Bone Debris: Dead Matter or Vital Osteoblasts

Hoegel, Florian; Mueller, Claas; Peter, Robert; Pfister, Ulrich; Suedkamp, Norbert P.

doi:10.1097/01.ta.0000047811.13196.02

Cited by 59 publications

(32 citation statements)

References 10 publications

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“…The RIA system was used to prepare long bones for fracture fixation with intramedullary nails. Several investigators noted that the aspirate from the reaming system was laden with bioactive substrates (eg, osteoblasts) and growth factors (eg, bone morphogenetic protein-2 [BMP-2]) after performing cell cultures and flow cytometry [8,9,18,22,25,26]. The RIA system has been used clinically to procure bone graft from the femur; however, few studies describe its clinical use [12,13,15,24].…”

Section: Introductionmentioning

confidence: 99%

Bone Graft Harvest Using a New Intramedullary System

Belthur

Conway

Jindal

et al. 2008

Clinical Orthopaedics &Amp; Related Research

147

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Obtaining autogenous bone graft from the iliac crest can entail substantial morbidity. Alternatively, bone graft can be harvested from long bones using an intramedullary (IM) harvesting system. We measured bone graft volume obtained from the IM canals of the femur and tibia and documented the complications of the harvesting technique. Donor site pain and the union rate were compared between the IM and the traditional iliac crest bone graft (ICBG) harvest. Forty-one patients (23 male, 18 female) with an average age of 44.9 years (range, 15-78 years) had graft harvested from long bones using an IM harvest system (femoral donor site, 37 patients; tibial donor site, four patients). Forty patients (23 male, 17 female; average age, 46.4 years; range, 15-77 years) underwent anterior ICBG harvest. We administered patient surveys to both groups to determine pain intensity and frequency. IM group reported lower pain scores than the ICBG group during all postoperative periods. Mean graft volume for the IM harvest group was 40.3 mL (range, 25-75 mL) (graft volume was not obtained for the ICBG group). Using an intramedullary system to harvest autogenous bone graft from the long bones is safe provided a meticulous technique is used.

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Section: Introductionmentioning

confidence: 99%

Bone Graft Harvest Using a New Intramedullary System

Belthur

Conway

Jindal

et al. 2008

Clinical Orthopaedics &Amp; Related Research

147

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“…[21][22][23][24] Various papers establish that the benefit from reamed particles is the existence of viable osteoprogenitors within the bone matrix itself, not merely in the marrow, which is well accepted. 15,21,24,25 Quantitative analysis of the reaming debris have found higher levels of fibroblast growth factor (FGFa), platelet-derived growth factor (PDGF), insulin like growth factor (IGF)-1, BMP-2, and transforming growth factor (TGF)-b1 which play a vital role in osteosynthesis. 16 Wenisch and colleagues 21 studied human reaming debris using cell cultures and found multipotent stem cells capable of differentiating along the osteogenic pathway.…”

Section: Discussionmentioning

confidence: 99%

“…The use of reaming debris as a source of autologous bone graft is further supported by a number of studies showing that bone material collected from reaming retains osteocyte viability as well as the presence of biochemical proteins known to stimulate bonehealing. 14,15,17,21 The intramedullary reaming debris has an abundance of progenitor cells and growth factors. [21][22][23][24] Various papers establish that the benefit from reamed particles is the existence of viable osteoprogenitors within the bone matrix itself, not merely in the marrow, which is well accepted.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16][17][18][19][20] Reaming debris has been well studied and in many studies, they have shown that the osteocytes and osteoblasts in the reaming debris are viable, with presence of growth factors which are known to participate in the various phases of fracture-healing and bone formation. The use of reaming debris as a source of autologous bone graft is further supported by a number of studies showing that bone material collected from reaming retains osteocyte viability as well as the presence of biochemical proteins known to stimulate bonehealing.…”

Section: Discussionmentioning

confidence: 99%

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Case Series of Femoral Shaft Fractures Innovatively Managed by Using Reamed Material as Internal Bone Graft for Early Fracture Union

Palanimalai¹,

Kolundan²,

Srinivasan³

et al. 2017

jemds

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BACKGROUNDFemur fracture treatment has constantly evolved over time from various conservative methods to various newer modalities of fixation. Since the incidence of malunion and non-union in conservative methods was more, gradually the treatment shifted to fixation as the primary mode of treatment. After IM nailing was introduced it has almost become a gold standard for femur fracture fixation. Reaming femoral canal is an integral part of nailing procedure. Previously, reamed material which stuck to the reamers were often ignored and neglected. Hence, recent interest has been in the judicial use of reamed material obtained through reaming. We thought if we could accumulate the reamed material in the fracture site, even with closed nailing, we could achieve the objective of using this potential bone graft material effectively. At this juncture, we have devised this new idea of reaming the proximal femoral canal before reducing the fracture, thereby depositing the reamed material in the fracture site and studied the effect. MATERIALS AND METHODSThis is a case series study carried out in KAP Viswanatham Government Medical College/MGM Government Hospital, Trichy from 2013 to 2016 of 40 cases of femoral shaft fractures satisfying inclusion/exclusion criteria. Entry portal created as in any other standard nailing procedure and after entry portal is made, we did not pass the guide wire into the distal fragment and did not reduce the fracture. Instead, the fracture was left as it is and the guide wire was passed up to the fracture site only. Instead of using routine cutting reamers, we used a slightly modified reamer. Serial reaming was done until the fracture site was reached and up to the maximum size. Then as per standard IM nailing technique, appropriate-sized nail was inserted and locked. RESULTSBridging bony callus was visible in 4 -6 weeks in 22 cases of which 17 were simple and 5 comminuted. They subsequently united radiologically in 8 -10 weeks and complete union seen in 10 -12 weeks. In the rest 18 cases, bony callus was visible in 6 -8 weeks. These 18 patients had radiological union in 10 -12 weeks and complete union in 12 -14 weeks. In our study, all 40 cases went for complete union. CONCLUSIONIn our study, all 40 cases united well clinically and radiologically. And we also noted that there was early union occurring in all 40 cases. There was no incidence of non-union in our study. We advocate this simple modification in reamer and the reaming technique to obtain early union in femoral shaft fractures. Hence, we conclude this is a useful and safe mode of fixing femoral shaft fractures to avoid potential second surgery for grafting.

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“…There are also reports of bone damage due to the denaturation of proteins, changed metabolism or changed enzyme activity by increased heat, and changes in protoplasma lipids 23,24) . Accordingly, both the ultrasonic surgical instrument and the rotary cutting instrument used at the settings in this experiment may cause little stress and it was assumed that there was no difference in invasiveness, even though a clear difference in the cutting surface was observed between the Ui and Rb groups.…”

Section: Invasions Of Bone Structure In Early Stages After Making Bonmentioning

confidence: 99%

Comparison of Surface Morphology and Healing in Rat Calvaria Bone Defects between Ultrasonic Surgical Method and Rotary Cutting Method

Matsuda

Sasaki

Takanashi

et al. 2015

J. Hard Tissue Biology.

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The aim of this study was to investigate the influence of ultrasonic surgical method (piezoelectric surgery) on invasions of bone structure in early stages and the subsequent healing process of bone defects of rat calvaria as compared with that of rotary cutting using an appropriate rotation speed. Thirteen-week-old male Sprague-Dawley rats were used in this study. Bone defects were prepared in rat calvaria using either an ultrasonic surgical instrument with an ultrasonic insert tip (Ui) or a handpiece with a round bur (Rb) as a rotary cutting instrument (control). Morphological evaluations of the cutting surfaces in the bone defects were assessed by scanning electron microscope (SEM) and confocal laser microscope (CLM) observation. The degree of invasions of the bone structure in the early stages after bone defects were made was assessed by the ratio of empty osteocyte lacunae relative to the total number of osteocytes. The process of bone healing was analyzed by histological observation, immunohistochemical staining with proliferating cell nuclear antigen (PCNA) and osteocalcin (OC), and ratio of PCNA-positive cells. Many fine, parallel streaky cutting traces were observed in the Ui groove surfaces, whereas the Rb groove surfaces were flat and no parallel cutting traces were observed. The arithmetic average roughness of the Ui group (10.06 ± 1.96 µm) was significantly higher than that of the Rb group (2.52 ± 0.16 µm) (p < 0.05). During the entire observation period, no differences in histological observation and immunohistochemical staining were observed between the Ui and Rb groups. No significant differences were recognized in the ratio of empty lacunae and PCNA-positive cells between the Ui and Rb groups. In the present study, there were no appreciable differences in the invasions of bone structure in the early stages and the subsequent healing process of the bone defects of rat calvaria between ultrasonic surgical method and rotary cutting method.

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Bone Debris: Dead Matter or Vital Osteoblasts

Abstract: The results prove the vitality of the bone debris and confirm clinical observations.

Cited by 59 publications

References 10 publications

Bone Graft Harvest Using a New Intramedullary System

Bone Graft Harvest Using a New Intramedullary System

Case Series of Femoral Shaft Fractures Innovatively Managed by Using Reamed Material as Internal Bone Graft for Early Fracture Union

Comparison of Surface Morphology and Healing in Rat Calvaria Bone Defects between Ultrasonic Surgical Method and Rotary Cutting Method

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