Highlights
- •The induced membrane technique is used for bone defect of critical size.
- •Bioactive glass S53P4 (BAG-53P4) in induced membrane technique failures is a new treatment proposal.
- •In cases of high risk of failure because of the occurrence or the recurrence of an infection, bioactive glass may help the surgeon to improve bone union.
- •BAG-S53P4 may be considered as bone graft in an induced membrane technique.
Abstract
Background
The induced membrane technique has been developed to address bone defect of critical
size from various origins. Despite its exceptional efficacy, several cases underwent
a failure, which is regularly associated with a septic problem. The best way to conduct
in this situation remains debated.
Purpose
To estimate use of bioactive glass S53P4 (BAG-53P4) in induced membrane technique
failures or with an anticipated high risk of failure.
Material and method
We conducted a retrospective analysis of patients from several medical centers in
Europe where BAG-S53P4 has been used inside an induced membrane. The etiology of the
defect, the bone fixation used, the delay the bioactive glass was placed, the reason
why the bioactive glass was used and the results were reported.
Results
Eight cases were included (3 women and 5 men). Mean age was 43 years (16-82; Standard
deviation 23). Mean height was 171 cm (162-184; SD 7), mean weight was 69 kg (60-85;
SD 8) and Body Mass Index was 23,39 M/Kg2 (21,9-25,1; SD 1,22). Mean length of defect
was 68 mm (40-100mm, SD 23). All patients received BAG-S53P4 granules (BonAlive Biomaterials
Ltd, Turku, Finland) to fill the resultant cavity (3 as a stand-alone in the induced
membrane and 5 mixed with autograft). Three patients were implanted with BAG-S53P4
during the second stage of a first induced membrane technique because of a high risk
of infection (three open fractures); two patients were implanted with BAG-S53P4 during
the second stage of a first induced membrane technique because of the great size of
the defect (two infectious non-union); two patients were implanted with BAG-S53P4
as a third stage of induced membrane technique, i.e. inside a previously grafted membrane,
because of a recurrence of the infection; and one patient was implanted with BAG-S53P4
during the second stage of a second induced membrane technique to avoid a new failure.
At a follow-up of 16 months, all healed without any recurrence of the infection.
Discussion
Critical size bone defects caused by an open fracture or an active infection can usually
be addressed by the induced membrane technique. However, some cases are at high risk
of failure because of the occurrence or recurrence of an infection. In these cases,
bioactive glass may help the surgeon to improve the rate of bone union.
Conclusion
BAG-S53P4 may be considered as bone graft in an induced membrane technique, especially
when there is a high probability of occurrence or recurrence of a bone infection.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Current management of long bone large segmental defects.Orthopaed Trauma. 2010; 24: 149-163
- Excision-graft with deliberately delayed closing in chronic osteomyelitis.Nouv Presse Med. 1973; 2: 2753-2755
- Free vascularized bone grafting for large-gap nonunion of long bones.Orthop Clin North Am. 1984; 15: 131-142
- Local bone transportation for treatment of intercalary defects by the Ilizarov technique. Biomechanical and clinical considerations.Clin Orthop Relat Res. 1989; 243: 71-79
- Reconstruction of the long bones by the induced membrane and spongy autograft.Ann Chir Plast Esthet. 2000; 45: 346-353
- The concept of induced membrane for reconstruction of long bone defects.Orthop Clin North Am. 2010; 41: 27-37
- Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration.J Orthop Res. 2004; 22: 73-79
- Bonding mechanisms at the interface of ceramic prosthetic materials.J Biomed Mater Res. 1971; 2: 117-141
- Study on antibacterial effect of 45S5 Bioglass.J Mater Sci Mater Med. 2009; 20: 281-286
- Bioactive glass in tissue engineering.Acta Biomater. 2011 Jun; 7; : 2355-2373
- Antibacterial effect of bioactive glasses on clinically important anaerobic bacteria in vitro.J Mater Sci Mater Med. 2008; 19: 547-551
- Bioactive glass stimulates the secretion of angiogenic growth factors and angiogenesis in vitro.Tissue Eng. 2005; 11: 768-777
- Evaluation of angiogenesis of bioactive glass in the arteriovenous loop model.Tissue Eng Part C Methods. 2013; 19: 479-486
- Molecular basis for action of bioactive glasses as bone graft substitute.Scand J Surg. 2006; 95: 95-102
- Efficacy of antibacterial bioactive glass S53P4 against S. aureus biofilms grown on titanium discs in vitro.J Orthop Res. 2014; 32: 175-177
- Bioactive glass for long bone infection: a systematic review.Injury. 2015; 46 (Suppl): S3-S7
- The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.Lancet. 2007; 370: 1453-1457
- Grading of patients for surgical procedures.Anesthesiology. 1941; 2: 281-284
- Comparison of antibacterial effect of three bioactive glasses.Key Eng Mat. 2006; 309-311: 345-348
- Antibacterial effects of a bioactive glass paste on oral microorganisms.Acta Odontol Scand. 1998; 56: 161-165
- Bactericidal effects of bioactive glasses on clinically important aerobic bacteria.J Mater Sci Mater Med. 2008; 19: 27-32
- Calcium phosphate formation at the surface of bioactive glass in vitro.J Biomed Mat Res. 1991; 25: 1019-1030
- Calcium-phosphate formation at the surface of bioactive glass invivo.J Non Cryst Solids. 1990; 119: 290-296
- Direct chemical bond of bioactive glass-ceramic materials to bone and muscle.J Biomed Mat Res. 1973; 7: 25-42
- Proangiogenic potential of a collagen/bioactive glass substrate.Pharm Res. 2008; 25: 1222-1229
- Bone morphogenic protein expression and bone formation are induced by bioactive glass S53P4 scaffolds in vivo.J Biomed Mater Res B Appl Biomater. 2019; 107: 847-857
- Bioactive glass S53P4 as bone graft substitute in treatment of osteomyelitis.Bone. 2010; 47: 212-218
- Bioactive glass BAG-S53P4 for the adjunctive treatment of chronic osteomy- elitis of the long bones: an in vitro and prospective clinical study.BMC Infect Dis. 2013; 13: 584
- Antibiotic treatment of osteomyelitis: what have we learned from 30 years of clinical trials?.Int J Infect Dis. 2005; 9: 127-138
Article info
Publication history
Published online: July 16, 2022
Accepted:
July 15,
2022
Footnotes
This paper is part of a Supplement supported by the European Society of Tissue Regeneration in Orthopaedics and Traumatology (ESTROT).
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
