gms | German Medical Science

German Congress of Orthopedic and Trauma Surgery (DKOU 2017)

24.10. - 27.10.2017, Berlin

Size matters: Effect of granule size of the bone graft substitute (Herafill®) on bone healing using Masquelet's induced membrane in a critical size defect model in the rat's femur

Meeting Abstract

  • presenting/speaker Maximilian Leiblein - Uniklinik Goethe Universität Frankfurt, Frankfurt, Germany
  • Elias Koch - Uniklinik Goethe Universität Frankfurt, Frankfurt, Germany
  • Andreas Winkenbach - Uniklinik Goethe Universität Frankfurt, Frankfurt, Germany
  • Alexander Schaible - Uniklinik Goethe Universität Frankfurt, Frankfurt, Germany
  • Christoph Nau - Uniklinik Goethe Universität Frankfurt, Frankfurt, Germany
  • Hubert Buechner - Heraeus Medical GmbH, Werheim, Germany
  • Ingo Marzi - Uniklinik Goethe Universität Frankfurt, Frankfurt, Germany
  • Dirk Henrich - Uniklinik Goethe Universität Frankfurt, Frankfurt, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocPO25-1095

doi: 10.3205/17dkou818, urn:nbn:de:0183-17dkou8184

Published: October 23, 2017

© 2017 Leiblein et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objectives: The Masquelet technique is a two-stage procedure for the treatment of critical size bone defects. In the first step a fibrous membrane is induced around a polymethylmethacrylate (PMMA) spacer is inserted into the defect. In a second step, the thus formed membrane is opened, the PMMA-spacer removed and the resulting cavity surrounding the bone defect is filled with either autologous bone or bone graft substitute.

Evidence is reported that the size a scaffold granule is a critical factor for the bone healing response due to different surface-to-volume ratio. In the present study we therefore analysed the influence of the granule size of Herafill in combination with Masquelet's induced membrane

Methods: A total of 126 male SD rats, 350g weight, were allocated to 7 treatment groups and received a 10mm critical size defect of the right femur which was stabilized by a plate osteosynthesis and filled with gentamycin-containing PMMA. Three weeks after the initial operation the induced Masquelet's membrane was opened and the cement spacer taken out. The membranes were filled with either granula (0.5-1.0mm / 1.0-3.0mm / 3.0-5.0mm) or syngenic cancellous bone (n=18/group). After 8 weeks animals were euthanized and the bone defects were harvested for analysis of new bone formation using histomorphometry and micro-CT, respectively. Statistics: Kruskall-Wallis test with Bonferroni-Holm correction, p<0.05 is significant. The experiments were approved by the local animal ethics committee.

Results and Conclusion: Significantly higher bone formation was seen in groups with smallest granule size compared to groups that received large granules (30% vs 17%, p<0.05). Bone healing in groups with small granules was comparable to the autologous bone group (30% vs 31%). Significantly increased BMD was found, if small granula scaffold were used compared to large granula scaffold (1.02 vs 0.95, p=0.02). The comparison between autologous bone and scaffold, either small, medium or large, showed no significant difference of BMD.

We demonstrated that the granule size of bone graft substitute has a significant influence on bone defect healing, particularly small granula showed the best results. Our results further indicate that small sized Herafill granules are effective for the bone defect healing in concert with the Masquelet-procedure.