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.

In the present study, scaffold composites based on alginate-pullulan-bioactive glass‑gold nanoparticles were orthotopically implanted in an experimental model of delayed bone union, in rats, given by a metabolic pathology, namely osteoporosis. Differences between treated and untreated groups were observed and the efficacy of our biomaterial was evaluated by applying micro-CT imaging, together with histological evaluation of the osteoporotic animals with sub-critical bone defects, at 30 and 60 days. Osteoporosis was successfully induced by ovariectomy in 9-month-old rats, confirmed by micro-CT and histopathological analysis. A secondary complication from a cortical bone defect was further induced to study bone proliferation in such a delayed environment. The studied composite presents osteointegration and angiogenesis properties at 60 days post-implantation in the osteoporotic animals. These results are given by the micro-CT analysis in which higher bone mineral density and bone volume fraction were observed, alongside histopathology, stating a lack of tissue necrosis and inflammatory reaction and the presence of new woven islands within and around the implanted biomaterial. This is the first endeavor to treat cortical bone defects in osteoporotic animals using scaffold biopolymers containing bioactive glass‑gold nanoparticles instead of cement.

Spinal fusion surgeries remain a successful treatment for degenerative disc disease. While autograft is considered the gold standard bone graft, synthetic bone void fillers are increasingly used to limit donor site morbidity while giving sufficient graft volume.

This retrospective clinical study evaluates MagnetOs Easypack PuttyTM as a standalone graft without autograft in interbody fusion. An independent radiologist blinded to the clinical status provided evaluation of computed tomography (CT) images obtained at 12 months and graded each treated level based on the Brantigan-Steffee-Fraser (BSF) Classification. Twenty subjects were enrolled in the study. A total of 36 spinal levels were treated with an average of 1.8 levels per subject (L2-L3 to L5-S1).

The primary endpoint of CT-based fusion was 94.4% (34/36 levels) based on the presence of bridging bone or locked pseudoarthrosis at 12 months. The high fusion rate was accompanied by consistent improvement in pain scores. Visual analogue scale (VAS) pain scores decreased an average of 25% from 5.3/10 pre-operatively to 2.8/10 at 12 months post-operative, and all subjects who reported pre-operative back or leg pain reported improved pain post-operatively. Although the patient population included risk factors and comorbidities, the fusion rate remained high, and no device-related adverse events (AEs) were observed.

The high fusion rate and favorable safety profile support the performance of MagnetOs Easypack Putty for standalone use without autograft in interbody fusion procedures.

Anterior glenoid reconstruction using bone blocks is increasingly recognised as treatment option after critical bone loss. In this study, a biomechanical test setup is used to assess micromotion after bone block augmentation at the glenoid, comparing bone block augmentation with a spina-scapula block to the standard coracoid bone block (Latarjet). Twenty-four synthetic shoulder specimens were tested. Two surgical techniques (coracoid and spina-scapula bone block augmentation) were used on two different types of synthetic bone (Synbone and Sawbone). The specimens were cyclically loaded according to the 'rocking horse' setup defined in ASTM F2028. A mediolateral force of 170 N was applied on the bone block and a complete test comprised 5000 cycles. The Micromotion between bone block and glenoid was measured using a 3D Digital Image Correlation system. The measured micromotion divided into irreversible and reversible displacement of the augmented block. Medial irreversible displacement was the dominant component of the micromotion. The spina-scapula bone block showed a significantly higher irreversible displacement in medial direction compared to the coracoid block, when aggregating both types of synthetic bone (spina: 1.00 ± 0.39 mm, coracoid: 0.56 ± 0.39 mm, p = 0.01). The dominant irreversible medial displacement can be interpreted as initial settling behaviour.

Despite the wide body of research into prevention and treatment of nonunion, current bone fracture therapies remain suboptimal in their efficacy. Previous animal studies show that MES-1022, a bone-targeted prodrug that activates the prostaglandin E2 receptor EP4, stimulates bone healing when applied locally in uneventful defects. Here we investigated the healing capacity of systemically administered MES-1022 in a rat femoral critical size segmental defect. Ten-week-old female Sprague-Dawley rats (n = 8/group) underwent a 5 mm osteotomy of the left femoral midshaft, stabilized by a unilateral external fixator. Rats received weekly subcutaneous injections of MES-1022 at 5 mg/kg (MES1022-Hi), 1.7 mg/kg (MES1022-Lo), or Vehicle without a defect site scaffold. Serum bone markers and open field activity were measured pre-osteotomy and throughout the study. Rats were sacrificed after 12 weeks and osteotomized femora were imaged via microcomputed tomography (microCT) followed by histology and immunohistochemistry to assess healing. Complete bridging of the defect occurred in one rat from the MES1022-Hi group and zero from MES1022-Lo and Vehicle groups. However, healing outcomes in both MES-1022 groups for bone volume fraction, bone volume, bridging score, callus tissue composition, callus blood vessel density, P1NP levels, TRAcP-5b levels, and physical activity did not differ from Vehicle. Fracture callus osteoclast density and spleen weight were increased in MES1022-Hi rats relative to Vehicle. Overall, systemic administration of MES-1022 alone may not suffice for treatment of large segmental bone defects. Additional studies are needed to determine whether systemic MES-1022 is a useful therapeutic in conjunction with local scaffolds like bone graft substitutes.

Progressive collapsing flatfoot deformity (PCFD) is a complex condition characterized by hindfoot valgus, midfoot varus, and forefoot abduction, leading to functional impairment and pain. Surgical correction often includes lateral column lengthening (LCL), which addresses structural deformity and restores alignment. Autografts remain the gold standard as an osteotomy gap filler for LCL despite donor site morbidity. Allografts augmented with patient's own bone marrow aspirate concentrate (BMAC) offer a potential alternative because of their osteogenic properties. This study compares the clinical and radiologic outcomes of autografts vs allografts with BMAC in LCL for PCFD.

This retrospective study reviewed 38 patients who underwent LCL for PCFD at a tertiary institution from 2012 to 2022. Patients were divided into 2 groups: the 25 who received autografts (group A), and the 13 who received allografts (group B) mixed with BMAC. Clinical outcomes were assessed using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, and 36-Item Short Form Health Survey (SF-36) scores at 6 and 24 months postoperatively. Radiologic union was evaluated through serial weightbearing radiographs at regular interval post-surgery.

Both groups A and B achieved radiologic union at an average of 5.64 ± 1.80 and 5.15 ± 2.58 months, respectively. There were no cases of delayed union or nonunion. Both groups demonstrated significant improvements in VAS, AOFAS, and SF-36 scores at 6 and 24 months, with no statistically significant differences in outcomes. Group A had 2 cases of peroneal tendinopathy, 1 case of peroneal tendon adhesion to the plate, 1 case of screw prominence, and 1 case of chronic pain attributed to plantar nerve irritation. Group B had no reported complications.

This study suggests that allografts augmented with BMAC may be a viable alternative to autografts for LCL in PCFD, offering comparable union rates and functional outcomes. However, as a retrospective cohort study with a small sample size, further prospective research is needed to confirm these findings.

Level III, retrospective cohort studies.

Barraquer Simons Syndrome (BSS) is a subtype of idiopathic acquired lipodystrophy, wherein patients-mostly female-lose subcutaneous fat in the upper half of the body starting in childhood or puberty. A disproportionate fat allocation can be seen in the trochanteric region and thighs.

Along with three cases of lipoatrophy treated at our hospital, we conducted a comprehensive review and presented the treatments in the literature for improving bilateral facial lipodystrophy.

Flaps and autologous fat grafting procedures were favored across the literature, and regardless of the intervention of choice, patients reported satisfaction and improved life prospects.

The loss of facial fat is especially afflicting for patients as the bilateral lipoatrophy imparts an aged, cachexic look which negatively affects not only their self-image but their social status as well. Alternatives to approach lipoatrophy vary in their invasiveness, permanency, and feasibility; thus, treatments must be thoroughly tailored to each patient's needs and expectations. Barraquer Simons Syndrome is a rare subtype of lipodystrophy primarily affecting females, leading to fat loss in mainly the upper body. The negative social impact of the syndrome necessitates intervention, and patients receiving appropriate treatment reported improved psychosocial parameters. Treatment plans should consider each patient's specific needs and expectations, balancing invasiveness, permanency, and feasibility of the procedures.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

The purpose of this cadaveric study was to compare the volume and weight of bone graft harvested using the curettage vs. the trephination technique from the anterior iliac crest.

Embalmed cadavers were studied in this experimental research. The right hemipelvis of each cadaver was used for the trephine bone harvesting technique, whereas the left hemipelvis was used for the conventional curettage technique. The weight and the volume of the harvested bone were measured and statistically compared between the 2 sides. The Wilcoxon Signed-Rank test was employed to compare the graft volume and weight obtained from the right and left sides of the hemipelvis.

Ten embalmed adult cadavers were used in this study. All subjects were Caucasian males with a mean age of 59.8 years (range 44 - 73 years) at the time of death. A total of 81 cylindrical bone grafts were harvested from the right iliac crest. In 9 out of 81 (11.1%), the cortex of the ilium was penetrated by the chisel. The mean weight of the bone graft harvested with the trephine technique (26.97 ± 2.32) g was heavier than that harvested with the curettage technique (23.74 ± 2.09) g (p = 0.007). Similarly, the volume of the bone graft was higher in the trephine technique (8.40 ± 0.84) cm3 compared to the curettage technique (6.60 ± 1.26) cm3 (p = 0.011). The trephination technique lasted a mean of (12.76 ± 1.87) min (range 10.30-16.10 min), while the curettage technique lasted a mean of (14.53 ± 0.89) min (range 13.50-16.00 min) (p = 0.028).

Harvesting anterior iliac crest bone graft with the trephine technique provides a higher bone volume and weight than the conventional curettage technique. The trephine technique might be advocated over the curettage technique, especially when a large amount of autologous bone graft is required. However, a meticulous harvesting technique should be followed to prevent complications. In particular, the three-dimensional anatomy should be kept in mind, and the depth of trephination should be well-controlled.

Institutional Review Board registration: 2022/499.

The transforaminal lumbar interbody fusion (TLIF) technique, pioneered by Harms and Rolinger in 1982 and further refined in the early 2000s by Rosenberg and Mummaneni and later by Foley and Lefkowitz, uses Kambin triangle to access the disc space, thecal sac, and nerve roots. The minimally invasive surgery (MIS) approach to TLIF minimizes soft tissue disruption and spinal segment destabilization, offering benefits such as reduced operative times, blood loss, complications, and postoperative opiate use, with comparable fusion rates to open techniques. Despite these advantages, MIS interbody selection poses challenges, with the MIS TLIF preferred for L4-5 fusions when lordosis restoration is not needed. Key to the MIS TLIF technique is the use of expandable retractors, image-guided pedicle screw placement, and innovations like the expandable TLIF, which improves disc space lordosis. Navigation technologies, including 3-dimensional navigation, augmented reality, and robotics, may enhance surgical accuracy and visualization and may allow more precise screw and cage placement and reducing operative time and complications. Awake MIS TLIF, incorporating conscious sedation and local anesthesia, offers additional benefits of faster discharge and reduced postoperative pain. Some authors have also started using endoscopic techniques as well to further minimize tissue trauma. The integration of these advanced techniques and technologies in MIS TLIF continues to improve surgical outcomes and expands the applicability of this minimally invasive approach, making it a valuable tool in spine surgery.

Bone graft materials are essential for achieving arthrodesis after spine surgery. Safe bone graft products, with osteoinductive, osteoconductive properties and the ability to monitor fusion in real-time, are highly desirable. A novel hyper-crosslinked carbohydrate polymer (HCCP) bone graft substitute was shown to aid in bone regeneration in critical-size defect studies in a rabbit model. These studies further evaluated the in vivo application of HCCP as a bone graft substitute in an ovine model of spinal fusion and a retrospective study in adult human spine surgery patients. Sheep studies demonstrated the safety and efficacy of HCCP with no evidence of adverse histopathology over 6 months of follow-up. In human studies, patients (N = 63) underwent posterolateral fusion with HCCP, with follow-up to assess fusion success. No adverse reaction related to the HCCP bone graft substitute was identified. Fusion success was noted to be non-inferior to other bone graft substitutes. HCCP appears to be a safe bone void filler adjunct for use in spinal fusion surgery for both trauma and degenerative disease. It has a good degradation profile for forming bone with the ability to provide new vasculature and may also function as a scaffold to carry cells, medications, and growth factors. Given the safety profile experienced in our preclinical and clinical studies, future investigation into its efficacy to achieve solid fusion is currently ongoing.

Core decompression is a common method for treating early osteonecrosis of the femoral head (ONFH). However, the surgical procedure is cumbersome due to the lack of appropriate surgical instruments. This study aims to modify surgical instruments to improve surgery efficiency. A total of 28 patients with early ONFH treated with the core decompression were enrolled. 13 cases were treated with new instruments and the other 15 cases were treated with the traditional methods. The convenience of the new instruments was evaluated by comparing evaluation indicators. The multi-functional instruments reduced the number of fluoroscopy, shorted the operation time, improved the delivery efficiency, reduced the intraoperative blood loss, and reduced the surgical incision compared with the traditional method (p < 0.05). The new instruments removed the healthy bone of the femoral head and neck for reuse, the overall hospitalization cost was lower, and patient satisfaction was higher (p < 0.05). In the postoperative follow-up, the VAS was lower and Harris score was higher compared with the traditional group (p < 0.05). The multi-functional instruments can achieve the advantages of accurate positioning of the necrotic area, removed and reused healthy bone, effective expanded decompression, and efficient implant delivery, which is the effective instrument for the early ONFH.

Demineralized bone matrix (DBM) is a commonly utilized allogenic bone graft substitute to promote osseous union. However, little is known regarding outcomes following DBM utilization in foot and ankle surgical procedures.

To evaluate the clinical and radiographic outcomes following DBM as a biological adjunct in foot and ankle surgical procedures.

During May 2023, the PubMed, EMBASE and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following DBM for the management of various foot and ankle pathologies. Data regarding study characteristics, patient demographics, subjective clinical outcomes, radiological outcomes, complications, and failure rates were extracted and analyzed. In addition, the level of evidence (LOE) and quality of evidence (QOE) for each individual study was also assessed. Thirteen studies were included in this review.

In total, 363 patients (397 ankles and feet) received DBM as part of their surgical procedure at a weighted mean follow-up time of 20.8 ± 9.2 months. The most common procedure performed was ankle arthrodesis in 94 patients (25.9%). Other procedures performed included hindfoot fusion, 1st metatarsophalangeal joint arthrodesis, 5th metatarsal intramedullary screw fixation, hallux valgus correction, osteochondral lesion of the talus repair and unicameral talar cyst resection. The osseous union rate in the ankle and hindfoot arthrodesis cohort, base of the 5th metatarsal cohort, and calcaneal fracture cohort was 85.6%, 100%, and 100%, respectively. The weighted mean visual analog scale in the osteochondral lesions of the talus cohort improved from a pre-operative score of 7.6 ± 0.1 to a post-operative score of 0.4 ± 0.1. The overall complication rate was 27.2%, the most common of which was non-union (8.8%). There were 43 failures (10.8%) all of which warranted a further surgical procedure.

This current systematic review demonstrated that the utilization of DBM in foot and ankle surgical procedures led to satisfactory osseous union rates with favorable wound complication rates. Excellent outcomes were observed in patients undergoing fracture fixation augmented with DBM, with mixed evidence supporting the routine use of DBM in fusion procedures of the ankle and hindfoot. However, the low LOE together with the low QOE and significant heterogeneity between the included studies reinforces the need for randomized control trials to be conducted to identify the optimal role of DBM in the setting of foot and ankle surgical procedures.

To systematically identify and evaluate different bone graft augmentation techniques in the operative treatment of complex proximal humerus fractures.

Four databases were searched from 1970 to February 2023 for Level I to IV English studies that investigated outcomes of different bone augments in the primary surgical fixation of proximal humerus fractures. The JBI critical appraisal checklist, methodological index for non-randomized studies and cochrane risk of bias tool were used to assess study quality. Descriptive statistics including weighted means are presented where applicable.

Thirty-three articles including 964 patients met the inclusion. Seven bone augments were identified, including fibular strut allograft (693 patients across 21 studies), femoral head allograft (84 patients across 4 studies), iliac crest allograft (54 patients across 3 studies), iliac crest autograft (94 patients across 5 studies), humeral endosteal allograft (6 patients in 1 single study), unspecified cancellous allograft (28 patients in 1 single study) and distal clavicle autograft (3 patients in 1 single study). Mean patient age was 67.1 years, with female patients comprising 65.2 %. Fracture union rates were similar between groups, with an average of 99.6 %. The average Constant Murley Score (CMS) was not reported in the humeral endosteal allograft or the distal clavicle autograft group but was 81.8 (fibular strut allograft), 79.1 (femoral head allograft), 76.8 (iliac crest allograft), 77.7 (iliac crest autograft), and 81.5 (unspecified cancellous allograft) in the remaining groups. Revision surgery was required in 16.7 % of patients receiving humeral endosteal allograft, 7 % of patients with femoral head allograft, 2 % of iliac crest autografts and 1.9 % in the fibular allograft group. Reported complications included avascular necrosis, hardware complications and loss of reduction.

Bone graft augmentation is an effective adjunct to open reduction internal fixation of complex proximal humerus fractures. Fibular strut allograft is the most common bone graft augment used. Majority of patients treated with bone graft augmentation achieved bony union (83%-100 %) and average CMS scores at final follow-up were similar between graft types (76-82). However, no conclusive data suggests superiority of one bone graft type over another. Future studies should aim to compare the outcomes amongst graft types.

Autologous cancellous bone grafting still represents the gold standard for the therapy of non-healing bone defects. However, donor site morbidity and the restricted availability of autologous bone grafts have initiated scientists to look for promising alternatives to heal even large defects. The present study aimed to evaluate the biomechanical potential and failure properties of a previously developed metaphyseal critical-size defect model of the proximal tibia in minipigs for future comparisons of bone substitute materials.

Fresh-frozen minipig tibiae were divided into two groups, with half undergoing the creation of critical-size defects. Specimens were subjected to biomechanical fatigue tests and load-to-failure tests. CT scans post-test verified bone damage. Statistical analysis compared the properties of defected and intact specimens.

In this model, it was demonstrated that under uniaxial cyclic compression within the loading axis, the intact tibiae specimens (8708 ± 202 N) provided a significant (p = 0.014) higher compressive force to failure than the tibiae with the defect (6566 ± 1653 N).

Thus, the used minipig model is suitable for comparing bone substitute materials regarding their biomechanical forces and bone regeneration capacity.

The efficiency of synthetic bone grafts can be evaluated either in osseous sites, to analyze osteoconduction or ectopically, in intramuscular or subcutaneous sites, to assess osteoinduction. Bone regeneration is usually evaluated in terms of the presence and quantity of newly formed bone, but little information is normally provided on the quality of this bone. Here, we propose a novel approach to evaluate bone quality by the combined use of spectroscopy techniques and nanoindentation. Calcium phosphate scaffolds with different architectures, either foamed or 3D-printed, that were implanted in osseous or intramuscular defects in Beagle dogs for 6 or 12 weeks were analyzed. ATR-FTIR and Raman spectroscopy were performed, and mineral-to-matrix ratio, crystallinity, and mineral and collagen maturity were calculated and mapped for the newly regenerated bone and the mature cortical bone from the same specimen. For all the parameters studied, the newly-formed bone showed lower values than the mature host bone. Hardness and elastic modulus were determined by nanoindentation and, in line with what was observed by spectroscopy, lower values were observed in the regenerated bone than in the cortical bone. While, as expected, all techniques pointed to an increase in the maturity of the newly-formed bone between 6 and 12 weeks, the bone found in the intramuscular samples after 12 weeks presented lower mineralization than the intraosseous counterparts. Moreover, scaffold architecture also played a role in bone maturity, with the foamed scaffolds showing higher mineralization and crystallinity than the 3D-printed scaffolds after 12 weeks.

Autologous bone grafts are essential in reconstructive oral and maxillofacial surgery, and depending on the donor site, they can be associated with specific harvesting morbidities. One of the most commonly applied bone grafts is the iliac crest bone graft, irrespective of other grafts, which might be associated with an easier surgical procedure or the possibility of harvesting them under local anaesthesia. Objective of the study is the clinical evaluation of proximal tibia bone grafts regarding their eligibility for maxillofacial bone grafting.

In this retrospective study, proximal tibia bone grafts were examined with regard to associated donor and recipient site morbidity and their suitability for alveolar ridge augmentation and rhinoplasty.

In total, 21 tibia grafts were included. Fifty-seven percent of the bone grafts were used for alveolar ridge reconstruction, and 43% were used for augmentative rhinoplasty. No significant complications occurred during or after harvesting, but in 14.3% of the patients, minor wound healing disorders were recorded at the donor site, and in 19% of the patients, they were recorded at the recipient site. Statistically, patient sex, age, nicotine and alcohol abuse and metabolic diseases had no significant influence on the complication rate. Graft harvesting under local anaesthesia and at summer temperatures was associated with significantly more complications at the harvesting site (p < 0.05). In cases of dental implant insertion into augmented sites, the implants (n = 31) were followed up for a median period of 40.5 months, during this time 86.7% of the implants survived.

The proximal tibia is a suitable donor site for harvesting autologous bone grafts for alveolar ridge augmentation or rhinoplasty because the donor site morbidity is low, and in contrast to iliac crest bone grafts, they can be harvested under local anaesthesia, which might be advantageous for outpatient surgeries.

Nonunion following fracture treatment remains a significant clinical challenge, adversely affecting the patient's quality of life and imposing a substantial economic burden. The emergence of bone morphogenetic protein 2 (BMP-2) for bone regeneration represents a promising avenue, albeit limited by side effects such as inflammatory reactions primarily due to suboptimal drug delivery systems. This study focuses on NOVOSIS putty (NP), a novel biomaterial designed for the sustained release of BMP-2, aiming to mitigate these limitations and enhance bone healing.

This research aimed to evaluate the effectiveness of NP, a hydroxyapatite granules/β-tricalcium phosphate hydrogel composite (HA/β-TCP/hydrogel), as a BMP-2 carrier for promoting bone regeneration in a new rat nonunion model of long bone.

Using Sprague Dawley rats, a 2-mm silicone disk was interposed at the femoral fracture site, and intramedullary fixation with K-wire was performed to create a nonunion with a 2-mm bone defect. After 3 weeks, internal fixation with a plate, removal of the silicon disk, and refreshing the nonunion site were performed by implanting three different materials into the nonunion sites: allogenic iliac bone (IB), collagen sponge (CS) containing 10 μg of BMP-2, or NP containing 10 μg of BMP-2. Bone healing was evaluated weekly using micro-computed tomography (CT); ex vivo micro-Ct and histological evaluation were conducted at 6 weeks.

At 6 weeks, NP demonstrated a significantly higher bone union rate (76.5%) compared with the CS group (35.3%, p = 0.037), and the IB group (6.3%, p < 0.0001). Bone mineral density (BMD) and bone volume/tissue volume (BV/TV) were also significantly higher in the NP group compared with the CS group (BMD, p < 0.0001; BV/TV, p = 0.031). Histological analysis showed the fracture gap in the NP group was filled with more trabecular bone and less fibrous tissue compared with the CS group.

The study confirms NP is a highly effective BMP-2 carrier, significantly improving bone union rates and new bone formation in nonunion fractures. The sustained release of BMP-2 from the hydrogel component reduced inflammatory responses and enhanced bone regeneration. NP can be a promising alternative to collagen-based BMP-2 delivery systems.

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.

Forearm non-union poses a challenge in orthopaedic surgery due to its intricate anatomy and functional significance. This review provides a comprehensive overview of the assessment, diagnosis and management of forearm non-union. Initial evaluation involves a meticulous history, physical examination and imaging studies to identify factors contributing to non-union, including infection. Surgical approaches are discussed, with emphasis on restoring biomechanical stability and promoting bone healing. Treatment options range from autografts to allografts, with considerations for vascularised bone transfers in complex cases. Decision-making strategies are outlined, considering patient-specific factors and individualised treatment plans. Special considerations for specific types of forearm non-unions are addressed, along with postoperative care protocols to optimise healing and functional outcomes. Overall, this review aims to provide clinicians with a comprehensive understanding of forearm non-union management based on current evidence and clinical practice. Level of Evidence: Level V (Therapeutic).

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.

In a consecutive retrospective analysis of 190 patients treated with the Masquelet technique at the BG Klinikum Hamburg from January 2012 to January 2022, subgroup analysis for defect-specific features such as the extent and morphology of the defect were recorded, and their influence on the time to reach full weight-bearing of the affected limb was investigated.

A total of 217 defects were treated in 190 patients using the Masquelet technique. 70 % of all defects were in the tibia, followed by 22 % in the femur and only about 7 % in the upper extremity. The average length of all defects was 58 mm (+/- 31 mm), with the largest defect measuring 180 mm and the smallest measuring 20 mm. 89 % of the patients achieved full weight-bearing at the end of therapy. The average time from initiation of therapy to reaching safe full weight-bearing was 589 days. There was a significant correlation between defect length and time to reach full weight-bearing (p = 0.0134). These results could serve as a basis for creating a score for prognostics and evaluation of bone healing after treatment with the Masquelet technique. Additionally, the results could help guide indications for secondary stabilization using internal fixation.

Background: The surgical treatment of bony non-unions is traditionally performed with additional bone grafts when atrophic and/or stronger implants when hypertrophic. In the case of the clavicle shaft, however, in our experience, a more controversial method where no additional bone graft is needed leads to equally good consolidation rates, independent of the non-union morphology. This method requires the meticulous anatomical reconstruction of the initial fracture and fixation according to the AO principle of relative stability. Methods: A retrospective review following the STROBE guidelines was performed on a consecutive cohort of all patients who received surgical treatment of a midshaft clavicle non-union at the Medical Center of the University of Freiburg between January 2003 and December 2023. Patients were identified using a retrospective systematical query in the Hospital Information System (HIS) using the International Statistical Classification of Diseases and Related Health Problems Version 10 (ICD-10) codes of the German Diagnosis Related Groups (G-DRG). Two groups were formed to compare the consolidation rates of patients who received additional bone grafting from the iliac crest with those of patients who did not. A 3.5 mm reconstruction LCP plate was used in all patients. Consolidation rates were evaluated using follow-up radiographs and outcomes after material removal with a mean follow-up of 31.5 ± 44.3 months (range 0-196). Results: Final data included 50 patients, predominantly male (29:21); age: 46.0 ± 13.0 years, BMI 26.1 ± 3.7. Autologous bone grafts from the iliac crest were used in 38.0% (n = 19), while no bone addition was used in 62.0% (n = 30). Six patients were lost to follow-up. Radiological consolidation was documented after a mean of 15.1 ± 8.0 months for the remaining 44 patients. Consolidation rates were 94.4% (n = 17) in patients for whom additional bone grafting was used and 96.2% (n = 25) in patients for whom no graft was used. There was no relevant difference in the percentage of atrophic or hypertrophic non-unions between both groups (p = 0.2425). Differences between groups in the rate of consolidation were not significant (p = 0.7890). The complication rate was low, with 4.5% (n = 2). Conclusions: Independent of the non-union morphology, non-unions of the clavicle midshaft can be treated successfully with 3.5 mm locking reconstruction plates without the use of additional bone grafting in most cases.

The ankle joint, which connects the lower limbs and the sole of the foot, is prone to sprain during walking and sports, which leads to ankle arthritis. Supratroleolar osteotomy is an ankle preserving operation for the treatment of ankle arthritis, in which the osteotomy is an important fixing and supporting part. In order to avoid stress shielding effect as much as possible, the osteotomy block is designed as a porous structure. In this study, the osteotomy block was designed based on three-period minimal surface, and the designed structure was manufactured by 3D printing. The mechanical properties of different structures were studied by mechanical test and finite element simulation. In mechanical tests, the Gyroid structure showed a progressive failure mechanism from bottom to bottom, while the Diamond structure showed a shear failure zone at 45° Angle, which was not conducive to energy absorption and was more prone to brittle fracture than the Gyroid structure. Therefore, the Gyroid structure is valuable for further research in the development of porous osteotomy.

Although bone dehiscence may occur during orthodontic tooth movement into the narrow alveolar ridge, a non-invasive prevention method is yet to be fully established. We show for the first time prevention of bone dehiscence associated with orthodontic tooth movement by prophylactic injection of bone anabolic agents in mice. In this study, we established a bone dehiscence mouse model by applying force application and used the granular type of scaffold materials encapsulated with bone morphogenetic protein (BMP)-2 and OP3-4, the receptor activator of NF-κB ligand (RANKL)-binding peptide, for the prophylactic injection to the alveolar bone. In vivo micro-computed tomography revealed bone dehiscence with decreased buccal alveolar bone thickness and height after force application, whereas no bone dehiscence was observed with the prophylactic injection after force application, and alveolar bone thickness and height were kept at similar levels as those in the control group. Bone histomorphometry analyses revealed that both bone formation and resorption parameters were significantly higher in the injection with force application group than in the force application without the prophylactic injection group. These findings suggest that the prophylactic local delivery of bone anabolic reagents can prevent bone dehiscence with increased bone remodelling activity.

The 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.

FA 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.

Standard 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.

The 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.

The 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.

We performed a meta-analysis to identify risk factors affecting spinal fusion.

We systematically searched PubMed, Embase, and the Cochrane Library from inception to January 6, 2023, for articles that report risk factors affecting spinal fusion. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using fixed-effects models for each factor for which the interstudy heterogeneity I2 was < 50%, while random-effects models were used when the interstudy heterogeneity I2 was ≥ 50%. Using sample size, Egger's P value, and heterogeneity across studies as criteria, we categorized the quality of evidence from observational studies as high-quality (Class I), moderate-quality (Class II or III), or low-quality (Class IV). Furthermore, the trim-and-fill procedure and leave-one-out protocol were conducted to investigate potential sources of heterogeneity and verify result stability.

Of the 1,257 citations screened, 39 unique cohort studies comprising 7,145 patients were included in the data synthesis. High-quality (Class I) evidence showed that patients with a smoking habit (OR, 1.57; 95% CI, 1.11 to 2.21) and without the use of bone morphogenetic protein-2 (BMP-2) (OR, 4.42; 95% CI, 3.33 to 5.86) were at higher risk for fusion failure. Moderate-quality (Class II or III) evidence showed that fusion failure was significantly associated with vitamin D deficiency (OR, 2.46; 95% CI, 1.24 to 4.90), diabetes (OR, 3.42; 95% CI, 1.59 to 7.36), allograft (OR, 1.82; 95% CI, 1.11 to 2.96), conventional pedicle screw (CPS) fixation (OR, 4.77; 95% CI, 2.23 to 10.20) and posterolateral fusion (OR, 3.63; 95% CI, 1.25 to 10.49).

Conspicuous risk factors affecting spinal fusion include three patient-related risk factors (smoking, vitamin D deficiency, and diabetes) and four surgery-related risk factors (without the use of BMP-2, allograft, CPS fixation, and posterolateral fusion). These findings may help clinicians strengthen awareness for early intervention in patients at high risk of developing fusion failure.

To compare the bone healing effects of percutaneously delivered bone marrow aspirate concentrate (BMC) versus reamer irrigator aspirator (RIA) suspension in a validated preclinical canine ulnar nonunion model. We hypothesized that BMC would be superior to RIA in inducing bone formation across a nonunion site after percutaneous application. The null hypothesis was that BMC and RIA would be equivalent.

A bilateral ulnar nonunion model (n= 6; 3 matched pairs) was created. Eight weeks after segmental ulnar ostectomy, RIA from the ipsilateral femur and BMC from the proximal humerus were harvested and percutaneously administered into either the left or right ulnar defect. The same volume (3 ml) of RIA suspension and BMC were applied on each side. Eight weeks after treatment, the dogs were euthanized, and the nonunions were evaluated using radiographic, biomechanical, and histologic assessments.

All dogs survived for the intended study duration, formed radiographic nonunions 8 weeks after segmental ulnar ostectomy, and underwent the assigned percutaneous treatment. Radiographic and macroscopic assessments of bone healing at the defect sites revealed superior bridging-callous formation in BMC-treated nonunions. Histologic analyses revealed greater amount of bony bridging and callous formation in the BMC group. Biomechanical testing of the treated nonunions did not reveal any significant differences.

Bone marrow aspirate concentrate (BMC) had important advantages over Reamer Irrigator Aspirator (RIA) suspension for percutaneous augmentation of bone healing in a validated preclinical canine ulnar nonunion model based on clinically relevant radiographic and histologic measures of bone formation.

In this study the tibial shaft fracture non unions in diabetes mellitus are evaluated with percutaneous autologous platelet gel supplementation to accelerate union are compared with individually matched control group with autologous iliac crest bone marrow aspirate injection.

This present study was carried out on tibial non unions in diabetic patients recruited in an ongoing longitudinal study over a period of 2006 to 2017, treated by one surgeon at one institute, are included in this report. Each of 18 established tibial atrophic, aseptic non unions treated by percutaneous autologous platelets and iliac crest bone marrow aspirate were followed up on regular basis up till 9 months. The healing of non union was assessed clinically by painless full weight bearing and the radiological union was judged by bridging callus formation observed on at least 3 of 4 cortices in anteroposterior and lateral views.

Union was observed in 17 (94.4 %) patients of the autologous platelet group. The average time to union was 9.2 weeks (range 8 to 18 weeks) after percutaneous autologous platelet injection (P < 0.0517) .In the control group, union was observed in 14 (77.8 %) patients (P = 0.672). The average time to union following percutaneous bone marrow injection was 11.6 weeks (range 9 to 28 weeks). The proximal 1/3 shaft non union healed comparatively faster than the distal 1/3 shaft tibia (P ≤ 0.0612). No correlation was observed between the comminuted and non comminuted fracture non union (P = 0.789). A significant correlation was noted as regards the non union healing time duration in patients who were on insulin and oral hypoglycemic drugs (P ≤ 0.001) and also about the total duration of diabetes mellitus in years (P ≤ 0.003).

This investigation showed that percutaneous autologous platelet gel delivery is sufficient method to obtain union in diabetic tibial fracture non unions, which is less invasive procedure than bone marrow injection. The efficacy of this autologous platelets is once again well established and this study reinforced categorically the previously published report by the author.

The current report investigates fusion rates and patient-reported outcomes following lumbar spinal surgery using cellular bone allograft (CBA) in patients with risk factors for non-union.

A prospective, open label study was conducted in subjects undergoing lumbar spinal fusion with CBA (NCT02969616) to assess fusion success rates and patient-reported outcomes in subjects with risk factors for non-union. Subjects were categorized into low-risk (≤ 1 risk factors) and high-risk (> 1 risk factors) groups. Radiographic fusion status was evaluated by an independent review of dynamic radiographs and CT scans. Patient-reported outcome measures included quality of life (EQ-5D), Oswestry Disability Index (ODI) and Visual Analog Scales (VAS) for back and leg pain. Adverse event reporting was conducted throughout 24-months of follow-up.

A total of 274 subjects were enrolled: 140 subjects (51.1%) were categorized into the high-risk group (> 1 risk factor) and 134 subjects (48.9%) into the low-risk group (≤ 1 risk factors). The overall mean age at screening was 58.8 years (SD 12.5) with a higher distribution of females (63.1%) than males (36.9%). No statistical difference in fusion rates were observed between the low-risk (90.0%) and high-risk (93.9%) groups (p > 0.05). A statistically significant improvement in patient-reported outcomes (EQ-5D, ODI and VAS) was observed at all time points (p < 0.05) in both low and high-risk groups. The low-risk group showed enhanced improvement at multiple timepoints in EQ-5D, ODI, VAS-Back pain and VAS-Leg pain scores compared to the high-risk group (p < 0.05). The number of AEs were similar among risk groups.

This study demonstrates high fusion rates following lumbar spinal surgery using CBA, regardless of associated risk factors. Patient reported outcomes and fusion rates were not adversely affected by risk factor profiles.

NCT02969616 (21/11/2016).

This study aims to determine the optimal dose of recombinant-human bone morphogenic protein-2 (rhBMP-2) for successful bone fusion in minimally invasive lateral lumbar interbody fusion (MIS LLIF). Previous studies show that rhBMP is an effective alternative to autologous iliac crest bone graft, but the optimal dose remains uncertain. The study analyzes the fusion rates associated with different rhBMP doses to provide a recommendation for the optimal dose in MIS LLIF.

Ninety-three patients underwent MIS LLIF using demineralized bone matrix (DBM) or a mixture of rhBMP-2 and DBM as fusion material. The group was divided into the following three groups according to the rhBMP-2 usage : group A, only DBM was used (n=27); group B, 1 mg of rhBMP-2 per 5 mL of DBM paste (n=41); and group C, 2 mg of rhBMP-2 per 5 mL of DBM paste (n=25). Demographic data, clinical outcomes, postoperative complication and fusion were assessed.

At 12 months post-surgery, the overall fusion rate was 92.3% according to Bridwell fusion grading system. Groups B and C, who received rhBMP-2, had significantly higher fusion rates than group A, who received only DBM. However, there was no significant increase in fusion rate when the rhBMP-2 dosage was increased from group B to group C. The groups B and C showed significant improvement in back pain and Oswestry disability index compared to the group A. The incidence of screw loosening was decreased in groups B and C, but there was no significant difference in the occurrence of other complications.

Usage of rhBMP-2 in LLIF surgery leads to early and increased final fusion rates, which can result in faster pain relief and return to daily activities for patients. The benefits of using rhBMP-2 were not significantly different between the groups that received 1 mg/5 mL and 2 mg/5 mL of rhBMP-2. Therefore, it is recommended to use 1 mg of rhBMP-2 with 5 mL of DBM, taking both economic and clinical aspects into consideration.

How to deal with large tibial bone defects is still controversial. The purpose of this research was to compare the semi-focal bone transport (SFBT) technique with traditional bone transport (TBT) technique for treating such patients. Sixty-two patients were included and retrospectively analyzed. In all cases, after radical debridement large tibial bone defects remained. Patients were treated by the SFBT or TBT technique. The distraction, consolidation duration and complications were recorded by the patients' medical files. Based on the Association for the Study and Application of Methods of Ilizarov (ASAMI) standard, the bone and functional results were evaluated. The mean bone defect size was 7.7 ± 1.6 cm and 7.5 ± 2.1 cm for SFBT and TBT patients. The mean external fixation index (EFI) was 1.51 ± 0.14 months/cm and 1.89 ± 0.25 months/cm for SFBT and TBT patients (p < 0.05), respectively. With respect to bone and function results, there was no significant differences between the two groups (p > 0.05). The mean number of complications per patient was 1.1 ± 0.6 and 1.6 ± 0.7 for SFBT and TBT patients (p < 0.05). Compared to the traditional bone transport technique, patients using the semi-focal bone transport technique achieved better clinical effects, including shorter EFI and less complications. Therefore, the SFBT technique could be a new option for patients with large tibial bone defects.

There is a lack of strong evidence for use of expensive bone substitutes. This study compares perioperative data and patient reported quality-of-life outcomes across the varied types of bone graft extenders. The study analyzes the existing Quality and Outcomes Database and evaluates patient reported outcomes for 1-3 level lumbar fusion procedures comparing across different types of biologics bone graft.

We retrospectively analyzed a prospectively collected data registry. Bone graft implant data were collected and grouped into the following categories: (1) Autograft with basic allograft (2) Enhanced, synthetic, or cellular allograft (3) Use of BMP. Preoperative and 1 year patient reported outcomes and perioperative data from the prospective collected registry were analyzed.

There were 384 patients included in this study. There were 168 (43.8%) patients in group 1, 133 (34.6%) patients in group 2, and 83 (21.6%) in group 3. There were no group differences in baseline or 1 year back pain, leg pain, ODI, or EQ-5D. The GLM Repeated Measures results indicate a significant difference within each of the three groups between the preoperative and postoperative measures for back pain, leg pain, ODI, and EQ-5D. The change over time was not significantly different between the groups.

Bone graft extenders are a significant contributor to the cost of lumbar fusion. This study demonstrates no difference in preoperative, and 1 year patient reported outcomes between the three groups. There was no significant difference in rate of reoperations across the three groups.

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.

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.

The treatment of bone defects has always posed challenges in the field of orthopedics. Scaffolds, as a vital component of bone tissue engineering, offer significant advantages in the research and treatment of clinical bone defects. This study aims to provide an overview of how 3D printing technology is applied in the production of bone repair scaffolds. Depending on the materials used, the 3D-printed scaffolds can be classified into two types: single-component scaffolds and composite scaffolds. We have conducted a comprehensive analysis of material composition, the characteristics of 3D printing, performance, advantages, disadvantages, and applications for each scaffold type. Furthermore, based on the current research status and progress, we offer suggestions for future research in this area. In conclusion, this review acts as a valuable reference for advancing the research in the field of bone repair scaffolds.

Mesenchymal stem cell-derived exosomes have emerged as a promising cell-free therapy for tissue engineering. Compared to intact stem cells, exosomes have advantages like low immunogenicity and ability to carry regenerative cargo. This review examined the potential of exosomes to treat defects in skin, bone and cartilage. In preclinical models, exosomes improved wound healing, stimulated bone regeneration, and enabled cartilage repair by transferring proteins, mRNAs and microRNAs. Their effects were elicited by modulating inflammation, angiogenesis, cell proliferation and matrix synthesis. Exosomes represent a promising cell-free therapy for tissue engineering. However, challenges remain regarding scalable isolation, elucidating mechanisms, and translating this approach to human trials. Understanding these challenges will enable the successful clinical translation of exosomes for regenerative medicine applications.

Autologous bone graft is the gold standard in orthopedics, with the iliac crest the most common harvest site. In an attempt to minimize morbidity with open bone graft harvest from the iliac crest and still maintain the benefit of collecting and transplanting live cells and growth factors, bone marrow aspirate concentrate (BMAC) from the iliac crest has become increasingly popular. However, any harvest procedure can potentially cause pain and complications. The purpose of this study was to evaluate the safety and complications of BMAC from the iliac crest for use in foot and ankle fusion procedures.

A retrospective chart review was performed on all patients who underwent BMAC harvest from the iliac crest with their foot or ankle procedure by 1 of 4 fellowship-trained surgeons (2014-2017) with a minimum of 6-month follow-up. Patients were evaluated for complications, pain, and functional limitation secondary to the harvest. The final outcome follow-up was conducted using a specifically designed telephone questionnaire to assess patient satisfaction. A total of 55 patients were included, with a median age of 58 years (range 31-81 years) and 69% were women.

Out of 55 patients, 52 (94.5%) reported good to excellent results, and satisfaction with the procedure at the time of the questionnaire. Three patients reported persistent complications and some element of dissatisfaction after 6 months. Some patients reported transient complications (hematomas and numbness) that eventually resolved. Fifty percent of patients reported some element of immediate post-operative pain. However, at the time of final follow-up, only 2 reported persistent pain at the harvest site lasting up to 6 months, but it was not activity limiting.

BMAC harvest is a safe procedure with a high rate of patient satisfaction and minimal morbidity.

Level IV: Case series.

Advances in modern medicine and the significant reduction in infant mortality have steadily increased the population's lifespan. As more and more people in the world grow older, incidence of chronic, noncommunicable disease is anticipated to drastically increase. Recent studies have shown that improving the health of the aging population is anticipated to provide the most cost-effective and impactful improvement in quality of life during aging-driven disease. In bone, aging is tightly linked to increased risk of fracture, and markedly decreased regenerative potential, deeming it critical to develop therapeutics to improve aging-driven bone regeneration. Biomimetics offer a cost-effective method in regenerative therapeutics for bone, where there are numerous innovations improving outcomes in young models, but adapting biomimetics to aged models is still a challenge. Chronic inflammation, accumulation of reactive oxygen species, and cellular senescence are among three of the more unique challenges facing aging-induced defect repair. This review dissects many of the innovative biomimetic approaches research groups have taken to tackle these challenges, and discusses the further uncertainties that need to be addressed to push the field further. Through these research innovations, it can be noted that biomimetic therapeutics hold great potential for the future of aging-complicated defect repair.

Autologous bone grafts demonstrate osteoconductive, osteoinductive, and osteogenic properties. Hand surgeons commonly augment surgical fixation with autografts to promote fracture healing. This study compared the intrinsic stem cell-like properties of 2 commonly used autograft sources in hand surgery: the iliac crest and distal radius.

A total of 9 subjects who received an iliac crest bone graft and distal radius bone graft harvest as a part of the standard care of distal radius malunion or nonunion correction or scaphoid nonunion open reduction and internal fixation were enrolled in the study. Cells were isolated by serial collagenase digestion and subjected to fibroblast colony-forming units, osteogenesis, and adipogenesis assays. The expression levels of genes involved in osteogenesis and adipogenesis were confirmed using quantitative polymerase chain reaction.

The cells isolated from the iliac crest bone graft compared with those isolated from the distal radius bone graft demonstrated significantly higher mean fibroblast colony-forming unit efficiency; increased osteogenesis, as measured using alizarin red quantification; increased adipogenesis, as measured using oil red O quantification; and higher expression levels of genes involved in osteogenesis and adipogenesis under the respective differentiation conditions.

The cells isolated from the iliac crest bone graft demonstrated a higher fibroblast colony-forming unit capacity and an increased capability to undergo both osteogenesis and adipogenesis.

Limited evidence exists comparing the intrinsic stem cell-like properties of the iliac crest and distal radius despite the widespread use of each source in hand and wrist surgery. The information from this investigation may assist hand and wrist surgeons with the selection of a source of autograft.

Corticocancellous bone grafting from the iliac crest is acceptable treatment for unstable scaphoid nonunion with a viable proximal pole. However, harvesting graft from the iliac crest is associated with donor site morbidity and the requirement of general anesthesia. Thus, bone grafting from the anterolateral metaphysis of the distal radius (DR) can be a treatment option. However, no study has compared the clinical effect between the two grafting techniques.

From 2014 to 2019, patients with unstable scaphoid nonunion with humpback deformity underwent corticocancellous bone grafting from the anterolateral metaphysis of the DR (group DR) or iliac crest (group IC). Humpback deformity was determined by evaluating the scapholunate angle (SLA) ≥ 60°, intrascaphoid angle (ISA) ≥ 45°, and radiolunate angle (RLA) ≥ 15° from preoperative radiographs and computed tomography scans. The SLA, ISA, and RLA served to gauge carpal alignment. The operative time, grip strength, active range of motion (ROM), the Modified Mayo Wrist score (MMWS), and Disabilities of Arm, Shoulder, and Hand (DASH) score were assessed postoperatively.

Thirty-eight patients qualified for the study (group DR, 15; group IC, 23). Union rates did not differ by patient subset (group DR, 100%; group IC, 95.7%; P = .827), and grip strength, ROM, MWS, and DASH score were similar between groups at the last follow-up. The operative time (minutes) was significantly shorter in group DR (median, 98; quartiles, 80, 114) than in group IC (median, 125; quartiles, 105, 150, P < .001). The ISA, RLA, and SLA improved postoperatively in both groups (P < 0.001). The degree of restoring carpal alignment, as evaluated by SLA, showed superior correction capability in group DR (median, 25.3% quartiles, 21.1, 35.3, P < 0.05). Donor site complications were not significantly different between the groups.

Corticocancellous bone graft from the anterolateral metaphysis of the DR for unstable scaphoid nonunion is associated with a shorter operation time and comparable results with that from the iliac crest in regard to union, restoration of carpal alignment, and wrist function.

Level III.

Hydrogel microparticles (HMPs) stand out as promising entities in the realm of bone tissue regeneration, primarily due to their versatile capabilities in delivering cells and bioactive molecules/drugs. Their significance is underscored by distinct attributes such as injectability, biodegradability, high porosity, and mechanical tunability. These characteristics play a pivotal role in fostering vasculature formation, facilitating mineral deposition, and contributing to the overall regeneration of bone tissue. Fabricated through diverse techniques (batch emulsion, microfluidics, lithography, and electrohydrodynamic spraying), HMPs exhibit multifunctionality, serving as vehicles for drug and cell delivery, providing structural scaffolding, and functioning as bioinks for advanced 3D-printing applications. Distinguishing themselves from other scaffolds like bulk hydrogels, cryogels, foams, meshes, and fibers, HMPs provide a higher surface-area-to-volume ratio, promoting improved interactions with the surrounding tissues and facilitating the efficient delivery of cells and bioactive molecules. Notably, their minimally invasive injectability and modular properties, offering various designs and configurations, contribute to their attractiveness for biomedical applications. This comprehensive review aims to delve into the progressive advancements in HMPs, specifically for bone regeneration. The exploration encompasses synthesis and functionalization techniques, providing an understanding of their diverse applications, as documented in the existing literature. The overarching goal is to shed light on the advantages and potential of HMPs within the field of engineering bone tissue.

Postoperative loss of correction is a concern in cases of distal radius fracture with bone loss after surgery. The purpose of this study was to evaluate the usefulness of a β-tricalcium phosphate (β-TCP) with unidirectional pore structure (Affinos®: Kuraray Co., Ltd, Tokyo, Japan) with internal fixation in patients with bone defects during the correction of distal radius fractures. Thirty-nine patients (40 radii) treated between 2016 and August 2020 were included in the study. There were 8 males and 31 females; the mean age was 70.9 (32-88). The mean postoperative observation period was 14.6 (3.4-24) months. The bone defect that occurred in the surgery was filled with Affinos® and fixed with a locking plate. Radial inclination (RI), volar tilt (VT), and ulnar variance (UV) were evaluated after the operation and at the final observation. The start of absorption and the completion of replacement to the host bone of Affinos® were also evaluated. There were no complications associated with grafts of Affinos®. The mean time of translucent findings around artificial bone was 1.85 (0.5-6) months, and that of complete resorption was 10.6 (1.5-16.5) months after surgery. The mean RI was 21.82° after surgery and 21.16° at final observation. The mean VT was 8.54° after surgery and 8.50° at final observation. The mean UV was -0.3 mm after surgery and 0.5 mm at final observation. Affinos® was resorbed relatively early, and host bone formation was observed. Filling of unidirectional pore structure β-TCP with internal fixation showed favorable outcomes in the surgery of distal radius fractures with bone defects.