The Journal of Bone and Joint Surgery, Vol 68, Issue 8 1264-1274, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
The use of demineralized bone matrix in the repair of segmental defects. Augmentation with extracted matrix proteins and a comparison with autologous grafts
ME Bolander and G Balian
A soluble protein component of bone, bone morphogenetic protein, and
decalcified bone matrix have been shown to induce the formation of bone in
extraosseous tissue. Clinical and animal studies investigating the use of
these materials as bone grafts have shown radiographic and histological
evidence of formation of bone, but the clinical usefulness of these grafts
remains unknown. This study compared the healing processes when
plasma-coated demineralized bone matrix and autologous cancellous bone were
used to graft segmental defects of bone. A standard procedure was used to
make a two-centimeter defect bilaterally in the ulna of forty-eight
skeletally mature New Zealand White rabbits. In each rabbit, one ulnar
defect was grafted with autologous citrated plasma-coated demineralized
bone matrix while the other defect served as a control and was grafted with
either autologous cancellous bone from the iliac crest, demineralized bone
matrix, or demineralized bone matrix augmented with bone proteins that had
been extracted with guanidinium hydrochloride. The ulnar defect was
stabilized by the intact radius, and no supplemental device was necessary
for fixation. To examine spontaneous healing in this model, one group of
rabbits had a control defect that was not grafted. The grafts were
periodically evaluated by radiographs, and twelve weeks after surgery the
grafts were harvested and tested to failure in a standard torsion-test
machine. The mechanical parameters were calculated, and histological
examination of major fragments of the grafts was performed. The results of
the radiographic and histological evaluation showed that all of the grafted
ulnae healed, with fusion of the graft to the cut ends of the defect and
reformation of approximately normal anatomy. No ungrafted ulnar defects
healed. The results from the mechanical tests were evaluated by comparing
the defect that was grafted with plasma-coated demineralized bone matrix
with the control graft in each animal. These data showed that: twelve weeks
after grafting, the normal ulnae were significantly stronger than the ulnae
that had been grafted with plasma-coated demineralized bone matrix; the
ulnae that had been grafted with plasma-coated demineralized bone matrix
and those that had been grafted with autologous bone were equivalent in
strength; and twelve weeks after grafting, grafts of demineralized bone
matrix that were augmented with extracted bone proteins were significantly
stronger than those that had not been so augmented.
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