Editors' ChoiceOrthopedic Surgery

Rebuilding Broken Bones with Bioactive Ceramics

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Science Translational Medicine  11 Aug 2010:
Vol. 2, Issue 44, pp. 44ec126
DOI: 10.1126/scitranslmed.3001546

The emergency room doors fling open, and in they come—mangled mortals with cracked limbs and shattered bones, the victims of car crashes, falls, fights, or something more gruesome. Orthopedic trauma surgeons spend their days and nights tending these serious injuries, saving both lives and limbs. When large sections of bone have been crushed, trauma surgeons often use bone grafts to replace the damaged areas. These bone grafts are harvested from a healthy, uninjured part of the patient’s body (autograft) or from a processed cadaver source (allograft). However, if the patient’s injuries are extensive, there may not be enough bone graft available to repair all of the damage. Motivated by this life-altering limitation, Yuan et al. sought to demonstrate that porous ceramic materials can serve as an alternative to bone grafts for clinical use.

The authors sintered the bone-compatible materials hydroxyapatite (HA), tricalcium phosphate (TCP), or a mix of the two to create porous ceramic scaffolds. When these scaffolds were implanted into the muscle tissue of dogs, only the TCP scaffold induced bone formation in this environment in which bone growth would not normally occur. Each of the three ceramic scaffolds (HA, TCP, and HA+TCP) and autograft bone (as a gold-standard control) were then implanted into large holes that had been drilled in to the hip bones of sheep. After 12 weeks, Yuan et al. discovered that the TCP scaffold and the autograft bone both yielded comparable bone healing, whereas the HA and mixed scaffolds spurred inferior bone regeneration. These results demonstrate that TCP is a bioactive material that can stimulate bone formation and healing in a manner similar to that of natural bone. With further development and testing, this material may allow orthopedic trauma surgeons to repair very severe bone-shattering injuries and permit trauma victims to walk out of the hospital doors and return to their normal lives.

H. Yuan et al., Osteoinductive ceramics as a synthetic alternative to autologous bone grafting. Proc. Natl. Acad. Sci. U.S.A. 107, 13614–13619 (2010). [Abstract]

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