The choice between allograft or demineralized bone matrix is not unambiguous in trauma surgery

Abstract

In fracture surgery, large bone defects and non-unions often require bone transplantation, and alternatives to autograft bone substitutes in the form of allografts from bone banks and the derivate demineralised bone matrix (DBM) are widely used. With a focus on efficacy, clinical evidence, safety, cost, and patient acceptance, this review evaluated the difference between allogeneic allograft or DBM as a bone substitute in trauma surgery. The efficacy in supporting bone healing from allograft and DBM is highly influenced by donor characteristics and graft processing. Mechanical stability is achieved from a structural graft. Based on the existing literature it is difficult to identify where DBM is useful in trauma surgery, and the level of evidence for the relevant use of allograft bone in trauma is low. The risk of transmitting diseases is negligible, and the lowest risk is from DBM due to the extensive processing procedures. A cost comparison showed that DBM is significantly more expensive. The experiences of dental patients have shown that many patients do not want to receive allografts as a bone substitute. It is not possible to definitively conclude whether it makes a difference if allograft or DBM is used in trauma surgery. It is ultimately the surgeon's individual choice, but this article may be useful in providing considerations before a decision is made.

Biomimetic Remineralized Three-Dimensional Collagen Bone Matrices with an Enhanced Osteostimulating Effect

“…Spongy autografts are still the “gold standard” for guaranteed bone tissue regeneration; however, two natural problems arise when using them: a hard limit on the amount of bone tissue possible for sampling and additional traumatic loads on the patient’s body [ 10 , 11 , 12 , 13 ]. Allografts from donors or cadavers from bone banks and their demineralized bone matrix (DBM), or partially demineralized bone matrix (pDBM), derivatives serve as alternatives to autografts in the reconstruction of bone [ 14 , 15 ]. In turn, the use of allografts is significantly limited by the risk of infection transmission and the development of rejection in the recipient’s body [ 16 , 17 , 18 ].…”

MicroRNA-loaded biomaterials for osteogenesis

“…Unfortunately, the source of autologous bone transplantation is limited, and complications, such as pain, occur at the donor site. As an alternative therapy, allogeneic bone transplantation is expensive and prone to disease transmission and rejection ( Brink, 2021 ). Therefore, it is of great clinical significance to find new biomaterials that promote bone regeneration and solve serious problems of bone defects.…”

Osteogenesis of Iron Oxide Nanoparticles-Labeled Human Precartilaginous Stem Cells in Interpenetrating Network Printable Hydrogel

“…Repair of large bone defects caused by trauma, disease, or tumor resection has become a fundamental challenge in the field of orthopedics (Stahl and Yang, 2021). Currently, autologous or allogeneic bone grafts are considered as the most appropriate materials for the treatment of large bone defects but come with some limitations such as infection, possible fracture, and limited bone availability (Brink, 2021). To overcome these shortcomings, functional tissue engineering bone grafts, containing osteoblast or stem cells, growth factor, and bioactive materials, are considered as promising alternatives that have attracted a great deal of interest from researchers and focuses on regenerative strategies for large bone defects (Battafarano et al, 2021;Chansaenroj et al, 2021).…”