Search

Mesoporous bioactive glasses (MBGs) of the SiO2–CaO–P2O5 system are biocompatible materials with a quick and effective in vitro and in vivo bioactive response. MBGs can be enhanced by including therapeutically active ions in their composition, by hosting osteogenic molecules within their mesopores, or by decorating their surfaces with mesenchymal stem cells (MSCs). In previous studies, our group showed that MBGs, ZnO-enriched and loaded with the osteogenic peptide osteostatin (OST), and MSCs exhibited osteogenic features under in vitro conditions. The aim of the present study was to evaluate bone repair capability after large bone defect treatment in distal femur osteoporotic rabbits using MBGs (76%SiO2–15%CaO–5%P2O5–4%ZnO (mol-%)) before and after loading with OST and MSCs from a donor rabbit. MSCs presence and/or OST in scaffolds significantly improved bone repair capacity at 6 and 12 weeks, as confirmed by variations observed in trabecular and cortical bone parameters obtained by micro-CT as well as histological analysis results. A greater effect was observed when OST and MSCs were combined. These findings may indicate the great potential for treating critical bone defects by combining MBGs with MSCs and osteogenic peptides such as OST, with good prospects for translation to clinical practice.

Resumen: Introducción: El dispositivo de fijación interna Internal Joint Stabilizer of the Elbow (IJS-E) se ha planteado recientemente como una alternativa válida a la fijación externa y/o transarticular en la adyuvancia del tratamiento quirúrgico de la inestabilidad aguda compleja persistente de codo tras una correcta reparación osteoligamentosa. Material y métodos: Presentamos un estudio retrospectivo de una serie de casos tratados con IJS-E System (Skeletal DynamicsR) entre febrero del 2019 y 2020. Como criterio de inclusión se establece: pacientes mayores de 18 años con inestabilidad aguda de codo persistente tras una correcta reparación osteoligamentosa, tratados con fijador interno IJS-E. Resultados: Se incluyeron cinco pacientes en el estudio (cuatro varones y una mujer) con una edad media de 37,4 años (24 a 71 años). El patrón lesional fue el de inestabilidad pósterolateral, triada terrible de codo (TTIE), en todos los casos. El seguimiento medio total fue de 9,8 meses (seis a 12 meses). La puntuación Disabilities of the Arm Shoulder and Hand (DASH) media fue de 11,78 (4,2 a 20,6) y la puntuación Mayo Elbow Performance (MEP) media fue de 94 puntos (85 a 100). Se obtuvo un arco de movilidad final de 134°. El porcentaje de reintervención fue del 100% debido a la realización de movilización bajo anestesia asociada a extracción programada del dispositivo. Como complicaciones identificamos un caso de osificación heterotópica y uno de rigidez que requirió artrolisis abierta. En ninguno de los casos se objetivó durante el seguimiento pérdida de congruencia articular ni otras complicaciones mayores. Conclusiones: Nuestra serie de casos presenta unos resultados funcionales y radiológicos prometedores mediante el empleo del IJS-E como alternativa a la fijación externa. Abstract: Introduction: Treatment of acute complex fracture-dislocation of the elbow has been associated with a high rate of complications. Internal Joint Stabilizer of the Elbow (IJSE) device appears as a valid option to optimize and improve our results. Material and methods: We present a retrospective case series of five patients treated at our institution with IJS-E System (Skeletal DynamicsR) from February 2019 to 2020. Our inclusion criteria was: patients over 18 years old surgically treated with IJS-E due to persistent elbow instability despite of a suitable osteoligamentous surgical repair. Results: We obtained a total of five patients (4 males and 1 female) with an average age of 37.4 years old (24-71). The Injury pattern was posterolateral instability, TTIE in all cases. The mean final postoperative MEP score was 94 points (85-100) and the postoperative DASH score was 11.78 points (4.2-20.6) with an average follow-up of 9.8 months (6-12). We described a final arc of motion of 134° with a range of flexionbetween 120° and 140° and a mean lack of extension of 12° (5°-20°), with a complete arc of pronosupination. As complications we found one case of heterotopic ossfication and one case of elbow stiffnes. However, no complications device-related or articular incongruence were reported during follow-up. Conclusions: The IJS-E device appears as an effective alternative instead of external fixation. Nevertheless, a high rate of reoperation up to 100% is associated with IJS-E. A larger series, longer follow-up and prospective studies are needed to define properly his role in the surgical treatment of acute elbow instability.