Bone void filler materials for augmentation in comminuted fractures: a comprehensive review

Abstract Comminuted fractures, characterized by multiple bone fragments, present significant challenges in orthopedic surgery. Effective treatment often requires augmentation techniques to enhance fixation stability and promote bone regeneration. This review explores the application of bone void fil...

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Main Authors: S-Sina Mohammadi, Sunjeev S. Phull, B. Sonny Bal, Mark R. Towler
Format: Article
Language:English
Published: BMC 2025-05-01
Series:Journal of Orthopaedic Surgery and Research
Subjects:
Online Access:https://doi.org/10.1186/s13018-025-05857-2
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author S-Sina Mohammadi
Sunjeev S. Phull
B. Sonny Bal
Mark R. Towler
author_facet S-Sina Mohammadi
Sunjeev S. Phull
B. Sonny Bal
Mark R. Towler
author_sort S-Sina Mohammadi
collection DOAJ
description Abstract Comminuted fractures, characterized by multiple bone fragments, present significant challenges in orthopedic surgery. Effective treatment often requires augmentation techniques to enhance fixation stability and promote bone regeneration. This review explores the application of bone void filler materials, including autografts, allografts, polymethyl methacrylate (PMMA), and synthetic bone substitutes such as calcium phosphate ceramics and bioactive glass, in managing comminuted fractures. Autografts are the gold standard due to their superior osteogenic potential but are limited by donor site morbidity and availability. Allografts mitigate these issues but face concerns regarding immunogenicity and reduced biological activity. PMMA, widely used for structural augmentation, provides immediate stability but suffers from thermal necrosis, polymer shrinkage, and cytotoxic risks. Synthetic bone substitutes, including calcium phosphate cement and bioactive glass, offer promising alternatives by promoting bone integration while reducing complications associated with traditional grafts. However, their mechanical limitations and their artificial nature leave room for improvement. The review highlights recent advancements in biomaterial modifications to improve degradation rates, osteointegration, and mechanical resilience, such as composite materials and ion-doped bio ceramics. Despite these innovations, a gap remains in developing an ideal augmentation material that combines structural integrity with bioactivity. Future research should focus on integrating bioactive elements with load-bearing capabilities to optimize patient outcomes in comminuted fracture management.
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series Journal of Orthopaedic Surgery and Research
spelling doaj-art-7774e48b367745e7b9b6733c37b5d0802025-08-20T02:15:28ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-05-0120111210.1186/s13018-025-05857-2Bone void filler materials for augmentation in comminuted fractures: a comprehensive reviewS-Sina Mohammadi0Sunjeev S. Phull1B. Sonny Bal2Mark R. Towler3Missouri University of Science and Technology, Department of Chemical and Biochemical EngineeringMissouri University of Science and Technology, Department of Chemical and Biochemical EngineeringOrthopedic Surgery Aetna-CVS HealthMissouri University of Science and Technology, Department of Chemical and Biochemical EngineeringAbstract Comminuted fractures, characterized by multiple bone fragments, present significant challenges in orthopedic surgery. Effective treatment often requires augmentation techniques to enhance fixation stability and promote bone regeneration. This review explores the application of bone void filler materials, including autografts, allografts, polymethyl methacrylate (PMMA), and synthetic bone substitutes such as calcium phosphate ceramics and bioactive glass, in managing comminuted fractures. Autografts are the gold standard due to their superior osteogenic potential but are limited by donor site morbidity and availability. Allografts mitigate these issues but face concerns regarding immunogenicity and reduced biological activity. PMMA, widely used for structural augmentation, provides immediate stability but suffers from thermal necrosis, polymer shrinkage, and cytotoxic risks. Synthetic bone substitutes, including calcium phosphate cement and bioactive glass, offer promising alternatives by promoting bone integration while reducing complications associated with traditional grafts. However, their mechanical limitations and their artificial nature leave room for improvement. The review highlights recent advancements in biomaterial modifications to improve degradation rates, osteointegration, and mechanical resilience, such as composite materials and ion-doped bio ceramics. Despite these innovations, a gap remains in developing an ideal augmentation material that combines structural integrity with bioactivity. Future research should focus on integrating bioactive elements with load-bearing capabilities to optimize patient outcomes in comminuted fracture management.https://doi.org/10.1186/s13018-025-05857-2Comminuted fractureAugmentationBone Void fillerPMMABone grafts
spellingShingle S-Sina Mohammadi
Sunjeev S. Phull
B. Sonny Bal
Mark R. Towler
Bone void filler materials for augmentation in comminuted fractures: a comprehensive review
Journal of Orthopaedic Surgery and Research
Comminuted fracture
Augmentation
Bone Void filler
PMMA
Bone grafts
title Bone void filler materials for augmentation in comminuted fractures: a comprehensive review
title_full Bone void filler materials for augmentation in comminuted fractures: a comprehensive review
title_fullStr Bone void filler materials for augmentation in comminuted fractures: a comprehensive review
title_full_unstemmed Bone void filler materials for augmentation in comminuted fractures: a comprehensive review
title_short Bone void filler materials for augmentation in comminuted fractures: a comprehensive review
title_sort bone void filler materials for augmentation in comminuted fractures a comprehensive review
topic Comminuted fracture
Augmentation
Bone Void filler
PMMA
Bone grafts
url https://doi.org/10.1186/s13018-025-05857-2
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AT sunjeevsphull bonevoidfillermaterialsforaugmentationincomminutedfracturesacomprehensivereview
AT bsonnybal bonevoidfillermaterialsforaugmentationincomminutedfracturesacomprehensivereview
AT markrtowler bonevoidfillermaterialsforaugmentationincomminutedfracturesacomprehensivereview