Three-dimensional (3D) printed scaffold and material selection for bone repair

Bone defects are common and are associated with a significant burden of disease. The treatment of these injuries remains controversial, particularly those defects which are critical sized. Despite the need for decision making to be evidence based, a lack of consensus around definitions of critical-sized defects still exists, particularly around those defects in the 1-3 cm range. There is a need to define "critical" in bone defect size because noncritical defects may heal without planned reconstruction and secondary surgery. This article reviews the current evidence around the definition of a critical-sized bone defect and concludes that defects in the order of 2.5 cm or greater seem to have a poor natural history.

Size Matters: Defining Critical in Bone Defect Size!

Critical-sized bone defects are defined as those that will not heal spontaneously within a patient's lifetime. Current treatment options include vascularized bone grafts, distraction osteogenesis, and the induced membrane technique. The induced membrane technique is an increasingly utilized method with favorable results including high rates of union. Tissue engineering holds promise in the treatment of large bone defects due to advancement of stem cell biology, novel biomaterials, and 3D bioprinting. In this review, we provide an overview of the current operative treatment strategies of critical-sized bone defects as well as the current state of tissue engineering for such defects.

Treatment of critical-sized bone defects: clinical and tissue engineering perspectives.

There is a significant burden of disease associated with bone defects, and their management is challenging. These injuries have a profound clinical and economic impact, and outcomes are limited by high rates of complication and reoperation, as well as poor functional outcomes. There remains a lack of consensus around definitions, reliable models, and best practices for the surgical management of bone defects. The current state of the literature on bone defects is reviewed here, with a focus on defining critical-size bone defect, the use of the induced membrane technique, the role of biologics, and the management of infected bone defects.

Critical-Size Bone Defects: Is There a Consensus for Diagnosis and Treatment?

Segmental bone defects cause significant disability in patients. Modern orthopaedic surgical techniques have proved to be reliable for reconstruction of these defects. Autogenous bone graft remains the standard of care for reconstruction of small defects (<5 cm). Induced membrane technique and distraction osteogenesis are contemporary strategies of choice for reconstruction of larger bony defects. The use of vascularized fibular grafts has waned in popularity because of donor site morbidity and the success of alternative methods. Complications are ubiquitous with all methods of reconstruction for segmental bone defects but can be limited with careful surgical judgment and technique. In most cases, the rehabilitation period is prolonged, although some treatment options are shorter and enable a more active recovery than do others.

Management of segmental bone defects.

Historically, because of the problems involved in initial limb salvage and the subsequent difficulty of reconstructing large skeletal defects many fractures with significant bone loss were treated by primary amputation. Modern techniques of fracture stabilisation and soft-tissue reconstruction mean

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The management of fractures with bone loss

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The management of fractures with bone loss