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Size Matters: Defining Critical in Bone Defect Size!

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TLDR
The current evidence around the definition of a critical-sized bone defect is reviewed and it is concluded that defects in the order of 2.5 cm or greater seem to have a poor natural history.
Abstract
Bone defects are common and are associated with a significant burden of disease. The treatment of these injuries remains controversial, particularly those defects which are critical sized. Despite the need for decision making to be evidence based, a lack of consensus around definitions of critical-sized defects still exists, particularly around those defects in the 1-3 cm range. There is a need to define "critical" in bone defect size because noncritical defects may heal without planned reconstruction and secondary surgery. This article reviews the current evidence around the definition of a critical-sized bone defect and concludes that defects in the order of 2.5 cm or greater seem to have a poor natural history.

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Materials design for bone-tissue engineering

TL;DR: In this paper, the authors provide an overview of materials-design considerations for bone-tissue-engineering applications in both disease modelling and treatment of injuries and disease in humans, and highlight scalable technologies that can fabricate natural and synthetic biomaterials (polymers, bioceramics, metals and composites) into forms suitable for bone tissue engineering applications in human therapies and disease models.
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Biodegradable materials for bone defect repair

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Mechanical performance of highly permeable laser melted Ti6Al4V bone scaffolds.

TL;DR: The study demonstrates that stiffness and strength of bone scaffold at a targeted porosity is linked to the pore shape and the associated stress concentration allowing to exploit the design freedom associated with SLM.
References
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Journal ArticleDOI

The critical size defect as an experimental model to test bone repair materials.

TL;DR: Animal models that fulfill stringent testing criteria and analytical methodology for assessment are described in this review of new bone repair materials.
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Bone fracture healing: Cell therapy in delayed unions and nonunions

TL;DR: This review will envisage the current clinical trials on bone healing augmentation based on cell therapy, with the experience provided by the REBORNE Project, and the insight from investigator-driven clinical Trials on advanced therapies towards the future.
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The challenge of establishing preclinical models for segmental bone defect research.

TL;DR: The author expresses his opinion on methodologies to establish preclinical critically sized, segmental bone defect models used in past research with reference to surgical techniques, fixation methods and postoperative management focusing on tibial fracture and segmental defect models.
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The management of fractures with bone loss

TL;DR: Historically, because of the problems involved in initial limb salvage and the subsequent difficulty of reconstructing large skeletal defects many fractures with significant bone loss were treated by primary amputation.
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Locked intramedullary nailing of open tibial fractures

TL;DR: The use of Grosse-Kempf reamed intramedullary nailing in the treatment of 41 Gustilo type II and III open tibial fractures was reported, and the incidence of malunion was less and fewer required bone grafting.
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