OBJECTIVETo observe the effective of the injectable artificial bone combined with plate fixation for reconstructing the collapse tibial plateau fracture.

METHODSFrom June 2005 to January 2008,21 cases of collapse tibial plateau fracture of type Schatzker II, III were treated by injectable calcium sulfate bone substitute combined with supportive plate reconstruction including 16 males and 5 females with an average age of 35.3 years ranging from 27 to 62 years. The disease course was from 3 to 7 days (means 4 days). According to Schatzker classification, there were 17 cases of type II, 4 of type III. All patients preoperatively underwent radiography, CT scanning and three-dimensional reconstruction in order to accurately understand the extent of fracture and fracture collapse and the shattered fragments of the flip direction. All the fracture with collapse > 3 mm, without joint degeneration were selcected for surgical treatment. The knee joint function after fracture healing and recovery were evaluated by Lysholm scoring.

RESULTSAll patients were followed-up for from 6 months to 2.5 years (means 1.5 years). The X-ray films and features of all fractures showed anatomic reduction or near anatomic reduction, except one case of grade II severe comminuted fracture occurred a high degree of loss and platform reset ineffective after 6 months. The Lysholm scoring of knee function showed that the mean score was (88.3 +/- 5.2). The results were excellent in 12 cases,good in 7 cases, fair in 2 cases.

CONCLUSIONMinimally invasive injectable calcium sulfate bone combined with plate fixation for reconstructing the collapse tibial plateau fracture of type II, III can effectively prevent the further loss after reduction, to improve the long-term results. Minimally invasive injectable calcium sulfate as an artificial bone substitute materials has good prospects for clinical application.

Adult ; Bone Plates ; Bone Substitutes ; administration & dosage ; Calcium Phosphates ; administration & dosage ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Injections ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Tibial Fractures ; surgery

OBJECTIVETo prepare a goat model of tibial bone hole defect suitable for studies of bone defect repair using tissue-engineered injectable bone materials.

METHODSA circular hole bone defect 1.2 cm in diameter was induced below the tibial medial plateau of the goat. X-ray, histological inspection, and image analysis were carried out to evaluate the validity of the model in simulating limb bone defect for the study of tissue-engineered injectable bone materials.

RESULTSAt 4 and 8 weeks after the operation, neither X-ray nor histological examination showed obvious bone tissues in the bone defect. Image analysis showed a area of new bone tissue formation of (8.79 - or + 3.63)% in the total defect area at 4 weeks, which increased to (15.41 - or + 4.21)% at 8 weeks.

CONCLUSIONThe goat model of tibial bone hole defect established in this study is suitable for studying the ability of injectable bone materials for repairing limb bone defect, and offers a simple and reliable means to simulate the local condition of bone regeneration and mechanical environment of bone defect in the limbs.

Animals ; Biocompatible Materials ; administration & dosage ; Bone Regeneration ; Bone Substitutes ; administration & dosage ; Disease Models, Animal ; Female ; Goats ; Injections ; Male ; Tibia ; injuries ; Tibial Fractures ; therapy ; Tissue Engineering

BACKGROUND: Distraction osteogenesis (DO) is a promising tool for bone and tissue regeneration. However, prolonged healing time remains a major problem. Various materials including cells, cytokines, and growth factors have been used in an attempt to enhance bone formation. We examined the effect of percutaneous injection of demineralized bone matrix (DBM) during the consolidation phase on bone regeneration after distraction. METHODS: The immature rabbit tibial DO model (20 mm length-gain) was used. Twenty-eight animals received DBM 100 mg percutaneously at the end of distraction. Another 22 animals were left without further procedure (control). Plain radiographs were taken every week. Postmortem bone dual-energy X-ray absorptiometry and micro-computed tomography (micro-CT) studies were performed at the third and sixth weeks of the consolidation period and histological analysis was performed. RESULTS: The regenerate bone mineral density was higher in the DBM group when compared with that in the saline injection control group at the third week postdistraction. Quantitative analysis using micro-CT revealed larger trabecular bone volume, higher trabecular number, and less trabecular separation in the DBM group than in the saline injection control group. Cross-sectional area and cortical thickness at the sixth week postdistraction, assessed using micro-CT, were greater in the regenerates of the DBM group compared with the control group. Histological evaluation revealed higher trabecular bone volume and trabecular number in the regenerate of the DBM group. New bone formation was apparently enhanced, via endochondral ossification, at the site and in the vicinity of the injected DBM. DBM was absorbed slowly, but it remained until the sixth postoperative week after injection. CONCLUSIONS: DBM administration into the distraction gap at the end of the distraction period resulted in a significantly greater regenerate bone area, trabecular number, and cortical thickness in the rabbit tibial DO model. These data suggest that percutaneous DBM administration at the end of the distraction period or in the early consolidation period may stimulate regenerate bone formation and consolidation in a clinical situation with delayed bone healing during DO.
Animals ; Bone Regeneration/*drug effects ; Bone Substitutes/*administration & dosage/*pharmacology ; Disease Models, Animal ; Humans ; Injections ; Male ; Osteogenesis, Distraction/*methods ; Rabbits ; Tibia/radiography/surgery

OBJECTIVETo systematically review the effectiveness of bone substitute augmentation combined with internal fixation versus internal fixation alone in treating proximal femoral fractures in the elderly.

METHODSSubject term and keywords were searched from Pubmed, Cochrane databases and CNKI from database foundation to August 2015. Randomized controlled studies and qusi-randomized controlled studies on bone substitutes augmentation combined with internal fixation versus internal fixation alone for the treatment of proximal femoral fractures in the elderly were chosen. Postoperative re-displacement, re-operation rate, complications (infection and bone ununion), functional outcome, quality of life scores and muscle strength were seen as outcome indicators. Enumeration data were statistical analyzed by risk difference and 95% confidence interval. Measurement data were analyzed by standardized mean difference and 95% confidence interval. If the same measurement data were evaluated by different standards in different studies, standardized mean differences and 95% confidence interval were used. The methods of statistical analysis were used by Cochrane databases.

RESULTSEleven RCTs (677 patients) were included. Meta-analysis results indicated that bone substitutes augmentation combined with internal fixation occurred fewer re-displacement [SMD = -0.75, 95% CI (-1.03, -0.47)] and obtained better function [SMD = 0.40, 95% CI (0.20, 0.59)]. While there were no significant differences in reoperation rate [RD = 0.02, 95% CI (-0.05, -0.09)], pain at 1 week after operation [MD = -1.79, 95% CI (-13.55, -9.96)], pain ranged from 6 to 8 weeks [MD = -7.24, 95% CI (-20.07, -5.59)], postoperative pain at 12 weeks [MD = -0.32, 95% CI (-4.9, -3.55)], muscle strength [MD = 1.25, 95% CI (-6.98, -9.48)], bone ununion [RD = 0.02, 95% CI (-0.01, -0.05)] and postoperative complications [MD = 0.01, 95% CI (-0.03, -0.04)].

CONCLUSIONCompared with single internal fixation, bone substitutes augmentation combined with internal fixation for the treatment of proximal femoral fractures in the elderly less occur re-displacement and could obtain better functional recovery.

Aged ; Aged, 80 and over ; Bone Substitutes ; administration & dosage ; Female ; Femoral Fractures ; surgery ; therapy ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Randomized Controlled Trials as Topic ; Treatment Outcome

This research sought to asses the efficacity of a new type of tissue engineering bone developed by PDLLA/ PLA-PEG-PLA and BMP as a kind of bone graft substitute in the rabbit model of mandibular defects; 15 mm x 6 mm bilateral mandibular periosteum bone defects were made surgically in 20 New Zealand adult rabbits. The porous scaffolds impregnated with rhBMP-2 were used for the purpose, and the scaffolds without rhBMP-2 were used as control. The methods adopted in this research were: macroscopy, histomorphologic exam, X-ray exam, SEM micrography, computer-aided analysis and graphics. The experimental group was shown to have an earlier inception of bone forming. New bone formation was seen along the border of the original mandibular bone and in the middle. At 12 weeks after surgery,the defects were almost filled with new bone. In the control group, the defects could not be repaired in its entirety, and there was no new bone in the middle. The porous scaffold is a promising carrier for BMP. This kind of bone graft substitute can serve as an osteoconductive and osteoinductive matrix.
Animals ; Bone Morphogenetic Protein 2 ; administration & dosage ; Bone Substitutes ; metabolism ; Female ; Implants, Experimental ; Lactic Acid ; administration & dosage ; Male ; Mandibular Injuries ; surgery ; Osteogenesis ; Polyesters ; administration & dosage ; Polyethylene Glycols ; administration & dosage ; Polymers ; administration & dosage ; Rabbits ; Recombinant Proteins ; administration & dosage ; Tissue Engineering ; Tissue Scaffolds

BACKGROUND: Injectable calcium sulfate is a clinically proven osteoconductive biomaterial, and it is an injectable, resorbable and semi-structural bone graft material. The purpose of this study was to validate the clinical outcomes of injectable calcium sulfate (ICS) grafts as compared with those of a demineralized bone matrix (DBM)-based graft for filling in contained bony defects created by tumor surgery. METHODS: Fifty-six patients (41 males and 15 females) with various bone tumors and who were surgically treated between September 2003 and October 2007 were included for this study. The patients were randomly allocated into two groups, and either an ICS graft (28 patients) or a DBM-based graft (28 patients) was implanted into each contained defect that was developed by the surgery. The radiographic outcomes were compared between the two groups and various clinical factors were included for the statistical analysis. RESULTS: When one case with early postoperative pathologic fracture in the DBM group was excluded, the overall success rates of the ICS and DBM grafting were 85.7% (24/28) and 88.9% (24/27) (p > 0.05), respectively. The average time to complete healing was 17.3 weeks in the ICS group and 14.9 weeks in the DBM group (p > 0.05). Additionally, the ICS was completely resorbed within 3 months, except for one case. CONCLUSIONS: Although the rate of resorption of ICS is a concern, the injectable calcium sulfate appears to be a comparable bone graft substitute for a DBM-based graft, with a lower cost, for the treatment of the bone defects created during surgery for various bone tumors.
Absorbable Implants ; Adolescent ; Adult ; Biocompatible Materials/*administration & dosage ; Bone Demineralization Technique ; Bone Matrix/*transplantation ; Bone Neoplasms/radiography/surgery/*therapy ; Bone Substitutes/*administration & dosage ; Calcium Sulfate/*administration & dosage ; Child ; Child, Preschool ; Curettage ; Female ; Humans ; Infant ; Injections ; Male ; Middle Aged ; Wound Healing ; Young Adult

BACKGROUND: Porous beta-calcium pyrophosphate (beta-CPP) was developed to improve the fusion success of posterolateral lumbar fusion (PLF). The possibility of accomplishing PLF using a mixture of porous beta-CPP and iliac bone was studied. This paper reports the radiologic results of PLF using the beta-CPP plus autograft for lumbar degenerative disease as a bone graft extender. METHODS: A prospective, case-matched, radiographic study evaluating the results of short segment lumbar fusion using a beta-CPP plus autograft was performed to compare the efficacy of beta-CPP plus autograft with that of an autograft alone for short segment lumbar fusion. Thirty one consecutive patients (46 levels) underwent posterolateral fusion with pedicle screw fixation and additional posterior lumbar interbody fusion. In all patients, 3 mL of beta-CPP plus 3 mL of autogenous bone graft was placed randomly in one side of a posterolateral gutter, and 6 mL of autogenous iliac bone graft was placed on the other. The fusion rates, volumes of fusion masses, and bone absorption percentage were evaluated postoperatively using simple radiographs and 3 dimensional computed tomography (3D-CT) scans. RESULTS: The control sides treated with an autograft showed significantly better Lenke scores than the study sides treated with beta-CPP at 3 and 6 months postoperatively, but there was no difference between the two sides at 12 months. The fusion rates (confirmed by 3D-CT) were 87.0% in the beta-CPP group and 89.1% in the autograft group, which were not significantly different. The fusion mass volumes and bone absorption percentage at 12 months postoperatively were 2.49 mL (58.4%) and 1.89 mL (69.5%) for the beta-CPP and autograft groups, respectively, and mean fusion mass volume was significantly higher in the beta-CPP group. CONCLUSIONS: beta-CPP combined with an autograft is as effective as autologous bone for grafting during instrumented posterolateral spinal fusion. These findings suggest that beta-CPP bone chips can be used as a novel bone graft extender for short-segment posterolateral spinal fusion.
Adult ; Aged ; *Bone Substitutes ; *Bone Transplantation ; Calcium Pyrophosphate/*administration & dosage ; Female ; Humans ; Ilium ; Imaging, Three-Dimensional ; Lumbar Vertebrae/radiography/*surgery ; Male ; Middle Aged ; Spinal Fusion/*methods ; Tomography, X-Ray Computed

The aim of this study was to evaluate the injectability, histocompatibility, function and other properties of the injectable bioactive bone repairing material of nano-hydroxyapatite and polyamide-66 (n-HA/PA66) composite. The XRD pattern, the relationship between the injectability and liquid-powder ratio, setting time and liquid-powder ratio, compressive strength and liquid-powder ratio were assessed. The size of the composite was determined to be 70 nm in length and 30 to 50 nm in width, and the molecular weight of polyamides-66 was 18000. The diameter of pores of the composite was about 200 to 400 micrometer. To evaluate the histocompatibility and function, 8 male dogs were studied with the injectable n-HA/PA66 composite implanted in the artificial defected alveolus of mandible on only one side to be compared with the intact alveolus on the other side. The specimens were taken at 4, 8, 12, 16 months after the implantation and the results were evaluated. The XRD pattern of the solidificated n-HA/PA66 composite was the same as the powdered n-HA/PA66 composite. The injectable n-HA/PA66 composite had a good injectability, 25 to 30 minutes setting time and about 37 MPa compressive strength when the liquid-powder ratio was 0.50. The healing of the gingiva was well at the implanted areas in all animals. The height of the repaired alveolar bone was obvious higher than that of the blank control. The earlier sign of ossification was histologically observed at 16 weeks after implantation. The injectable n-HA/PA66 composite has good biocompatibility and osteoconductive property. As an injectable material, with good maneuverability, it is useful for repairing irregular bone defects, especially in oral and maxillofacial surgery.
Alveolar Process ; drug effects ; physiology ; Animals ; Bone Regeneration ; drug effects ; physiology ; Bone Substitutes ; administration & dosage ; pharmacology ; Dogs ; Durapatite ; Injections ; Male ; Materials Testing ; Nylons ; Prosthesis Implantation ; methods ; X-Ray Diffraction