Comparison of reconstruction methods in the treatment of long bone defects

Objectives: We aimed to demonstrate improving healing in long bone defects histologically, radiologically and mechanically on the rabbit model combined use of titanium mesh cage and induced membrane technique. Material and Methods: In our study, twent four skeletally-mature New Zealand rabbits were used that the weights were among 2500 to 3000 g. A 15 mm segmental bone defect was formed in the femur bones in all groups. The first group was fixed with an empty titanium mesh cage (Tasarımmed®, İstanbul) and 2 cross intramedullary kirschner wire. In the second group, PMMA cement (Gentafix®,Teknimed, Fransa) was placed in the defect area and fixed intramedullary kirschner wire. After 4 weeks, the cement was removed while protect the membran and replaced graft-filled (Gencure®,San Antonio, Amerika) titanium cage with kirschner wire. In the third group, a titanium cage graft-filled was fixed with kirschner wire in the defect area, the Subjects were sacrificed and the femurs were disarticulated at the end of the third month. The femurs were examined mechanically, histologically and radiologically. In the histological examination, the scoring method described by Huo et al. were combined and used. In the radiological examination, Lane and Sandhu were scored. Mechanical evaluation was performed on the Testometric M500-50CT. Statistical significance levels were 0.05. Results: When groups were evaluated according to fibrous tissue, cartilaginous tissue, immature bone, mature bone tissue formation in histological evaluation, it was statistically significant that the group was better in the reconstructed group with induced membrane technique (p<0,05) When radiological evaluation revealed new bone formation in the defect area, the prominence of the fracture line and remodeling, there was a statistically significant difference in induced membrane technique (p<0,05) Although the samples were not evaluated in a wide range of mechanical evaluations, although the result was good in induced membrane technique, it was not found statistically significant (P>0,05). Conclusion: Previous studies have shown that the induced membrane technique has positive effects on healing of bone defects. It has been observed in clinical and experimental studies that titanium mesh cage helps to achieve stabilization alignment and graft incorperation in the reconstruction of the bone defects. In this study, we showed the effect of improving the bone healing using of induced membrane technique with a titanium mesh cage. Similar experimental studies have to be done more in the literature in order for clinical use to be widespread and to be used in the treatment of long bone defects. Similar experimental studies have to be done more in the literature in order for this combined technique to be used in the treatment of long bone defects by widespread clinical use.