Select the right filling: Different forms of membrane filling with and without bone marrow mononuclear cells (BMC) in large femoral bone defects in rats

Abstract text (incl. references and figure legends)

Treatment of large bone defects is one of the great challenges in contemporary orthopedic and traumatic surgery. The induced membrane technique is a successful working procedure. In the first operation step, a membrane is induced around a spacer. In the second step, the removal of the spacer and the filling of the membrane pocket takes place. To improve the induced membrane process, demineralized bone matrix in granular (GDBM) and fibrous form (f-DBM) was tested with and without bone marrow mononuclear cells (BMC) as filling of the membrane against the gold standard filling with syngeneic cancellous bone (SCB).

65 male Sprague–Dawley rats obtained a 5 mm femoral defect. The membrane was induced by an implanted PMMA-spacer over a period of 3-4 weeks and afterwards filled with SCB, GDBM, or f-DBM, with or without BMC. After a healing period of eight weeks, the femurs were harvested and submitted for histological, radiological, and biomechanical analyses.

The fracture load in the defect zone was lower compared to SCB in all groups. The extent of new bone formation in defects filled with GDBM + BMC was most prominent (median value: 63.2%). Comparably high values were recorded in the two fiber groups (median f-DBM: 44.8%; median f-DBM + BMC: 52.7%), the differences between the groups were without statistical significance. However, further analysis showed comparable bone mineral density, cartilage proportions, and vascularization.

In summary, the results indicate that f-DBM in combination with BMC and the induced membrane technique cannot reproduce the very good results of this material in large, non-membrane coated bone defects, nevertheless it supports the maturation of new bone tissue locally.

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Sponsor:

German Institute for cell and tissue replacement (DIZG),

Berlin, Germany