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Updated: Aug 23, 2025
A Reliable and Reproducible Critical-Sized Segmental Femoral Defect Model in Rats Stabilized with a Custom External Fixator
Published on: March 24, 2019
The antibiotics supplemented bone cement improved the masquelet's induced membrane in a rat femur critical size
Nezih Ziroglu1, Alican Koluman2, Belisa Kaleci3
1Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Acibadem Atakent Hospital, Kucukcekmece/Istanbul, Turkey.
Background:
Masquelet technique is a two-stage surgical procedure used in the treatment of critical-size bone defects (CSD). Adding antibiotics to polymethylmethacrylate (PMMA) is still questionable to create higher quality induced membrane (IM). The aim of the study was to evaluate the effects of three antibiotic-supplemented cement, fusidic acid, teicoplanin, and gentamicin, on osteogenesis and IM progression applied to rat femur CSD model by comparing histopathological, biochemical, and immunohistochemical findings.
Methods:
Twenty-eight male rats were divided into four groups control, gentamicin (G), teicoplanin (T), and fusidic acid (FA). A 10 mm CSD was created in rat femurs. In the postoperative 4th week, intracardiac blood samples were collected for biochemical analysis of bone alkaline phosphatase (BALP), osteocalcin (OC), and tumor necrosis factor-alpha (TNF-α) levels. IMs obtained in secondary operation were fixed and prepared for histopathological scoring of membrane progression and immunohistochemical evaluation of rat-specific Transforming Growth Factor-Beta (TGF-β), Runt-related Transcription Factor 2 (Runx2), and Vascular Endothelial Growth Factor (VEGF) expressions.
Results:
Levels of BALP and OC in serum didn't change among groups significantly while serum TNF-α levels significantly decreased in all antibiotic groups compared to the control group (P = 0.017). Histological scores of groups FA and T were significantly higher than those of groups Control and G (P = 0.0007). IMs of groups T and FA showed good progression while those of groups Control and G were also moderately progressed. A significant increase in TGF-β expression was observed in group G and FA (P = 0.001) while a significant increase in the expression of VEGF was observed in groups G and T compared to the control group (P = 0.036).
Conclusions:
The bone cement impregnated with thermostable and safe antibiotics, gentamicin, fusidic acid, and teicoplanin can increase osteogenesis and support IM progression by increasing the expressions of TGF-β and VEGF. Anabolic effects of induced membranes used in the treatment of critical-size bone defects can be enhanced by antibiotic-supplemented PMMAs applied by altering the original technique.
Insights
Antibiotics like fusidic acid and teicoplanin in bone cement enhance bone healing and induced membrane (IM) progression in critical-size bone defects (CSD). This study evaluated their effects on osteogenesis in a rat model.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Regenerative Medicine
Background:
- The Masquelet technique uses polymethylmethacrylate (PMMA) cement for critical-size bone defects (CSDs).
- The role of antibiotics within PMMA for enhancing induced membrane (IM) quality is under investigation.
- This study examines fusidic acid, teicoplanin, and gentamicin effects on osteogenesis and IMs in a rat femur CSD model.
Purpose of the Study:
- To evaluate the impact of antibiotic-supplemented PMMA (fusidic acid, teicoplanin, gentamicin) on osteogenesis.
- To assess the influence of these antibiotics on induced membrane (IM) progression in a rat femur CSD model.
- To compare histopathological, biochemical, and immunohistochemical outcomes.
Main Methods:
- Twenty-eight rats with femur CSDs were divided into four groups: control, gentamicin (G), teicoplanin (T), and fusidic acid (FA).
- Biochemical markers (BALP, OC, TNF-α) were analyzed from blood samples at week 4.
- Histopathology and immunohistochemistry (TGF-β, Runx2, VEGF) of IMs were performed.
Main Results:
- Serum TNF-α levels decreased significantly in all antibiotic groups compared to control.
- Histological scores were significantly higher for FA and T groups versus control and G groups.
- Increased TGF-β expression was noted in G and FA groups; increased VEGF was observed in G and T groups.
Conclusions:
- Antibiotic-supplemented PMMA (gentamicin, fusidic acid, teicoplanin) can enhance osteogenesis and IM progression.
- Increased TGF-β and VEGF expression contribute to the anabolic effects of antibiotic-modified PMMA in CSD treatment.
- Altering the Masquelet technique with antibiotic-supplemented PMMA shows potential for improving CSD treatment outcomes.
