Bone grafts and biomaterials substitutes for bone defect repair: A review.

Bone substitutes are being increasingly used in surgery as over two millions bone grafting procedures are performed worldwide per year. Autografts still represent the gold standard for bone substitution, though the morbidity and the inherent limited availability are the main limitations. Allografts, i.e. banked bone, are osteoconductive and weakly osteoinductive, though there are still concerns about the residual infective risks, costs and donor availability issues. As an alternative, xenograft substitutes are cheap, but their use provided contrasting results, so far. Ceramic-based synthetic bone substitutes are alternatively based on hydroxyapatite (HA) and tricalcium phosphates, and are widely used in the clinical practice. Indeed, despite being completely resorbable and weaker than cortical bone, they have exhaustively proved to be effective. Biomimetic HAs are the evolution of traditional HA and contains ions (carbonates, Si, Sr, Fl, Mg) that mimic natural HA (biomimetic HA). Injectable cements represent another evolution, enabling mininvasive techniques. Bone morphogenetic proteins (namely BMP2 and 7) are the only bone inducing growth factors approved for human use in spine surgery and for the treatment of tibial nonunion. Demineralized bone matrix and platelet rich plasma did not prove to be effective and their use as bone substitutes remains controversial. Experimental cell-based approaches are considered the best suitable emerging strategies in several regenerative medicine application, including bone regeneration. In some cases, cells have been used as bioactive vehicles delivering osteoinductive genes locally to achieve bone regeneration. In particular, mesenchymal stem cells have been widely exploited for this purpose, being multipotent cells capable of efficient osteogenic potential. Here we intend to review and update the alternative available techniques used for bone fusion, along with some hints on the advancements achieved through the experimental research in this field.

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Bone substitutes in orthopaedic surgery: from basic science to clinical practice

Advancing biomaterials of human origin for tissue engineering

https://cyberleninka.org/article/n/81531.pdf

A framework for assessing and implementing the co-benefits of nature-based solutions in urban areas

Three-dimensional (3D) printed scaffold and material selection for bone repair

Bone fusion represents a challenge in the orthopedics practice, being especially indicated for spine disorders. Spinal fusion can be defined as the bony union between two vertebral bodies obtained through the surgical introduction of an osteoconductive, osteoinductive, and osteogenic compound. Autogenous bone graft provides all these three qualities and is considered the gold standard. However, a high morbidity is associated with the harvest procedure. Intensive research efforts have been spent during the last decades to develop new approaches and technologies for successful spine fusion. In recent years, cell and gene therapies have attracted great interest from the scientific community. The improved knowledge of both mesenchymal stem cell biology and osteogenic molecules allowed their use in regenerative medicine, representing attractive approaches to achieve bone regeneration also in spinal surgery applications. In this review we aim to describe the developing gene- and cell-based bone regenerative approaches as promising future trends in spine fusion.

https://downloads.hindawi.com/journals/tswj/2014/406159.pdf

Spinal Fusion in the Next Generation: Gene and Cell Therapy Approaches

Introduction:The aim of this retrospective case-control study is to evaluate clinical and radiographic results of short stems compared with traditional hip prostheses.Methods:46 short stems (SS) an...

Stemless hip arthroplasty versus traditional implants: a comparative observational study at 30 months follow-up.

Proximal humeral fractures can be addressed with different approaches, depending on the type of fracture, surgical technique, bone quality, patient’s needs, and surgeon’s preference. The standard deltopectoral approach is extremely versatile and makes it possible to achieve fracture reduction and fixation and to implant a prosthesis if necessary. By extending the traditional approach, some proximal humerus fractures requiring a more posterior route can be treated. The lateral approaches through the deltoid fibers are utilized to fix the humeral head and metadiaphyseal fractures and to treat concomitant rotator cuff tears. These approaches require the longitudinal splitting of the deltoid muscle. The axillary nerve must be protected when establishing these approaches. Posterior approaches to the shoulder often require the osteotomy of the acromion or the detachment of the deltoid. The osteotomy of the acromion at the level of the origin of the spine of the scapula provides a better access to the superior aspect of the shoulder. These routes are rather invasive and create some difficulties in reconstructing the anatomy. The axillary approach provides a good exposure of the shoulder for anterior stabilization and capsular release. It is relatively noninvasive. However, it is rarely used because it requires the isolation of major neurovascular structures.

Vincenzo Campana

Papers

Bone substitutes in orthopaedic surgery: from basic science to clinical practice

Spinal Fusion in the Next Generation: Gene and Cell Therapy Approaches

Stemless hip arthroplasty versus traditional implants: a comparative observational study at 30 months follow-up.

Proximal Humerus: Surgical Approaches