The effects of cryopreserved human amniotic membrane on fracture healing: Animal study

Abstract

ObjectiveThe aim of this study was to investigate the effects of human amniotic membrane (HAM) on fracture healing in an animal model.MethodsStandard tibial diaphysial fractures were created in twenty-eight Wistar-Albino rats and treated with intramedullary Kirschner wire (K-wire) and HAM (HAM (+) group) or K-wire only (HAM (–) group). Fracture healing was evaluated by histological analysis, radiologic X-ray views and callus diameter measurements at 3rd and 6th weeks postoperatively.ResultsFracture healing was histologically better in the HAM (+) group and the difference was statistically significant at both 3rd and 6th weeks postoperatively (p < 0.05). The highest histologic scores and entire woven bone formation (Huo Stage 8–9) were obtained at 6th weeks postoperatively in the HAM (+) group. Histological examination also revealed predominant fibrous tissue and partial cartilage formation (Huo Stage 2) at the postoperative 3rd week in the HAM (-) group. Equal amounts of woven bone and cartilage formation (Huo Stage 6–7) were observed at 3rd weeks postoperatively in the HAM (+) group and at 6th weeks postoperatively in the HAM (-) group. The callus diameters were greater in the HAM (+) group and the difference was statistically significant (p < 0.05) at 3rd and 6th weeks postoperatively. Although there was only a statistically significant difference (p < 0.05) at the postoperative 3rd week, radiological scores tended to be higher in the HAM (+) group at both the 3rd and 6th weeks postoperatively.ConclusionHAM is a cheap and easily accessible alternative biological material. HAM may be used to support surgical treatment of fractures, particularly where bone healing is expected to last longer.

Use of Amniotic Membrane and Its Derived Products for Bone Regeneration: A Systematic Review

“…This result was corroborated by the enhancement of gene expression connected with cell recruitment and bone remodeling expression. Recently, Sari et al investigated the efficacy of wrapped AM to promote tibial bone shaft fracture healing in rats (Sar et al, 2019 ). They observed that wrapping AM circumferentially around the fracture line significantly promoted fracture healing compared to the bone reduction without membrane.…”

Osteochondral regeneration in rabbit using xenograft decellularized ECM in combination with different biological products; platelet‐rich fibrin, amniotic membrane extract, and mesenchymal stromal cells

“…53 Additionally, the healing potential of cryopreserved AM in bone fracture of rat tibia model was reported with assessments of histologic scores and callus diameters, but the exact mechanism of this enhancement was not clear. 54 Due to the biphasic feature of OC, a dual positive effect of AME and PRF on bone and cartilage differentiation led to significantly enhanced regeneration compared to other groups.…”

“…Regarding AME utilization, it has been reported that the amniotic membrane with or without seeded stromal cells could elevate chondrocytes population for damaged OC in a rabbit after 24 weeks of treatment 53 . Additionally, the healing potential of cryopreserved AM in bone fracture of rat tibia model was reported with assessments of histologic scores and callus diameters, but the exact mechanism of this enhancement was not clear 54 . Due to the biphasic feature of OC, a dual positive effect of AME and PRF on bone and cartilage differentiation led to significantly enhanced regeneration compared to other groups.…”

Biological properties and surgical applications of the human amniotic membrane

“…It also has anti-adhesion capacity in tendon repair, for example in the flexor tendon in zone II, as well as promoting tendon healing ( Demirkan et al, 2002 ; Liu et al, 2019 ). The use of cryopreserved AM focused on bone tissue has demonstrated various benefits such as in fracture healing ( Sari et al, 2019 ). The amniotic stem cells is used as part of an osteoinductive biomaterial for bone regeneration, either from the cellular components it contains (MSC) ( Li J. et al, 2020 ) or from its acellular features (acellular natural ECM material) ( Tang et al, 2018 ).…”