A better approach to critical size bone defect treatment

When addressing a defect in the middle part of a long bone like a femur, doctors have a few surgical scaffold options: autografts, which use bone from another part of the patient’s body; allografts, which use cadaver bone; vascularized grafts, which use autograft bone with blood vessels attached; and bone transport, by which bones are cut or broken near the defect to facilitate new tissue growth that fills in the gaps.

All of these have significant drawbacks in terms of both safety and long-term efficacy.

Figueroa et al. demonstrated a polymer scaffold combined with fat derived stem cells offers an alternative method for large load-bearing bone defects. The method involves the standard use of a metal surgical implant combined with the scaffold and stem cells and, to promote long-term healing, a secondary surgery called dynamization six months after the initial procedure.

“Dynamization is a relatively minor surgery where one of two screws stabilizing the implant is removed to increase loading across the bone defect site,” said author David Margolis. “Overall, this strategy had a high success rate of treating a difficult clinical problem where failed treatment may lead to amputation.”

Another aspect of the research emphasizes the incorporation of sensors into the scaffolds for monitoring purposes. This is a major deviation from the current use of radiographs, which require specialized equipment, expose patients to radiation, and cannot provide continuous mechanical environment measurements.

“The proposed sensor technology provides a monitoring method throughout the entire healing and rehabilitation process,” said Margolis. “This will improve the clinical care of any patient undergoing surgical fracture management.”

Source: “Instrumentalized 3D printed scaffolds enable bone regeneration and fracture healing monitoring in critical size bone defects,” by Gerardo Figueroa Romero, David A. Gonzales, Ginelle Maldonado, Stephany R. Maldonado, Joselyn M. Toothaker, Annemarie E. Rau, Efren Barron Villalobos, Robert V. Childers, Sabina M. Romero, Paige E. Rudy Gayatri Kaimal, John A. Szivek, and David S. Margolis, APL Bioengineering (2026). The article can be accessed at https://doi.org/10.1063/5.0295886 .