Search Results (949)

Bone-related defects present a key challenge in orthopaedics. The current gold standard, autografts, poses significant limitations, such as donor site morbidity, limited supply, and poor morphological adaptability. This study investigates the potential of scaffold geometry to induce osteogenic differentiation of human adipose-derived stem cells (hADSCs) through mechanotransduction, without the use of chemical inducers. Four distinct poly-(L)-lactic acid (PLA) scaffold architectures—Traditional Cross (Tc), Triangle (T), Diamond (D), and Gyroid (G)—were fabricated using fused filament fabrication (FFF) 3D printing. hADSCs were cultured on these scaffolds, and their response was evaluated utilising an alkaline phosphatase (ALP) assay, immunofluorescence, and extensive proteomic analyses. The results showed the D scaffold to have the highest ALP activity, followed by Tc. Proteomics results showed that more than 1200 proteins were identified in each scaffold with unique proteins expressed in each scaffold, respectively Tc—204, T—194, D—244, and G—216. Bioinformatics analysis revealed structures with complex curvature to have an increased expression of proteins involved in mid- to late-stage osteogenesis signalling and differentiation pathways, while the Tc scaffold induced an increased expression of signalling and differentiation pathways pertaining to angiogenesis and early osteogenesis. Full article

Background/Objectives: Radial head arthroplasty is a commonly preferred treatment for complex, unreconstructable radial head fractures. Recent studies have raised the question of whether factors such as bone resorption may be related to failure. This observational, retrospective, multicenter, spontaneous, and non-profit study aims to assess radiological outcomes, focusing on bone resorption around the stem, for radial head replacement using a modular, cementless radial head prosthesis with interconnected porosity. Methods: A series of 42 cases was available for review. Patients underwent radial head arthroplasty using a three-dimensional-printed radial head prosthesis. Patients were eligible for inclusion if they had undergone at least one follow-up between 6 and 15 months post-operatively. A scoring system to detect bone resorption was developed and administered by two independent evaluators. Results: Forty-two patients (14 males, 28 females), with an average age of 59 ± 11 years (range: 39–80 years), were analyzed with a minimum of six months’ and a maximum of 32 months’ follow-up. At follow-up, 50 radiological evaluations were collected, with 29 showing ≤3 mm and 12 showing 3–6 mm resorption around the stem. The average resorption was 3.5 mm ± 2.3. No correlation was found between the extent of resorption and the time of follow-up. The developed scoring system allowed for a high level of correlation between the evaluators’ measurements of bone resorption. Conclusions: Radial head prosthesis with interconnected porosity provided a low stem resorption rate for patients after a radial head fracture at short-to-mid-term follow-up after the definition of a reliable and easy-to-use radiological-based classification approach. (Level of Evidence: Level IV). Full article

Myocardial infarction (MI) remains one of the most common cardiovascular diseases and a leading cause of morbidity and mortality worldwide. In recent years, natural polymeric patches have attracted increasing attention as a promising therapeutic platform for myocardial tissue repair. This study explored the fabrication and evaluation of screen-printed electrodes (SPEs) on chitosan film as a novel platform for cardiac patch applications. Chitosan is a biodegradable and biocompatible natural polymer that provides an ideal substrate for SPEs, providing mechanical stability and promoting cell adhesion. Silver ink was employed to enhance electrochemical performance, and the electrodes exhibited strong adhesion and structural integrity under wet conditions. Mechanical testing and swelling ratio analysis were conducted to assess the patch’s physical robustness and aqueous stability. Silver ink was employed to enhance electrochemical performance, which was evaluated using cyclic voltammetry. In vitro, electrical stimulation through the chitosan–SPE patch significantly increased the expression of cardiac-specific genes (GATA-4, β-MHC, troponin I) in bone marrow mesenchymal stem cells (BMSCs), indicating early cardiogenic differentiation potential. In vivo, the implantation of the chitosan–SPE patch in a rat MI model demonstrated good tissue integration, preserved myocardial structure, and enhanced ventricular wall thickness, indicating that the patch has the potential to serve as a functional cardiac scaffold. These findings support the feasibility of screen-printed electrodes fabricated on chitosan film substrates as a cost-effective and scalable platform for cardiac repair, offering a foundation for future applications in cardiac tissue engineering. Full article

Piezocatalytic therapy (PCT) is a promising strategy for combating implant-associated infections due to its high tissue penetration depth and non-invasive nature. However, its catalytic efficiency remains limited by inefficient electron–hole separation. In this work, an ultrasound-responsive heterojunction (BiOI/Ti₃C₂) was fabricated through in situ growth of bismuth iodide oxide on titanium carbide nanosheets. Subsequently, we integrated BiOI/Ti₃C₂ into poly(e-caprolactone) (PCL) scaffolds using selective laser sintering. The synergistic effect between BiOI and Ti₃C₂ significantly facilitated the redistribution of piezo-induced charges under ultrasound irradiation, effectively suppressing electron–hole recombination. Furthermore, abundant oxygen vacancies in BiOI/Ti₃C₂ provide more active sites for piezocatalytic reactions. Therefore, it enables ultrahigh reactive oxygen species (ROS) yields under ultrasound irradiation, achieving eradication rates of 98.87% for Escherichia coli (E. coli) and 98.51% for Staphylococcus aureus (S. aureus) within 10 minutes while maintaining cytocompatibility for potential tissue integration. This study provides a novel strategy for the utilization of ultrasound-responsive heterojunctions in efficient PCT therapy and bone regeneration. Full article

This study proposes a continuous preparation strategy for poly (l-lactic acid) (PLLA) scaffolds with oriented hierarchical microporous structures for bone repair. A PLLA-oriented multi-stage microporous bone repair scaffold (hereafter referred to as the oriented multi-stage microporous scaffold) was designed using a novel extrusion foaming technology that integrates fused deposition modeling (FDM) 3D printing with supercritical carbon dioxide (SC-CO₂) microcellular foaming technology. The influence of the 3D-printed structure on the microcellular morphology of the oriented multi-stage microporous scaffold was investigated and optimized. The combination of FDM and SC-CO₂ foaming technology enables a continuous extrusion foaming process for preparing oriented multi-stage microporous scaffolds. The mechanical strength of the scaffold reached 15.27 MPa, meeting the requirements for bone repair in a low-load environment. Notably, the formation of open pores on the surface of the oriented multi-stage microporous scaffold positively affected cell proliferation, differentiation, and activity, as well as the expression of anti-inflammatory and pro-inflammatory factors. In vitro cell experiments (such as CCK-8) showed that the cell proliferation rate in the oriented multi-stage microporous scaffold reached 100–300% after many days of cultivation. This work provides a strategy for the design and manufacture of PLLA scaffolds with hierarchical microcellular structures and biocompatibility for bone repair. Full article

Three-dimensional cell culture systems are relevant in vitro models for studying cellular behavior. In this regard, this present study investigates the interaction between human osteoblast-like cells and 3D-printed scaffolds mimicking physiological and osteoporotic bone structures under simulated microgravity conditions. The objective is to assess the effects of scaffold architecture and dynamic culture conditions on cell adhesion, proliferation, and metabolic activity, with implications for osteoporosis research. Polylactic acid scaffolds with physiological (P) and osteoporotic-like (O) trabecular architectures were 3D-printed by means of fused deposition modeling technology. Morphometric characterization was performed using micro-computed tomography. Human osteoblast-like SAOS-2 and U2OS cells were cultured on the scaffolds under static and dynamic simulated microgravity conditions using a rotary cell culture system (RCCS). Scaffold biocompatibility, cell viability, adhesion, and metabolic activity were evaluated through Bromodeoxyuridine incorporation assays, a water-soluble tetrazolium salt assay, and an enzyme-linked immunosorbent assay of tumor necrosis factor-α secretion. Both scaffold models supported osteoblast-like cell adhesion and growth, with an approximately threefold increase in colonization observed on the high-porosity O scaffolds under dynamic conditions. The dynamic environment facilitated increased surface interaction, amplifying the effects of scaffold architecture on cell behavior. Overall, sustained cell growth and metabolic activity, together with the absence of detectable inflammatory responses, confirmed the biocompatibility of the system. Scaffold microstructure and dynamic culture conditions significantly influence osteoblast-like cell behavior. The combination of 3D-printed scaffolds and a RCCS bioreactor provides a promising platform for studying bone remodeling in osteoporosis and microgravity-induced bone loss. These findings may contribute to the development of advanced in vitro models for biomedical research and potential countermeasures for bone degeneration. Full article

Osteosarcoma is one of the most common primary bone malignancies, typically occurring around the knee. However, the forearm is a rare site, with tumors in the proximal ulna being extremely uncommon. Primary sarcoma in this location presents a surgical challenge due to the complex anatomy and limited reconstructive options. We report a rare case of a 19-year-old female with non-metastatic, high-grade giant cell-rich osteosarcoma involving the right proximal ulna. To our knowledge, this is only the second reported adult case of this histological subtype in this location. The patient was treated at a specialized oncology center with neoadjuvant and adjuvant chemotherapy, along with wide intra-articular resection for local tumor control. Reconstruction was achieved using a novel, customized 3D-printed articulating cement spacer mold with plate osteosynthesis. Artificial elbow ligamentous reconstruction was performed using FiberTape and FiberWire sutures passed through drill holes, and the triceps tendon was reattached to the cement mold using an endobutton. This cost-effective and personalized surgical approach allowed successful joint reconstruction while maintaining elbow stability and function. Our case highlights a feasible reconstructive option for rare and anatomically challenging osteosarcoma presentations, contributing to the limited literature on proximal ulna giant cell-rich osteosarcoma. Full article

Introduction: The important factor in applying substances for inner ear therapy is the atraumatic execution, as well as effective concentration uniformly distributed in all regions of the cochlea within a reasonable time frame. This study investigates whether an additional cochlear opening (“second-hole technique”) can improve fluid distribution and reduce intracochlear pressure during dye delivery into the cochlear models and human petrous bone. Material and Methods: Three experimental setups were used: an uncoiled scala tympani model, a full-scale 3D-printed cochlear model, and a human petrous bone. In all cases, 1% methylene blue-stained saline was infused using a cochlear catheter (MED-EL, Innsbruck, Austria) through the round window. Intracochlear pressure was measured via fiberoptic pressure sensors inserted through a burr hole (artificial cochlear models) or at the lateral semicircular canal (human petrous bone). A second hole was made on the helicotrema in the inner ear models or at the oval window of the human petrous bone to examine the effect of a second hole on intracochlear pressure and fluid distribution. Dye distribution and intracochlear pressure were measured in 3D artificial models at two flow rates (0.2 and 0.4 mL/h). The intracochlear pressure were measured in the human petrous bone at a fixed rate (0.4 mL/h). Results: The use of a second hole significantly improved dye distribution in 3D models at both flow rates (p < 0.05) and led to earlier saturation-level distribution. Intracochlear pressure remained significantly lower and more stable in models with a second hole (p < 0.05). In human petrous bones, pressure fluctuation was reduced by the second hole, though pressure still increased over time. Conclusions: Using a second-hole technique leads to a faster, uniform level of dye distribution throughout the cochlear models, as well as a lower intracochlear pressure, which can be assumed to be an essential factor for hearing preservation during dye application. Full article

Background: Traumatic fractures of the cervical spine pose significant challenges in management, particularly in young patients, where preserving mobility is crucial. Patient Characteristics: A 30-year-old woman presented with a C3 lateral mass and pedicle fracture following a motor vehicle collision. Initial conservative management with a rigid cervical collar for three months failed to reduce the diastasis, and the debilitating neck pain worsened. Preoperative imaging confirmed fracture instability without spinal cord compression. Intervention and Outcome: Preoperative screw trajectory planning was conducted with the My Spine MC system (Medacta), and fine-tuning was achieved on a 3D-printed model of the vertebra. A posterior midline approach was employed to expose the C3 vertebra, and a Herbert screw was inserted under fluoroscopic guidance. Imaging at three months demonstrated significant fracture reduction and early bone fusion. The patient achieved substantial improvement in functional mobility without complications. Conclusion: Herbert screw fixation holds potential as a less-invasive alternative to conventional posterior stabilization for selected cervical fractures. This technical note provides the reader with the required information to support surgical planning and execution. Full article

Background/Objectives: Recent breakthroughs in three-dimensional (3D) printing and high-resolution imaging have opened up new possibilities in personalized medicine, surgical planning, and forensic reconstruction. This study breaks new ground by evaluating the integration of high-resolution peripheral quantitative computed tomography (HR-pQCT) with multimodal imaging and additive manufacturing to assess a chronic, infected gunshot injury in the knee joint of a red deer. This unique approach serves as a translational model for complex skeletal trauma. Methods: Multimodal imaging—including clinical CT, MRI, and HR-pQCT—was used to characterise the extent of osseous and soft tissue damage. Histopathological and molecular analyses were performed to confirm the infectious agent. HR-pQCT datasets were segmented and processed for 3D printing using PolyJet, stereolithography (SLA), and fused deposition modelling (FDM). Printed models were quantitatively benchmarked through 3D surface deviation analysis. Results: Imaging revealed comminuted fractures, cortical and trabecular degradation, and soft tissue involvement, consistent with chronic osteomyelitis. Sphingomonas sp., a bacterium that forms biofilms, was identified as the pathogen. Among the printing methods, PolyJet and SLA demonstrated the highest anatomical accuracy, whereas FDM exhibited greater geometric deviation. Conclusions: HR-pQCT-guided 3D printing provides a powerful tool for the anatomical visualisation and quantitative assessment of complex bone pathology. This approach not only enhances diagnostic precision but also supports applications in surgical rehearsal and forensic analysis. It illustrates the potential of digital imaging and additive manufacturing to advance orthopaedic and trauma care, inspiring future research and applications in the field. Full article

Background/Objectives: Personalized 3D-printed (3DP) metallic implants delivery systems are being explored to repair bone fractures, allowing the customization of medical implants that respond to individual patient needs, making it potentially more effective and of greater quality than mass-produced devices. However, challenges associated with postsurgical infections caused by bacterial adhesion remain a clinical issue. To address this, local antibiotic therapies are receiving extensive attention to minimize the risk of implant-related infections. This study investigated the use of amikacin (AMK), a broad-spectrum aminoglycoside antibiotic, incorporated onto 3D-printed 316L stainless steel implants using biodegradable polymer coatings of chitosan and poly lactic-co-glycolic acid (PLGA). Methods: This research examined different approaches to coat 3DP implants with amikacin. Various polymer-based coatings were studied to determine the optimal formulation based on the characteristics and release profile. The optimal formulation was performed on the antibacterial activity studies. Results: AMK-chitosan with PLGA coating implants controlled the rate of drug release for up to one month. The 3DP drug-loaded substrates demonstrated effective, concentration-dependent antibacterial activity against common infective pathogens. AMK-loaded substrates showed antimicrobial effectiveness for one week and inhibited bacteria significantly compared to the uncoated controls. Conclusions: This study demonstrated that 3DP metal surfaces coated with amikacin can provide customizable drug release profiles while effectively inhibiting bacterial growth. These findings highlight the potential of combining 3D printing with localized delivery strategies to prevent implant-associated infections and advance the development of personalized therapies. Full article

Background and Objectives: Bone regeneration (BR) is a cornerstone technique in reconstructive dental surgery, traditionally using either barrier membranes, titanium meshes, or perforated non-resorbable membranes to facilitate bone regeneration. Recent advancements in 3D technology, including CAD/CAM and additive manufacturing, have enabled the development of customized scaffolds tailored to patient needs, potentially overcoming the limitations of conventional methods. Materials and Methods: A scoping review was conducted according to the PRISMA guidelines. Electronic searches were performed in MEDLINE (PubMed), the Cochrane Library, Scopus, and Web of Science up to January 2025 to identify studies on digital technologies applied to bone augmentation. Eligible studies encompassed randomized controlled trials, cohort studies, case series, and case reports, all published in English. Data regarding digital workflows, software, materials, printing techniques, and sterilization methods were extracted from 23 studies published between 2015 and 2024. Results: The review highlights a diverse range of digital workflows, beginning with CBCT-based DICOM to STL conversion using software such as Mimics and Btk-3D^®. Customized titanium meshes and other meshes like Poly Ether-Ether Ketone (PEEK) meshes were produced via techniques including direct metal laser sintering (DMLS), selective laser melting (SLM), and five-axis milling. Although titanium remained the predominant material, studies reported variations in mesh design, thickness, and sterilization protocols. The findings underscore that digital customization enhances surgical precision and efficiency in BR, with several studies demonstrating improved bone gain and reduced operative time compared to conventional approaches. Conclusions: This scoping review confirms that 3D techniques represent a promising advancement in BR. Customized digital workflows provide superior accuracy and support for BR procedures, yet variability in protocols and limited high-quality trials underscore the need for further clinical research to standardize techniques and validate long-term outcomes. Full article

Spinal injuries have a major impact on patients’ quality of life due to the implacable consequences they bring, such as reduced mobility and loss of flexibility, in most cases requiring surgery to restore spinal stability and functionality. In this respect, spinal fixation devices represent an important strategy to stabilize the spine after severe injuries or degenerative conditions, providing structural support and preserving spinal function. However, at the moment, the materials used to manufacture spinal implants present numerous disadvantages (e.g., Young’s modulus larger than cortical bone, which can produce bone resorption and implant enlargement) that can lead to implant failure. In this context, nanotechnology can offer promising solutions, bringing improved properties (e.g., biocompatibility, osseointegration, and increased mechanical performance) that increase the potential for obtaining devices customized to patients’ needs. Thus, the present work aims to present an overview of the types of nanocoating surface modification, the impact of rough and porous implant surfaces, and the integration of bioactive nanoparticles that reduce the risk of infection and implant rejection. In addition, incorporating 3D printing technology and the use of biodegradable materials into the discussion provides a valuable perspective for future studies in this field. Although the emerging results are encouraging, further studies to assess the long-term safety of implant coatings are needed. Full article

Nature’s principles offer design references for additive manufacturing (AM), enabling structures that achieve remarkable efficiency through hierarchical organization rather than material excess. This perspective article proposes a framework for integrating biomimetic principles into AM beyond morphological mimicry, focusing on functional adaptation and sustainability. By emulating biological systems like nacre, spider silk, and bone, AM utilizes traditional geometric replication to embed multifunctionality, responsiveness, and resource efficiency. Recent advances in the fields of 4D printing, soft robotics, and self-morphing systems demonstrate how time-dependent behaviors and environmental adaptability can be engineered through bioinspired material architectures. However, challenges in scalable fabrication, dynamic material programming, and true functional emulation (beyond morphological mimicry) necessitate interdisciplinary collaboration. In this context, the synthesis of biological intelligence with AM technologies offers sustainable, high-performance solutions for aerospace, biomedical, and smart infrastructure applications, once challenges related to material innovation and standardization are overcome. Full article

Background/Objectives: Guided implant surgery relies on the use of surgical templates to direct osteotomy drills, but guide design may influence irrigation efficiency, hence bone overheating, a critical factor in preventing thermal necrosis. This ex vivo study compared temperature changes when drilling using two guide designs: a closed-frame (occlusive structure) and an open-frame (non-occlusive design), evaluating their clinical relevance in mitigating overheating. Methods: Sixteen pig ribs were scanned, and implant osteotomies were planned via a guided surgery software. Two 3D-printed resin templates, one with a closed-frame design and one with an open-frame design, were tested (8 ribs per group, 24 implants per group). Drilling was performed sequentially (diameter of 1.9 mm, 3.25 mm, and 4.1 mm) at 800 rpm, while bone temperatures were recorded at depths of 3 mm and 10 mm using K-type thermo§s. Results: Significantly higher temperature rises were observed with the closed-frame guide. Drilling depth had also a significant influence, with higher temperatures at 3 mm than 10 mm (p < 0.001), suggesting that cortical bone density may amplify frictional heat. No significant effect of drill diameter was detected. Conclusions: Within the limitations of this ex vivo model, the open-frame design kept the maximal temperature rise about 0.67 °C lower than the closed-frame guide (1.22 °C vs. 0.55 °C), i.e., a 2.2-fold relative reduction was observed during the most demanding drilling step. This suggests a more efficient cooling capacity, especially in dense cortical bone, which offers a potential benefit for minimizing thermal risk in guided implant procedures. Full article