Dataset Information

Novel application of 3D printed microporous prosthesis to repair humeral nonunion with segmental bone defects: a case report.

ABSTRACT:

Background

Nonunion of the humeral shaft can turn into bone defects. There is no consensus on the optimal treatment of humeral shaft nonunion with bone defects. Herein, we presented a single case of a patient with a 9.5 cm humerus shaft bone defect treated with a 3D printed Ti₆Al₄V microporous prosthesis after internal fixation failure of a middle-inferior humerus fracture.

Case description

A 53-year-old female who injured her left upper limb by falling was diagnosed with a fracture of the left humeral shaft. The fracture was treated with open reduction and internal fixation. Nine months postoperatively, radiography examination indicated humeral nonunion with a 9.5 cm segmental bone defect. A 3D printing technology was then used to design and fabricate a customized microporous prosthesis with an intramedullary nail and lateral plates. A two-stage surgical strategy was performed, including radical debridement, temporary fixation for the induced membrane formation, and the implantation of the prosthesis. At 18 months of follow-up, encouraging clinical outcomes were observed. The prosthesis remained stable in the original implantation area and callus formation was found at the contact end of the prosthesis and bone stump. The upper limb functions returned to normal with a satisfactory functional score. Also, no complications were found.

Conclusions

Reconstruction with a 3D printed microporous prosthesis might be used as an alternative for the repair of large segmental bone defects of limbs.

SUBMITTER: Qiu W

PROVIDER: S-EPMC9403914 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Publications

Novel application of 3D printed microporous prosthesis to repair humeral nonunion with segmental bone defects: a case report.

Qiu Weipeng W Liu Bingchuan B Li Xingcai X Tian Yun Y

Annals of translational medicine 20220801 15

<h4>Background</h4>Nonunion of the humeral shaft can turn into bone defects. There is no consensus on the optimal treatment of humeral shaft nonunion with bone defects. Herein, we presented a single case of a patient with a 9.5 cm humerus shaft bone defect treated with a 3D printed Ti<sub>6</sub>Al<sub>4</sub>V microporous prosthesis after internal fixation failure of a middle-inferior humerus fracture.<h4>Case description</h4>A 53-year-old female who injured her left upper limb by falling was d ...[more]

PMID: 36034998

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Project description:Objective: Scaphoid and lunate fractures have a relatively high incidence rate. Traditional carpectomy and carpal arthrodesis in the treatment of carpal osteonecrosis will lead to many complications. Three-dimensional (3D) printed tantalum has good biocompatibility and can be designed to match the patient's personalized anatomical carpal structure. This study aims to investigate carpal function and prosthesis-related conditions after carpal bone replacement using 3D printed tantalum prostheses. Methods: From July 2020 to January 2022 at our center, seven patients with osteonecrosis of the carpus received carpal bone replacement using 3D printed tantalum prosthesis. The Disability of the Arm, Shoulder and Hand (DASH) score and patient satisfaction, as well as the Mayo Wrist Scores (Cooney method, modified Green, and O'Brien wrist score), were used to evaluate the preoperative and postoperative wrist function of patients. The Visual Analog Scale (VAS) pain scores were also recorded before and after surgery. The angles of flexion, dorsiflexion, ulnar deviation, and radial deviation were measured using an arthrometer. The grip strength and pinch strength of the operated hand after carpal bone replacement and the contralateral healthy carpus were measured using a dynamometer. Radiographs were taken to confirm the condition and complications of the tantalum prosthesis. Results: All seven patients were followed for 19.6 ± 2.7 months. At the last follow-up, the grip strength of the operated wrist joint after carpal bone replacement was 33.4 ± 2.3 kg, the pinch strength was 8.9 ± 0.7 kg, the flexion was 54.6° ± 0.8°, the dorsiflexion was 54.7° ± 1.7°, the ulnar deviation was 34.6° ± 1.9°, and the radial deviation was 25.9° ± 0.8°, all of which showed no statistically significant difference with the contralateral healthy carpus (p > 0.05). There were significant differences in the VAS, DASH, and MAYO scores between the preoperative and the last follow-up (p < 0.01). Patients had reduced postoperative pain and improved wrist function and range of motion (ROM), and the tantalum prostheses were stable. Conclusion: The 3D printed tantalum brings us new hope, not only for hip or knee replacement, but also for joint replacement of other complex anatomical structures, and patients with other irregular bone defects such as bone tumors and deformity, which could realize personalized treatment and precise medicine.

Project description:BackgroundThus far, the hip revision surgery has been widely used and promoted, and the technology has been constantly innovated, such as tissue engineering, 3D printing prosthesis, etc. However, traditional standardized prosthesis, allograft, autograft, bone cement and reinforcing ring are still the main treatment methods in the mainstream pelvic defects classification systems for hip revision. In addition, the mainstream classification systems are still mainly focus on the peri-acetabulum, but less on the large-scale complex pelvic defects that widely affecting the regions far away from the acetabulum, which also have a significant impact on the holistic biomechanical properties of pelvis.MethodsAfter integrating the design experience of custom prostheses and the understanding of biomechanical properties of pelvis, an innovative pelvic defects classification for custom revision was preliminarily proposed, and was practiced in surgeries. Some typical cases were chosen for elucidation in this study, and two observers each evaluated their CT data independently twice. Intraobserver and interobserver agreement were calculated using the kappa statistic to evaluate the reliability. The pelvis defects were classified into five types and two subtypes. The corresponding reconstruction principles, as the main basis to support the classification, were also described in detail. Prosthesis position examination and Harris hip score were utilized to evaluate the clinical outcome.ResultsThe installed prostheses resulted in high concordance with preoperative position planning, significantly improved Harris score, low postoperative complication rate and no re-revision case. In addition, The interobserver and intraobserver agreement were both excellent.ConclusionThe presenting revision system for complex pelvic defects utilizing 3D-printed custom prosthesis and corresponding classification of pelvic defects can preliminarily guide patients' grouping and prosthesis design, and may potentially provide an innovative, feasible, and efficient basis for complex total hip arthroplasty (THA) revision.Translational potential statementThis study provides a novel method for prosthetic revision of peri-acetabular pelvic defects, and is expected to systematically improve the efficiency of prosthesis design and surgery in clinical practice.

Project description:Background/objectiveRepair of long bone defects remains a major challenge in clinical practice, necessitating the use of bone grafts, growth factors, and mechanical stability. Hence, a combination therapy involving a 3D-printed polycaprolactone (PCL)/β-tricalcium phosphate (β-TCP) scaffold coated with polydopamine (PDA) and alginate microbeads (AM) for sustained delivery of bone morphogenetic protein-2 (BMP-2) was investigated to treat long bone segmental defects.MethodsSeveral in vitro analyses were performed to evaluate the scaffold osteogenic effects in vitro such as PDA surface modification, namely, hydrophilicity and cell adhesion; cytotoxicity and BMP-2 release kinetics using CCK-8 assay and ELISA, respectively; osteogenic differentiation in canine adipose-derived mesenchymal stem cells (Ad-MSCs); formation of mineralized nodules using ALP staining and ARS staining; and mRNA expression of osteogenic differentiation markers using RT-qPCR. Bone regeneration in femoral bone defects was evaluated in vivo using a rabbit femoral segmental bone defect model by performing radiography, micro-computed tomography, and histological observation (hematoxylin and eosin and Masson's trichrome staining).ResultsThe PDA-coated 3D-printed scaffold demonstrated increased hydrophilicity, cell adhesion, and cell proliferation compared with that of the control. BMP-2 release kinetics assessment showed that BMP-2 AM showed a reduced initial burst and continuous release for 28 days. In vitro co-culture with canine Ad-MSCs showed an increase in mineralization and mRNA expression of osteogenic markers in the BMP-2 AM group compared with that of the BMP-2-adsorbed scaffold group. In vivo bone regeneration evaluation 12 weeks after surgery showed that the BMP-2 AM/PDA group exhibited the highest bone volume in the scaffold, followed by the BMP-2/PDA group. High cortical bone connectivity was observed in the PDA-coated scaffold groups.ConclusionThese findings suggest that the combined use of PDA-coated 3D-printed bone scaffolds and BMP-2 AM can successfully induce bone regeneration even in load-bearing bone segmental defects.The translational potential of this articleA 3D-printed PCL/β-TCP scaffold was fabricated to mimic the cortical bone of the femur. Along with the application of PDA surface modification and sustained BMP-2 release via AM, the developed scaffold could provide suitable osteoconduction, osteoinduction, and osteogenesis in both in vitro settings and in vivo rabbit femoral segmental bone defect models. Therefore, our findings suggest a promising therapeutic option for treating challenging long bone segmental defects, with potential for future clinical application.

Project description:ObjectivesTo investigate the feasibility of the 3D printed scaffold for periapical bone defects.MethodsIn this study, antimicrobial peptide KSL-W-loaded PLGA sustainable-release microspheres (KSL-W@PLGA) were firstly prepared followed by assessing the drug release behavior and bacteriostatic ability against Enterococcus faecalis and Porphyromonas gingivalis. After that, we demonstrated that KSL-W@PLGA/collagen (COL)/silk fibroin (SF)/nano-hydroxyapatite (nHA) (COL/SF/nHA) scaffold via 3D-printing technique exhibited significantly good biocompatibility and osteoconductive property. The scaffold was characterized as to pore size, porosity, water absorption expansion rate and mechanical properties. Moreover, MC3T3-E1 cells were seeded into sterile scaffold materials and investigated by CCK-8, SEM and HE staining. In the animal experiment section, we constructed bone defect models of the mandible and evaluated its effect on bone formation. The Japanese white rabbits were killed at 1 and 2 months after surgery, the cone beam computerized tomography (CBCT) and micro-CT scanning, as well as HE and Masson staining analysis were performed on the samples of the operation area, respectively. Data analysis was done using ANOVA and LSD tests. (α = 0.05).ResultsWe observed that the KSL-W@PLGA sustainable-release microspheres prepared in the experiment were uniform in morphology and could gradually release the antimicrobial peptide (KSL-W), which had a long-term antibacterial effect for at least up to 10 days. HE staining and SEM showed that the scaffold had good biocompatibility, which was conducive to the adhesion and proliferation of MC3T3-E1 cells. The porosity and water absorption of the scaffold were (81.96 ± 1.83)% and (458.29 ± 29.79)%, respectively. Histological and radiographic studies showed that the bone healing efficacy of the scaffold was satisfactory.ConclusionsThe KSL-W@PLGA/COL/SF/nHA scaffold possessed good biocompatibility and bone repairing ability, and had potential applications in repairing infected bone defects. Clinical significance The 3D printed scaffold not only has an antibacterial effect, but can also promote bone tissue formation, which provides an alternative therapy option in apical periodontitis.

Dataset Information

Novel application of 3D printed microporous prosthesis to repair humeral nonunion with segmental bone defects: a case report.

Background

Case description

Conclusions

Publications

Novel application of 3D printed microporous prosthesis to repair humeral nonunion with segmental bone defects: a case report.

Similar Datasets

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