An amputation is no longer the only remedy in some extremely complicated broken bones. For the first time in the Netherlands, researchers and surgeons from Maastricht have provided a patient with a printed implant together with his own stem cells. The patient is already up and about again, walking without the use of crutches.
It concerns a man from Maastricht (36), whose shin bone was shattered so badly after a motor bike accident that it was impossible to set. After the removal of the bone splinters, there was a gaping fifteen-centimetre hole in the lower leg.
Until now this would have led to amputation of the lower leg, resulting in great physical and psychological distress. In particular, because such fractures often occur in young people, usually after a traffic accident or sports such as mountain biking.
Regenerative medicine provides an alternative for amputation. This means that the body is stimulated to repair itself. The operation is the culmination of years of research, says Martijn van Griensven, professor of the MERLN institute in Maastricht. Years of trial and error, searching for the right material that could replace the missing piece of bone.
Last summer it was time. The patient agreed to undergo the - still experimental - treatment, which also involved the trauma surgeons from MUMC (Martijn Poeze and Taco Blokhuis). “First, a CT scan is made,” says Van Griensven, “to see how big the hole is and what the bone looks like. Based on that, we had an implant printed that fitted into the hole exactly. This was done by an Australian company that can make prints in a sterile environment.”
In the meantime, stem cells were extracted from the bone marrow in the patient’s pelvis, which were then injected into the implant. The stem cells must gradually grow into bone cells, which causes the biodegradable implant to disappear. “The operation was a tense process, especially at the supreme moment when the implant was placed on the bone. Fortunately, it fit like a glove.”
Then the long wait starts. Will the stem cells grow fast enough? Will there be sufficient new bone? “That is what we were most fearful of. We actually know that this doesn’t always go smoothly. In older people, the cells grow a lot slower, just like in patients with diabetes or osteoporosis. But after six weeks, we saw that there was already sufficient growth. That was a huge relief.”
The motor bike rider from Maastricht can now walk again, he doesn’t even have to use crutches. “He is extremely happy, although he still has to recuperate. Half of the new bone has regrown. In six months’ time, the hole will be filled in and in three years’ time the implant will have completely disappeared and he will be his old self again.”
The treatment is not just suitable for lower limbs, but also for the upper or lower arms, says Van Griensven. “The shin bone is rather vulnerable and that is why damage there is often great. But finger bones have also been printed and in Australia a missing piece of bone in a new-born baby’s skull was repaired using this method.”
By now a second patient has signed up, another traffic accident victim, with a similar fracture in the lower leg, measuring thirteen centimetres. At the moment, the wound is being cleaned with antibiotics, which will take a few weeks. The operation is planned to take place in spring.