). At 2 years, the BMP + cohort exhibited higher overall costs ($108,062 vs $95,144, p = 0.002), comparable QALYs (0.163 vs 0.171, p = 0.65) and higher cost per QALY (p = 0.001) at two years.

In this analysis, BMP-2 application was not associated with superior outcomes when compared to a less costly biologic alternative (bone marrow aspirate + cancellous bone chips + i-Factor) following ASD surgery. The use of BMP-2 in ASD surgery appears to have reduced cost-efficacy at two years postoperatively.

This study evaluated the regenerative potential of demineralized dentin-derived matrix (DDM) as a bone graft material in rabbit calvaria. DDM, sourced from extracted teeth, is emerging as an alternative to traditional grafts like allografts and xenografts. We aimed to identify the most effective demineralization protocol to optimize the regenerative capacity of DDM. Four groups were compared: a control group without grafts, a non-demineralized DDM group, and two demineralized DDM groups (15 and 30 min demineralization). Histomorphometric analysis was conducted in a randomized and blinded setting at 2, 4, and 8 weeks post-graft placement. The results revealed that the 15 min demineralized DDM group showed the most significant new bone formation (42.51% ± 6.40% at 8 weeks; p < 0.05), suggesting its potential as a highly effective regenerative graft material.

The purpose of the present study is to assess the gender-specific differences in the presentation and outcomes following Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) between male and female patients.

A prospective comparative analysis was performed comparing consecutive female and male patients having been treated by the press-fit TOPIC procedure. Clinical comparative assessment preoperatively and at 12 months of follow-up included determination of the Numeric Rating Scale (NRS) scores for pain during walking (primary outcome), at rest and during stair-climbing. The Foot and Ankle Outcome Score (FAOS) was also assessed. A computed tomography (CT) scan was performed for lesion size, morphology and localization determination preoperatively as well as 10-12 weeks postoperatively to assess the union of the osteotomy site and at 1 year postoperatively to assess consolidation of the graft as well as intra-graft cyst development.

A total of 48 patients (30 women, 18 men) were eligible for inclusion. Both men and women demonstrated significant functional improvements postoperatively concerning the clinical outcomes with no significant differences between men and women (n.s.) except for a significantly greater improvement in postoperative FAOS pain scores in women. Men presented with OLTs significantly larger in both surface area (208 mm2 for males versus 155 mm2 for females, p < 0.05) as well as lesion volume (3.0 cm3 for males versus 1.8 cm3 for females, p < 0.05). At 1-year postoperatively, all patients showed graft consolidation. Cyst formation was present in 11 females (37% of the group) and 10 males (59% of the group), respectively (n.s.).

Both males and females showed clinically relevant improvements in the clinical outcomes after undergoing the TOPIC procedure with significant differences in preoperative lesion size. The TOPIC procedure is a good treatment strategy for large OLTs in both men and women.

Level III, comparative prospective clinical cohort.

Recombinant human Bone morphogenetic proteins have been used for the treatment of nonunions with promising results. We have been investigating both experimentally and clinically the efficacy of the rhBMP-2 with the macro / micro-porous hydroxyapatite carrier granules on the potency on the reconstruction of long bone defect. The purpose of this study was to prospectively evaluate the efficacy and safety of this specific rhBMP-2 with HA carrier granules mixed with autologous cancellous bone in patients with nonunion and bone defect resulted from the fracture related infection.

This was a retrospective review of a prospective cohort at a university hospital. Patients diagnosed with nonunion under the definition of the United States Food and Drug Administration with bone defect after long bone fractures were enrolled from January 2020 to February 2021. We included patients with atrophic and oligotrophic nonunion, and hypertrophic nonunion with malalignment that needed to be corrected. The other patient group was consisted of segmental bone defect resulted from FRI. The maximum amount of rhBMP-2 allowed in this clinical study was 6 mg and was added to autologous bone at a 1:1 ratio. Autologous bone was added to the mixture if the volume of mixed graft was insufficient to fill the bone defect. Patients were followed 3, 6, and 12 months post-operatively. Each visit, a radiograph was taken for assessment. Visual analog scale (VAS), questionnaire for quality of life (SF-12 physical component summary [PCS], mental component summary [MCS]), and weight-bearing status were collected for functional outcome assessment. Drug safety was assessed by examining BMP-2 antibodies.

Of the 24 enrolled patients (mean age: 57 years), 15 (62.5 %), 2 (8.33 %), and 7 (29.17 %) presented atrophic nonunion, hypertrophic nonunion with deformity, and bone defect after fracture related infection, respectively. Thirteen patients had nonunion in the femur, 9 in the tibia, and 1 in the humerus and radius. The average amount of harvested autologous bone was 9.25 g and 4.96 mg of rhBMP-2. All 24 patients achieved union after 1-year follow up. The union rate was 95.83 % and 100 % at 6 and 12 months postoperatively, respectively. Preoperative SF-12 PCS (mean: 34.71) improved at 6 and 12 months postoperatively, respectively. Preoperative SF-12 MCS (mean: 42.89) improved 12 months postoperatively (49.13, p = 0.0338). Change of VAS was statistically significant 3 months postoperatively (p = 0.0012). No adverse effects or development of BMP-2 antibodies were observed.

BMP-2 combined with autogenous bone resulted in excellent radiographical and functional outcomes in a relatively small prospective series of patients with nonunion and bone defect, without adverse effects. Further investigations are necessary to support our finding and optimize treatment strategies in nonunion patients.

Tibial plateau fractures are mostly complex and surgically demanding joint fractures, which require a comprehensive understanding of the fracture morphology, ligamentous and neurovascular injuries, as well as the diagnostic and therapeutic options for an optimal clinical outcome. Therefore, a standardised and structured approach is required. The success of the treatment of tibial plateau fractures relies on the interdisciplinary cooperation between surgical and conservative physicians in an outpatient and inpatient setting, physical therapists, patients and service providers (health insurance companies, statutory accident insurance, pension providers). On behalf of the German Society for Orthopaedics and Trauma Surgery (DGOU), the German Trauma Society (DGU) and the Society for Arthroscopy and Joint Surgery (AGA), under the leadership of the Fracture Committee of the German Knee Society (DKG), a guideline for tibial plateau fractures was created, which was developed in several voting rounds as part of a Delphi process. Based on the current literature, this guideline is intended to make clear recommendations and outline the most important treatment steps in diagnostics, therapy and follow-up treatment. Additionally, 25 statements were revised by the authors in several survey rounds using the Likert scale in order to reach a final consensus.

The increasing prevalence of spinal disorders worldwide necessitates advanced treatments, particularly interbody fusion for severe cases that are unresponsive to non-surgical interventions. This procedure, especially 360° lumbar interbody fusion, employs an interbody cage, pedicle screw-and-rod instrumentation, and autologous bone graft (ABG) to enhance spinal stability and promote fusion. Despite significant advancements, a persistent 10% incidence of non-union continues to result in compromised patient outcomes and escalated healthcare costs. Innovations in lumbar stabilisation seek to mimic the properties of natural bone, with evolving implant materials like titanium (Ti) and polyetheretherketone (PEEK) and their composites offering new prospects. Additionally, biomimetic cages featuring precisely engineered porosities and interconnectivity have gained traction, as they enhance osteogenic differentiation, support osteogenesis, and alleviate stress-shielding. However, the limitations of ABG, such as harvesting morbidities and limited fusion capacity, have spurred the exploration of sophisticated solutions involving advanced bone graft substitutes. Currently, demineralised bone matrix and ceramics are in clinical use, forming the basis for future investigations into novel bone graft substitutes. Bioglass, a promising newcomer, is under investigation despite its observed rapid absorption and the potential for foreign body reactions in preclinical studies. Its clinical applicability remains under scrutiny, with ongoing research addressing challenges related to burst release and appropriate dosing. Conversely, the well-documented favourable osteogenic potential of growth factors remains encouraging, with current efforts focused on modulating their release dynamics to minimise complications. In this evidence-based narrative review, we provide a comprehensive overview of the evolving landscape of non-degradable spinal implants and bone graft substitutes, emphasising their applications in lumbar spinal fusion surgery. We highlight the necessity for continued research to improve clinical outcomes and enhance patient well-being.

Over 6.8 million fractures occur annually in the US, with 10% experiencing delayed- or non-union. Anabolic therapeutics like PTH analogs stimulate fracture repair, and small molecule salt inducible kinase (SIK) inhibitors mimic PTH action. This study tests whether the SIK inhibitor YKL-05-099 accelerates fracture callus osteogenesis.

126 female mice underwent femoral shaft pinning and midshaft fracture, receiving daily injections of PBS, YKL-05-099, or PTH. Callus tissues were analyzed via RT-qPCR, histology, single-cell RNA-seq, and μCT imaging. Biomechanical testing evaluated tissue rigidity. A hydrogel-based delivery system for PTH and siRNAs targeting SIK2/SIK3 was developed and tested.

YKL-05-099 and PTH-treated mice showed higher mineralized callus volume fraction and improved structural rigidity. RNA-seq indicated YKL-05-099 increased osteoblast subsets and reduced chondrocyte precursors. Hydrogel-released siRNAs maintained target knockdown, accelerating callus mineralization.

YKL-05-099 enhances fracture repair, supporting selective SIK inhibitors' development for clinical use. Hydrogel-based siRNA delivery offers targeted localized treatment at fracture sites.

Surface topography has been shown to influence cell behavior and direct stromal cell differentiation into distinct lineages. Whereas this phenomenon has been verified in two-dimensional cultures, there is an urgent need for a thorough investigation of topography's role within a three-dimensional (3D) environment, as it better replicates the natural cellular environment.

A co-culture of Wharton's jelly-derived mesenchymal stem/stromal cells (WJ-MSCs) and human umbilical vein endothelial cells (HUVECs) was encapsulated in a 3D system consisting of a permselective liquefied environment containing freely dispersed spherical microparticles (spheres) or nanogrooved microdiscs (microdiscs). Microdiscs presenting 358 ± 23 nm grooves and 944 ± 49 nm ridges were produced via nanoimprinting of spherical polycaprolactone microparticles between water-soluble polyvinyl alcohol counter molds of nanogrooved templates. Spheres and microdiscs were cultured in vitro with umbilical cord-derived cells in a basal or osteogenic medium within liquefied capsules for 21 days.

WJ-MSCs and HUVECs were successfully encapsulated within liquefied capsules containing spheres and microdiscs, ensuring high cellular viability. Results show an enhanced osteogenic differentiation in microdiscs compared to spheres, even in basal medium, evidenced by alkaline phosphatase activity and osteopontin expression.

This work suggests that the topographical features present in microdiscs induce the osteogenic differentiation of adhered WJ-MSCs along the contact guidance, without additional differentiation factors. The developed 3D bioencapsulation system comprising topographical features might be suitable for bone tissue engineering approaches with minimum in vitro manipulation.

The aim of the study was to compare conventional sintering with additive manufacturing techniques for β-TCP bioceramics, focusing on mechanical properties and biocompatibility. A "critical" bone defect requires surgical intervention beyond simple stabilization. Autologous bone grafting is the gold standard treatment for such defects, but it has its limitations. Alloplastic bone grafting with synthetic materials is becoming increasingly popular. The use of bone graft substitutes has increased significantly, and current research has focused on optimizing these substitutes, whereas this study compares two existing manufacturing techniques and the resulting β-TCP implants. The 3D printed β-TCP hybrid structure implant was fabricated from two components, a column structure and a freeze foam, which were sintered together. The conventionally fabricated ceramics were fabricated by casting. Both scaffolds were characterized for porosity, mechanical properties, and biocompatibility. The hybrid structure had an overall porosity of 74.4 ± 0.5%. The microporous β-TCP implants had a porosity of 43.5 ± 2.4%, while the macroporous β-TCP implants had a porosity of 61.81%. Mechanical testing revealed that the hybrid structure had a compressive strength of 10.4 ± 6 MPa, which was significantly lower than the microporous β-TCP implants with 32.9 ± 8.7 MPa. Biocompatibility evaluations showed a steady increase in cell proliferation over time for all the β-TCP implants, with minimal cytotoxicity. This study provides a valuable insight into the potential of additive manufacturing for β-TCP bioceramics in the treatment of bone defects.

Autologous bone dust can be filled in bone defects to promote effective bone healing but typically it is lost when using suction during surgery. The aim of this study was to develop a novel bone collector that can be used to collect bone chips/dust of varying sizes without changing current surgical procedures.

This collector was designed to connect to a surgical continuous suction system and comprised a plate filter with a 3 mm hole and featured a taper filter with a mesh size of 0.27 mm for the separation and collection of both coarse and fine bone chips/dust. The bone collector was manufactured using nylon 3D printing and plastic injection with biocompatible materials.

The bone collector functional test revealed high bone chip collection efficiency (93%) with automatic size separation function. Low (3.42%) filtration errors showed that most of the water can be drained smoothly from the bone collector. In clinical usability testing, bone collectors can provide functions demonstrated in in vivo spinal fusion and femoral fracture surgeries with different bone grafting size requirements.

The novel bone collector has been validated as a viable and effective surgical device, offering surgeons an additional option to enhance patient outcomes.

This study aims to investigate the impact of a short implant placed behind the mental foramen with the all-on-four treatment concept using the three-dimensional (3D) finite element stress analysis (FEA). Six different finite element analysis models were designed according to tilted implant angle (17° and 30°), presence of short implants, and short implant diameter (4.1 mm and 4.8 mm). A 100 N force was applied vertically from the central fossa of the lower right second premolar tooth. Maximum equivalent (von Mises) and Minimum/Maximum principal (Pmin/Pmax) stress values and distributions were evaluated by 3D-FEA. The highest stress value among tilted implants was in the T17 group. T30 was the group that caused the most stress in the cortical bone. Adding the short implant to the all-on-four design reduced von Mises stress on multi-unit abutments, abutment screws, and tilted implants in both the 17° and 30° groups. At the same time, it reduced Pmin/Pmax stresses in cortical bone. Similar behavior was observed in terms of stress values and distributions for the 4.1 and 4.8 mm short implant groups. The results show that short implant placement in the posterior region in the all-on-four concept reduces stress on the bone, implants, and prosthetic parts, regardless of the diameter of the short implant. In cases where biomechanical risks such as parafunctional habits and poor bone quality increase, we recommend increasing the number of implants with short implants.

Introduction Triggering the immune system via antigenic stimulation at the time of spinal fusion surgery may enhance bone morphogenesis and result in successful bony arthrodesis. We sought to demonstrate that bone morphogenesis could be enhanced via antigenic immunologic stimulation of a surgical fusion site. Methods New Zealand white rabbits underwent non-instrumented posterolateral fusion of L5-6 with implantation of either an immunologically activated graft (inert beta-tricalcium phosphate) or harvested autograft. Fusion was evaluated using plain radiographs, micro-computed tomography (CT), mechanical palpation, and biomechanical testing. The final evaluation was carried out at 12 weeks postoperatively. Results Eight rabbits received immunologically activated grafts; 10 received autografts and served as historical controls. Fusion rates were identical between groups (both 50%). Radiographs and micro CT of the fusion mass showed no significant difference between groups, and both showed good incorporation of the transverse processes into the fusion masses with radiographic evidence confirming trabeculation and bone remodeling. However, mechanical testing of the fusion sites showed superior fusion strength in the rabbits that received immunologically activated grafts, approaching a factor of two on flexion/extension, lateral bending, and axial rotation. Little to no graft material was appreciable in the non-fused antigen-treated specimens. Conclusions There is a long-standing need for a graft material that can replace autograft bone, due to the negative clinical consequences and financial costs pertaining to autologous bone harvesting. No allograft bone substitute to date has been able to reliably replicate the success of harvested autograft bone. This study suggests that immunological enhancement of inert beta-tricalcium phosphate can potentially be a substitute for allograft bone that can meet and even exceed the success of harvested autograft bone.

Critical bone loss after open fractures, while relatively uncommon, occurs most frequently in high-energy injuries. Fractures of the tibia account for the majority of open fractures with significant bone loss. A number of different surgical strategies exist for treatment of tibial bone loss, all with different advantages and disadvantages. Care should be taken by the surgeon to review appropriate indications and all relevant evidence before selecting a strategy.

Nano-hydroxyapatite (nHA)/ gel porous scaffolds loaded with WSM carriers are promising bone replacement materials that can improve osseointegration ability. This investigation aimed to evaluate the osteoinductive activity by implanting the composition of nano-hydroxyapatite (nHA)/ Gel porous scaffolds as a carrier of WSM via an animal model.

WSM was extracted and nHA was added to the matrix to construct porous composite scaffolds. The dose-effect curve of WSM concentration and alkaline phosphatase (ALP) activity was made by culturing rat osteoblasts and examining the absorbance. Three different materials were implanted into critical size defects (CSD) in the skulls of rats, which were further divided into four groups: WSM nHA /Gel group, n-WSM nHA /Gel group, HA powder group, and control group.

WSM (150 μg/mL-250μg/mL) effectively improved the activity of ALP in rat osteoblasts. All rats in each group had normal healing. WSM-loaded nHA /Gel group showed better performance on newly-formed bone tissue of rat skull and back at 4th week and 8th week, respectively. At the 4th week, the network of woven bone formed in the WSM-loaded nHA/Gel scaffold material. At 8th week, the reticular trabecular bone in the WSM-loaded scaffold material became dense lamellar bone, and the defect was mature lamellar bone. In the subcutaneous implantation experiment, WSM-loaded nHA/Gel scaffold material showed a better performance of heterotopic ossification than the pure nHA/Gel scaffold material.

WSM promotes osteoblast differentiation and bone mineralization. The results confirm that the nHA/ Gel Porous Scaffold with Nacre Water-Soluble Matrix has a significant bone promoting effect and can be used as a choice for tissue engineering to repair bone defects.

Fracture healing poses a significant challenge in orthopedics. Successful regeneration of bone is provided by mechanical stability and a favorable biological microenvironment. This systematic review aims to explore the clinical application of orthobiologics in treating aseptic delayed union and non-union of long bones in adults.

A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Three databases were explored, with no date restrictions, using keywords related to orthobiologics and delayed union and non-union. Eligible studies included human clinical studies in English, with available full texts, examining orthobiologics such as platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), and bone morphogenetic protein (BMPs) for treating aseptic delayed unions and non-unions in adults. Animal studies, in vitro research, and studies on non-unions due to congenital defects, tumors or infections were excluded.

The initial search identified 9417 studies, with 20 ultimately included in the review. These studies involved 493 patients affected by non-union and 256 patients affected by delayed union, with an average age respectively of 40.62 years and 41.7 years. The mean follow-up period was 15.55 months for non-unions and 8.07 months for delayed unions. PRP was the most used orthobiologic, and outcomes were evaluated through time to union, functional scores, and clinical examinations. The results indicated that orthobiologics, especially PRP, tended to yield better outcomes compared to surgical procedures without biological factors.

This systematic review suggests that orthobiologics, such as PRP, BMPs, and MSCs, can be effective and safe in the management of delayed union and non-union fractures. These biological treatments have the potential to improve union rates, reduce healing times, and enhance functional outcomes in patients with non-union fractures. Further research is essential to refine treatment protocols and determine the most suitable orthobiologic for specific patient populations and fracture types.

Autologous bone grafting is the standard treatment for the surgical management of atrophic nonunion of long bones. Other solutions, such as bone marrow mesenchymal stem cells (BM-MSC) combined with phospho-calcium material, have also been used. Here we evaluate the safety and early efficacy of a novel procedure using autologous or allogenic adipose tissue mesenchymal stromal cells (AT-MSC) seeded in a patented tricalcium phosphate-based biomaterial for the treatment of bone regeneration in cases of atrophic nonunion.

This was a prospective, multicentric, open-label, phase 2 clinical trial of patients with atrophic nonunion of long bones. Biografts of autologous or allogenic AT-MSC combined with a phosphate substrate were manufactured prior to the surgical procedures. The primary efficacy was measured 6 months after surgery, but patients were followed for 12 months after surgery and a further year out of the scope of the study. All adverse events were recorded. This cohort was compared with a historical cohort of 14 cases treated by the same research team with autologous BM-MSC.

A total of 12 patients with atrophic nonunion of long bones were included. The mean (SD) age was 41.2 (12.1) years and 66.7% were men. Bone healing was achieved in 10 of the 12 cases (83%) treated with the AT-MSC biografts, a percentage of healing similar (11 of the 14 cases, 79%) to that achieved in patients treated with autologous BM-MSC. Overall, two adverse events, in the same patient, were considered related to the procedure.

The results of this study suggest that AT-MSC biografts are safe for the treatment of bone regeneration in cases of atrophic nonunion and reach high healing rates.

Study registered with EUDRA-CT (2013-000930-37) and ClinicalTrials.gov (NCT02483364).

The structure and handling properties of a P407 hydrogel-based bone substitute material (BSM) might be affected by different poloxamer P407 and silicon dioxide (SiO2) concentrations. The study aimed to compare the mechanical properties and biological parameters (bone remodeling, BSM degradation) of a hydroxyapatite: silica (HA)-based BSM with various P407 hydrogels in vitro and in an in vivo rat model. Rheological analyses for mechanical properties were performed on one BSM with an SiO2-enriched hydrogel (SPH25) as well on two BSMs with unaltered hydrogels in different gel concentrations (PH25 and PH30). Furthermore, the solubility of all BSMs were tested. In addition, 30 male Wistar rats underwent surgical creation of a well-defined bone defect in the tibia. Defects were filled randomly with PH30 (n = 15) or SPH25 (n = 15). Animals were sacrificed after 12 (n = 5 each), 21 (n = 5 each), and 63 days (n = 5 each). Histological evaluation and histomorphometrical quantification of new bone formation (NB;%), residual BSM (rBSM;%), and soft tissue (ST;%) was conducted. Rheological tests showed an increased viscosity and lower solubility of SPH when compared with the other hydrogels. Histomorphometric analyses in cancellous bone showed a decrease of ST in PH30 (p = .003) and an increase of NB (PH30: p = .001; SPH: p = .014) over time. A comparison of both BSMs revealed no significant differences. The addition of SiO2 to a P407 hydrogel-based hydroxyapatite BSM improves its mechanical stability (viscosity, solubility) while showing similar in vivo healing properties compared to PH30. Additionally, the SiO2-enrichment allows a reduction of poloxamer ratio in the hydrogel without impairing the material properties.

Calcium sulfate bone cement (CSC) is extensively used as a bone repair material due to its ability to self-solidify, degradability, and osteogenic ability. However, the fast degradation, low mechanical strength, and insufficient biological activity limit its application. This study used magnesium polyphosphate (MPP) and constructed a composite bone cement composed of calcium sulfate (CS), MPP, tricalcium silicate (C3S), and plasticizer hydroxypropyl methylcellulose (HPMC). The optimized CS/MPP/C3S composite bone cement has a suitable setting time of approximately 15.0 min, a compressive strength of 26.6 MPa, and an injectability of about 93%. The CS/MPP/C3S composite bone cement has excellent biocompatibility and osteogenic capabilities; our results showed that cell proliferation is up to 114% compared with the control after 5 days. After 14 days, the expression levels of osteogenic-related genes, including Runx2, BMP2, OCN, OPN, and COL-1, are about 1.8, 2.8, 2.5, 2.2, and 2.2 times higher than those of the control, respectively, while the alkaline phosphatase activity is about 1.7 times higher. Therefore, the CS/MPP/C3S composite bone cement overcomes the limitations of CSC and has more effective potential in bone repair.

Morbidity associated with autograft harvest has led to the need for alternative bone grafts during fusion surgical procedures. The purpose of this study is to evaluate the efficacy of a cellular bone allograft (CBA) in patients who underwent foot/ankle fusion surgery. Retrospective data of patients who underwent foot/ankle arthrodesis using a CBA between XXXX and XXXX were collected from a single site. Patients were at least 18 years of age at the time of surgery and had ankle/foot surgery with Trinity ELITE CBA as the primary or only bone graft. Patients' radiographic union was assessed at three (3) months, six (6) months, nine (9) months, and twelve (12) months. Twenty-two (22) patients and 29 joints were evaluated. The mean age and BMI of the cohort were 54±9yrs and 30.5±6kg/m2, respectively. The surgical indications were degenerative joint diseases, trauma, and arthritis. All patients except one had at least one risk factor for non-union. At 12 months, 21 of the 22 patients (95%) attained successful fusion with an average time of 6 months. In addition, there was a 100% fusion among patients with prior failed fusion, nicotine use, diabetes, neuropathy, and osteoporosis. There was no significant difference in time to fusion between patients with non-union risk factor(s) ≤ 1 and ≥ 2 (p=0.71). No complication or adverse event was reported following the surgery. The use of CBA resulted in high fusion among patients with the risk of non-union. CBA is a viable bone graft substitute for autograft in foot/ankle arthrodesis procedures.

Anterior cervical discectomy and fusion (ACDF) aims to improve pain, relieve neural compression, achieve rapid solid bony arthrodesis, and restore cervical alignment. Bony fusion occurs as early as 3 months and up to 24 months after ACDF. The correlations between bony fusion and clinical outcomes after ACDF remain unclear. Macro-topographic and porous features have been introduced to interbody cage technology, aiming to improve the strength of the bone-implant interface to promote early fusion. In this study, we aimed to compare clinical outcomes and CT-evaluated fusion rates in patients undergoing ACDF using one of two different interbody cages: traditional NanoMetalene™ (NM) cages and NM cages with machined porous features (NMRT).

This was a prospective, observational, nonrandomised, cohort study of consecutive patients undergoing ACDF. The NM cage cohort was enrolled first, then the NMRT cohort second. The visual analogue scale, neck disability index, and 12-item Short Form Survey scores were evaluated preoperatively and at 6 weeks, 3 months, and 6 months. The minimum clinical follow-up period was 12 months. Plain radiographs were obtained on postoperative day 2 to assess instrumentation positioning, and computed tomography (CT) was performed at 3 and 6 months postoperatively to assess interbody fusion (Bridwell grade).

Eighty-nine (52% male) patients with a mean age of 62 ± 10.5 years were included in this study. Forty-one patients received NM cages, and 48 received NMRT cages. All clinical outcomes improved significantly from baseline to 6 months. By 3 months, the NMRT group had significantly higher CT fusion rates than the NM group (79% vs 56%, p=0.02). By 6 months, there were no significant differences in fusion rates between the NMRT and NM groups (83% vs 78%, p=0.69). The mean Bridwell grade at 6 months was 1.4 ± 0.7 in the NMRT group and 1.8 ± 1.0 in the NM group (p=0.08).

With both NM and NMRT cages, serial improvements in postoperative clinical outcomes were associated with fusion progression on CT. NMRT cages demonstrated significantly better fusion at 3 months and a trend toward higher quality of fusion at 6 months compared with NM cages, suggesting earlier cage integration with NMRT. An early 3-month postoperative CT is adequate for fusion assessment in almost 80% of patients undergoing ACDF with an NMRT cage, permitting an earlier return to activity.

Autogenous iliac bone graft (AIBG) is the treatment of choice for managing bone defects, and favorable results have been reported for bone defects < 5 cm in length. In large bone defects ≥ 5 cm, it is difficult to obtain good results with simple bone grafting, and other management options have drawbacks, such as long immobilization periods and high complication rates. We hypothesized that AIBG in the strut form might show favorable results in large bone defects with minimal complications. This study aimed to investigate the outcomes of strut-type AIBG and evaluate its effectiveness compared to cancellous AIBG. This retrospective study included 50 patients who underwent AIBG for bone defects at a single institution between March 2011 and April 2020. We performed corticocancellous AIBG in a strut form to manage bone defects ≥ 5 cm in the lower extremities. The strut bone was harvested along the iliac crest and grafted slightly longer than the bone defect to apply a sufficient compressive force. Demographic information and radiographic and clinical results of patients who underwent strut AIBG (Group S) were analyzed. The outcomes of union, time to union, complications, and reoperation were compared with those of patients who underwent cancellous AIBG (Group C). The study population comprised 37 men (74%) and 13 women (26%), with a mean age of 50.0 (range: 19-78). The average follow-up period was 25.6 months (12-104 months). Group S included 16 patients with a mean bone defect length of 6.8 ± 1.2 cm. In Group S, union was achieved in all patients, with an average time to union of 6.7 months. Complications occurred in four cases, all related to wound problems. Group C comprised d 34 patients with a mean defect length of 2.8 ± 1.1 cm. Complications occurred in five patients in Group C, including four soft tissue problems and one implant failure. When comparing the outcomes of Groups S and C, no significant differences were observed. AIBG is an effective and safe technique for managing bone defects. Strut AIBG can be used effectively for bone defects ≥ 5 cm in the lower extremities.

Addressing the repair of large-scale bone defects has become a hot research topic within the field of orthopedics. This study assessed the feasibility and effectiveness of using porous tantalum scaffolds to treat such defects. These scaffolds, manufactured using the selective laser melting (SLM) technology, possessed biomechanical properties compatible with natural bone tissue. To enhance the osteogenesis bioactivity of these porous Ta scaffolds, we applied calcium phosphate (CaP) and magnesium-doped calcium phosphate (Mg-CaP) coatings to the surface of SLM Ta scaffolds through a hydrothermal method. These degradable coatings released calcium and magnesium ions, demonstrating osteogenic bioactivity. Experimental results indicated that the Mg-CaP group exhibited biocompatibility comparable to that of the Ta group in vivo and in vitro. In terms of osteogenesis, both the CaP group and the Mg-CaP group showed improved outcomes compared to the control group, with the Mg-CaP group demonstrating superior performance. Therefore, both CaP and magnesium-CaP coatings can significantly enhance the osseointegration of three-dimensional-printed porous Ta, thereby increasing the surface bioactivity. Overall, the present study introduces an innovative approach for the biofunctionalization of SLM porous Ta, aiming to enhance its suitability as a bone implant material.

To introduce the method and experience of treating critical-sized tibial bone defect by taking large iliac crest bone graft.

From January 2020 to January 2022, iliac crest bone grafting was performed in 20 patients (10 men and 10 women) with critical-sized tibial bone defect. The mean length of bone defect was 13.59 ± 3.41. Bilateral iliac crest grafts were harvested, including the inner and outer plates of the iliac crest and iliac spine. The cortical bone screw was used to integrate two iliac bone blocks into one complex. Locking plate was used to fix the graft-host complex, supplemented with reconstruction plate to increase stability when necessary. Bone healing was evaluated by cortical bone fusion on radiographs at follow-up, iliac pain was assessed by VAS score, and lower limb function was assessed by ODI score. Complications were also taken into consideration.

The average follow-up time was 27.4 ± 5.6 (Range 24-33 months), the mean VAS score was 8.8 ± 1.9, the mean ODI score was 11.1 ± 1.8, and the number of cortical bone fusion in the bone graft area was 3.5 ± 0.5. Satisfactory fusion was obtained in all cases of iliac bone transplant-host site. No nonunion, shift or fracture was found in all cases. No infection and bone resorption were observed that need secondary surgery. One patient had dorsiflexion weakness of the great toe. Hypoesthesia of the dorsal foot was observed in 2 patients. Ankle stiffness and edema occurred in 3 patients. Complications were significantly improved by physical therapy and rehabilitation training.

For the cases of critical-sized tibial bone defect, the treatment methods are various. In this paper, we have obtained satisfactory results by using large iliac bone graft to treat bone defect. This approach can not only restore the integrity of the tibia, but also obtain good stability with internal fixation, and operation skills are more acceptable for surgeons. Therefore, it provides an alternative surgical method for clinicians.

Bone transport is one of several techniques that has been proven to be effective in addressing critical bone loss. While it was first described over 100 years ago, modifications to this technique coupled with advances in technology have allowed us to perform bone transport with higher success rates and reduced complication rates. Modern techniques of bone transport aim to shorten the duration of time an external fixator is utilized to reduce its associated complications and burden to patients. We present an update on modern techniques of bone transport for critical size defects and methods to shorten the external fixation time.

This study aims to analyse papers concerning journal impact factors published in the Injury-International Journal of the Care of the Injured between 1997 and 2022. Through this analysis, the research offers valuable insights into the publication performance and contributors to the journal impact factor, encompassing papers, authors, institutions, and countries.

Articles and reviews published in the Injury between 1995 and 2021 were examined using the Science Citation Index Expanded database. The study employed the journal impact factor contributing indicator to compare highly cited and high journal impact factor papers across various aspects, including papers, authors, institutions, and countries.

A notable correlation exists between prolific authors, institutions, and countries, alongside those who contribute to high journal impact factors. However, a less distinct connection was observed between highly cited papers/authors and high journal impact factor contributors. The Injury serves as a well-regarded international journal. Notably, editorial members of the journal play a substantial role, serving as model editors and contributing significantly to the journal's success. Out of the Top 25 IF contributing papers with the CN of 34 or more the following themes were noted to dominate: bone healing/tissue regeneration (40 %) of papers, covid-19 pandemic (24 %), polytrauma/coagulopathy (12 %) and infection (8 %).

Utilizing the journal impact factor to assess research performance at the individual, institutional, or national levels appears not to be the most appropriate method. The results show that highly cited authors did not hold the distinction of being the primary contributors to the IF. Analysis revealed a low significant relationship among the primary contributors to the IF, highly cited papers, and the most influential papers in 2022. A more effective indicator could involve considering the total number of citations a publication receives from its year of publication up to the end of the most recent year.

The anterior iliac crest is one of the most used options; however, pain and other complications have been reported. Other options for bone harvest in the lower extremity, such as the proximal tibia and calcaneus, can be useful sites for bone grafting. Computed tomography angiography images of the lower extremity were analyzed using 3-D Slicer™ medical imaging software, creating an advanced 3-dimensional model. Bone volume (cm3) and bone mineral density (Hounsfield units) were measured from the cancellous bone in the anterior iliac crest, posterior iliac crest, proximal tibia, and the calcaneus. Fifteen studies were included. The total volume measured it was of 61.88 ± 14.15 cm3, 19.35 ± 4.16 cm3, 32.48 ± 7.49 cm3, 26.40 ± 7.18 cm3, for the proximal tibia, anterior and posterior iliac crest, and calcaneus, respectively. Regarding Hounsfield units, the densities were 116 ± 58.77, 232.4 ± 68.65, 214.4 ± 74.45, 170.5 ± 52.32, for proximal tibia, anterior and posterior iliac crest, and calcaneus. The intraclass correlation coefficients were in average >0.94. In conclusion, the proximal tibia has more cancellous bone than the anterior and posterior iliac crest. The calcaneus has more cancellous bone than the anterior iliac crest. Bone mineral density was highest in the anterior iliac crest and in proximal tibia was the lowest value.