Influence of a titanium mesh on the management of segmental long bone defects

S. I. Zoi; S. A. Papadimitriou; A. D. Galatos; N. N. Prassinos; D. Psalla; M. Dalstra; A. Stavropoulos

doi:10.3415/VCOT-14-11-0173

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2015; 28(06): 417-424
DOI: 10.3415/VCOT-14-11-0173

Original Research

Schattauer GmbH

Influence of a titanium mesh on the management of segmental long bone defects

An experimental study in a canine ulnar model

Authors

S. I. Zoi

¹Veterinary Clinic of Larissa, Larissa, Greece

²Faculty of Veterinary Medicine, University of Thessaly, Clinic of Surgery, Karditsa, Greece
S. A. Papadimitriou

³School of Veterinary Medicine, Faculty of Health Sciences, Thessaloniki, Greece
A. D. Galatos

²Faculty of Veterinary Medicine, University of Thessaly, Clinic of Surgery, Karditsa, Greece
N. N. Prassinos

³School of Veterinary Medicine, Faculty of Health Sciences, Thessaloniki, Greece
D. Psalla

³School of Veterinary Medicine, Faculty of Health Sciences, Thessaloniki, Greece
M. Dalstra

⁴Faculty of Health Sciences, Aarhus University, Department of Dentistry Health, Section of Orthodontics, Aarhus, Denmark
A. Stavropoulos

⁵Faculty of Dentistry, Malmö University, Department of Periodontology, Malmö, Sweden

Abstract

Summary

Objectives: To evaluate the influence of titanium mesh on guided bone regeneration when used, either alone or in combination with autogenous bone block graft, in a canine ulnar model.

Methods: Thirty-two, purpose bred, adult, castrated male Beagles were used, divided into four equal-size groups. A unilateral middiaphyseal ulnar critical-size defect was created in each dog. The ulnar segments were stabilized with a stainless-steel plate and screws. Each defect was managed by: no further treatment (Group A) or by placement of a bone block graft taken from the ipsilateral iliac crest (Group B), or titanium mesh wrapped around the ulna (Group C), or a bone block graft and titanium mesh (Group D). After six months, bone block biopsies were performed and the samples were scanned using micro-computed tomography. Qualitative histological evaluation was performed on two non-decalcified longitudinal sections from each block.

Results: No significant differences in terms of mineralized bone volume were detected between the grafted sites (Groups B and D) or between the non-grafted ones (Groups A and C). The histological evaluation indicated good integration of the bone blocks irrespective of the use of titanium mesh.

Clinical significance: The use of titanium mesh does not influence the amount of bone formation. The canine ulnar critical-size defect model seems to be a reliable model to use in experimental studies.

Keywords

Titanium mesh - guided bone regeneration - osteometry - ulnar model - canine

Full Text

References

References
1 Johnson KD, August A, Sciadini MF. et al. Evaluation of ground cortical autograft as a bone graft material in a new canine bilateral segmental long bone defect model. J Orthop Trauma 1996; 10: 28-36.
2 Gauthier O. Stimulation of bone healing. Latest developments.. Proceedings of the European College for Veterinary Surgery Meeting 2011. July 7-9 Ghent, Belgium: 123-126.
3 Ragetly GR, Griffon DJ. The rationale behind novel bone grafting techniques in small animals. Vet Comp Orthop Traumatol 2011; 24: 1-8.
4 Akagi H, Ochi H, Kannno N. et al. Clinical efficacy of autogenous cancellous bone and fibroblast growth factor 2 combined with frozen allografts in femoral nonunion fractures. Vet Comp Orthop Traumatol 2013; 26: 123-129.
5 Dahlin C, Linde A, Gottlow J. et al. Healing of bone defects by guided tissue regeneration. Plast Reconstr Surg 1988; 81: 672-676.
6 Dimitriou R, Mataliotakis GI, Calori GM. et al. The role of barrier membranes for guided bone regeneration and restoration of large bone defects: current experimental and clinical evidence. BMC Med 2012; 10: 81
7 Donley TG, Gillette WB. Titanium endosseous implant-soft tissue interface: a literature review. J Periodontol 1991; 62: 153-160.
8 Patel MF, Langdon JD. Titanium mesh (Ti Mesh) osteosynthesis: a fast and adaptable method of semi-rigid fixation. Br J Oral Maxillofac Surg 1991; 29: 316-324.
9 Tideman H, Samman N, Cheung LK. Immediate reconstruction following maxilectomy: a new method. Int J Oral Maxilofac Surg 1993; 22: 221-225.
10 Wang RR, Fenton A. Titanium for prosthodontic applications: a review of the literature. Quintessence Int 1996; 27: 401-408.
11 Chen N, Du YF, Guo JL. et al. Biologic response to autogenous particulate bone graft and shaped titanium mesh in segmental mandibular defect reconstruction. Int J Oral Maxillofac Implants 2011; 26: 333-340.
12 Iino M, Fukuda M, Nagai H. et al. Evaluation of 15 mandibular reconstructions with Dumbach Titan Mesh-System and particulate cancellous bone and marrow harvested from bilateral posterior ilia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: e1-8.
13 McAfee PC. Interbody fusion cages in reconstructive operations on the spine. J Bone Joint Surg Am 1999; 81: 859-880.
14 Fujibayashi S, Kim HM, Neo M. et al. Repair of segmental long bone defect in rabbit femur using bioactive titanium cylindrical mesh cage. Biomaterials 2003; 24: 3445-3451.
15 Lindsey RW, Gugala Z, Milne E. et al. The efficacy of cylindrical titanium mesh cage for the reconstruction of a critical-size canine segmental femoral diaphyseal defect. J Orthop Res 2006; 24: 1438-1453.
16 Cobos JA, Lindsey RW, Gugala Z. The cylindrical titanium mesh cage for treatment of a long bone segmental defect. Description of a new technique and report of two cases. J Orthop Trauma 2000; 14: 54-59.
17 Ostermann PAW, Haase N, Rübberdt A. et al. Management of a long segmental defect at the proximal meta-diaphyseal junction of the tibia using a cylindrical titanium mesh cage. J Orthop Trauma 2002; 16: 597-601.
18 Attias N, Lehman RE, Bodell LS. et al. Surgical management of a long segmental defect of the humerous using a cylindrical titanium mesh cage and plates: a case report. J Orthop Trauma 2005; 19: 211-216.
19 Attias N, Lindsey RW. Management of large segmental tibial defects using a cylindrical mesh cage. Clin Orthop Relat Res 2006; 450: 259-266.
20 Clements JR, Carpenter BB, Pourciau JK. Treating segmental bone defects: a new technique. J Foot Ankle Surg 2008; 47: 350-356.
21 Segal U, Shani J. Surgical management of large segmental femoral and radial bone defects in a dog: through use of cylindrical titanium mesh cage and a cancellous bone graft. Vet Comp Orthop Traumatol 2010; 23: 66-70.
22 Shilov B. The first case of primary metacarpal V restoration with titanium mesh and cancellous bone graft. J Plast Reconstr Aesthet Surg 2006; 59: 1391-1393.
23 Donath K, Breuner G. A method for the study of undecalcified bones and teeth with attached soft tissues. The Säge-Schliff (sawing and grinding) technique. J Oral Pathol 1982; 11: 318-326.
24 Simion M, Dahlin C, Rocchietta I. et al. Vertical ridge augmentation with guided bone regeneration in association with dental implants: an experimental study in dogs. Clin Oral Implants Res 2007; 18: 86-94.
25 Gutta R, Baker RA, Bartolucci AA. et al. Barrier membranes used for ridge augmentation: is there an optimal pore size?. J Oral Maxillofac Surg 2009; 67: 1218-1225.
26 Radasch R. Biomechanics of bone and fractures. Vet Clin North Am Small Anim Pract 1999; 29: 1045-1082.
27 Hoikkai V, Jaroma H, Ritsilä V. Reconstruction of the patellar articulation with periosteal grafts: 4-year follow-up of 13 cases. Acta Orthopaedica 1990; 61: 36-39.
28 Duncan RL, Turner CH. Mechanotransduction and the functional response of bone to mechanical strain. Calcif Tissue Int 1995; 57: 344-358.
29 Kessler P, Bumiller L, Schlegel A. et al. Dynamic periosteal elevation. Br J Oral Maxillofac Surg 2007; 45: 284-287.
30 Brånemark PI. Osseointegration and its experimental background. J Prosthet Dent 1983; 50: 399-410.
31 Brånemark R, Brånemark PI, Rydevik B. et al. Osseointegration in skeletal reconstruction and rehabilitation: a review. J Rehabil Res Dev 2001; 38: 175-181.
32 Mills LA, Simpson AHRW. In vivo models of bone repair. J Bone Joint Surg Br 2012; 94: 865-874.
33 Einhorn TA. Enhancement of fracture healing. J Bone Joint Surg Am 1995; 77: 940-956.
34 Vertenten G, Gasthuys F, Cornelissen M. et al. Enhancing bone healing and regeneration: present and future perspectives in veterinary orthopaedics. Vet Comp Orthop Traumatol 2010; 23: 153-162.
35 Gielkens PFM, Bos RRM, Raghoebar GM. et al. Is there evidence that barrier membranes prevent bone resorption in autologous bone grafts during the healing period? A systematic review. Int J Oral Maxillofac Implants 2007; 22: 390-398.
36 Key J. The effect of local calcium depot on osteogenesis and healing of fractures. J Bone Joint Surg Am 1934; 16 (A) 176-184.
37 Viateau V, Guillemin G, Yang YC. et al. A technique for creating critical size defects in the metatarsus of sheep for use in investigation of healing of long bone defects. Am J Vet Res 2004; 65: 1653-1657.
38 Schmitz JP, Hollinger JO. The critical size defect as an experimental model for craniomandibulofacial nonunions. Clin Orthop Relat Res 1986; 205: 299-308.
39 Russell WMS, Burch Rl. The Principles of Humane Experimental Technique.. Wheathampsted, UK: Universities Federation for Animal Welfare (UFAW); 1959. Reprinted 1992

Supplementary Material

Online Supplementary Material (PDF) (PDF) (opens in new window)