Given the difficulty of fixation in osteoporotic bone and the high rate of osteoporotic fractures, treatment of metaphyseal bone defects is a growing surgical challenge in elderly patients Autografts remains the gold standard of treatment; however, autografts are associated with comorbidity of the graft site, loss of reduction due to rapid resorption, pain that can limit or delay ambulation, and limited availability. Autograft extenders increase the available volume to treat large defects by blending the harvested autograft with demineralized bone matrix, allograft chips, or ceramic particles. However, these non-settable grafts do not adequately address the loss of reduction and fixation challenges due to poor mechanical properties. Our laboratory has developed a novel emulsion templating methodology to generate injectable, high porosity bone void fillers that cure to rigid foams at body temperature with compressive properties in the range of trabecular bone. We have demonstrated that this injectable polyHIPE grafts can be mixed with freshly harvested autograft with minimal effect on the pore size, compressive properties and cure rate. In contrast to many bone extenders, a polyHIPE autograft extender offer advantages in porosity and mechanical properties with rapid in situ cure, Figure 1. We hypothesize that the high porosity will allow for improved bone regeneration at lower autograft volumes by providing cell infiltration, nutrient/waste transport, and high surface area to retain osteoinductive factors. These polyHIPE autograft extenders will be a significant advance in bone grafting procedures by providing a truly unique combination of attributes not available with other strategies.

Injectable PolyHIPEs with high porosity as an autograft extender

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ACS Fall 2022

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