How bone forms in large cancellous defects: Critical analysis based on experimental work and literature

• Published in: Injury Vol. 42; pp. S47 - S55
• Main Authors: Draenert, K, Draenert, M, Erler, M, Draenert, A, Draenert, Y
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.09.2011
• Subjects: Absorption; Adult; Animals; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - surgery; Bone Remodeling - physiology; Bone Substitutes - chemistry; Bone Substitutes - metabolism; Bone Substitutes - therapeutic use; Bone void filler; Calcium phosphate ceramics; Calcium Phosphates - chemistry; Calcium Phosphates - metabolism; Calcium Phosphates - therapeutic use; Ceramics - chemistry; Child; Chondroma - diagnostic imaging; Chondroma - surgery; Compressive Strength; Dogs; Female; Fibroma - diagnostic imaging; Fibroma - surgery; Humans; Materials Testing - methods; Orthopedics; Porosity; Primary bone formation; Prosthesis Implantation - methods; Radiography; Tissue Scaffolds; Calcium phosphate ceramics; Primary bone formation; Bone void filler
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2011.06.007

Abstract The behaviour of physiological biomaterials, β-tricalciumphosphate and hydroxyapatite, is analysed based on current literature and our own experimental work. The properties of graft substitutes based on ceramic materials are clearly defined according to their scientific efficiency. The strength of the materials and their biodegradability are still not fully evaluated. Strength and degradability have a direct proportional relationship and are considered the most efficient way to be adapted by their properties to the needs for the treatment of bone defects. New technologies for the manufacturing process are presented that increase those properties and thus open up new indications and easier application of the ceramic materials. The implantation process as well is carefully validated by animal experiments to avoid failures. Based on the experiments, a completely new approach is defined as to how primary bone formation with osteoconductive ceramics can be achieved. The milestones in that approach comprise a synthetically manufactured replica of the bone marrow spaces as osteoconductive ladder, whereas the bead is defined as bone-forming element. As a result, materials are available with high strength if the ceramic is solid or highly porous and possesses a micro-structure. The injection moulding process allows for the combination of high strength of the material with high porosity. Based on the strong capillary forces, micro-chambered beads fulfil most expectations for primary bone formation in cancellous bone defects, including drug delivery, mechanical strengthening if necessary, and stable implantation in situ by coagulation of the blood and bone marrow suctioned in.