Impact of scaffold granule size use in Masquelet technique on periosteal reaction: a study in rat femur critical size bo
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ORIGINAL ARTICLE
Impact of scaffold granule size use in Masquelet technique on periosteal reaction: a study in rat femur critical size bone defect model Maximilian Leiblein1 · Andreas Winkenbach1 · Elias Koch1 · Alexander Schaible1 · Hubert Büchner2 · Ingo Marzi1 · Dirk Henrich1 · Christoph Nau1 Received: 2 August 2020 / Accepted: 25 September 2020 © The Author(s) 2020
Abstract Purpose The Masquelet technique for the treatment of large bone defects is a two-stage procedure based on an induced membrane. Compared to mature periosteum, the induced membrane differs significantly. However, both play a crucial role in bone regeneration. As part of a histological and radiological post-evaluation of an earlier project, we analyzed the influence of the granule size of the bone void filler Herafill® on development of periosteum regrowth in a critical size defect. Methods We compared three different sizes of Herafill® granules (Heraeus Medical GmbH, Wehrheim) in vivo in a rat femoral critical size defect (10 mm) treated with the induced membrane technique. After 8 weeks healing time, femurs were harvested and taken for histological and radiological analysis. Results A significantly increased regrowth of periosteum into the defect was found when small granules were used. Large granules showed significantly increased occurrence of bone capping. Small granules lead to significant increase in callus formation in the vicinity to the membrane. Conclusion The size of H erafill® granules has significant impact on the development of periosteal-like structures around the defect using Masquelet’s induced membrane technique. Small granules show significantly increased regrowth of periosteum and improved bone formation adjacent to the induced membrane.
Introduction The treatment of large bone defects caused by tumor resections, osteomyelitis, or trauma is still a major issue for surgeons and patients [1]. While autologous bone grafting is still considered as gold standard for the treatment of bone defects, Masquelet et al. described an alternative two-stage procedure based on an induced membrane [2]. In a first step, a fibrous membrane is induced around the defect by implanting a PMMA spacer. Then, in a second step, after 6–8 weeks, the induced membrane is opened, the spacer removed and replaced with either cancellous bone or a scaffold material. * Maximilian Leiblein [email protected] 1
Klinik für Unfall‑, Hand‑ und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
Heraeus Medical GmbH, 61273 Wehrheim, Germany
2
In previous work our group demonstrated that multiple factors influence the development and quality of the induced membrane. We were able to show that different sorts of cement and additive antibiotics have a significant influence on the development of the membrane [3]. While neovascularization and osteogenic activity peaks at 2–4 weeks, it is hypothesized that after 6 weeks, the induced membrane acts as a bioreactor concentrating growth factor
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