Vasyl Shmahoi
Private Higher Educational Institution “Academy Dobrobut”, MC “Dobrobut”, UkrainePresentation Title:
Possibilities of using modified bioactive ceramics in the reconstruction of critical post-traumatic bone defects
Abstract
Between 2022 and 2025, we observed a significant number of
patients with critical-size bone defects, most of which were caused by gunshot
or shrapnel injuries. According to recent data, critical bone defects account
for up to 28% of gunshot fractures in modern warfare. Currently, the “gold
standard” for the reconstruction of such defects is the induced membrane
technique, also known as the two-stage Masquelet procedure. One of the
most promising alternatives to autologous bone grafts is biphasic bioactive ceramics,
due to their high biocompatibility and good osteoconductive and
osteointegrative properties. However, to ensure successful outcomes using the
Masquelet method, the bone implant material must also possess osteoinductive
properties. To address this, a modified calcium phosphate ceramic (CPC) was
developed, featuring osteoinductive potential through nanostructuring and
doping with osteotropic elements. Our study evaluated the potential of
reconstructing critical bone defects caused by combat trauma using a mixture of
this modified bioactive ceramic and autologous spongiosa during the second
stage of the Masquelet technique. We analyzed a sample of 42 patients who
underwent this technique, with defect filling using the CPC-autospongiosa
mixture combined with additive manufacturing technologies.
We assessed treatment outcomes in patients with post-war
critical long bone defects treated at Dobrobut Medical Center over the past 3
years. Evaluation criteria included clinical parameters (pain level, range of
motion, axial loading ability, and return of function/work capacity), as well
as radiological signs of callus formation, deformation, migration, and
remodeling of the ceramic-bone composite. At 12 months post-op, complete
functional recovery of the limb was achieved in 31 patients (74%), partial recovery
in 9 patients (21%), and 2 patients (5%) had significant functional impairments
requiring further surgery. Additionally, we monitored 20 cases with longer
follow-up periods of 18 to 30 months to assess the remodeling process of the
ceramic-bone mixture.
Conclusion
Based on our experience, using a combination of modified CPC
and autologous spongiosa during the second stage of two-step reconstruction for
critical diaphyseal defects shows positive outcomes in most clinical cases. The
use of 3D modeling and bioresorbable materials expands the possibilities of
modern bone reconstruction.
Prospects for further research
Modern additive technologies combined with bioactive and
bioresorbable materials simplify many of the technical challenges in
reconstructive surgery. However, evaluation of reparative processes at the
implantation site and bioresorption processes, radiological follow-up is needed
beyond 12 months—at 18, 24 months, and more. Such extended observation is
planned to assess long-term treatment outcomes in future research.
Biography
Vasyl Shmahoi graduated from the
Military Medical Academy in Saint Petersburg in 1997 and completed his
internship at the Military Medical Academy in Kyiv in 2000. In 2004, he
obtained his specialization in Orthopedics and Traumatology at NMAPE, Kyiv, and
in 2007 achieved the highest qualification category in this field. In 2016, he
defended his dissertation on “Optimization of Treatment Strategies for Tibial
Nonunion,” earning the degree of Candidate of Medical Sciences (PhD
equivalent). From 2000 to 2008, he worked as an orthopedic trauma surgeon in
the outpatient department of Solomiansky District, Kyiv, and from 2008 to 2016
served at Brovary Central District Hospital. Since 2016, he has been Head of
the Traumatology Department and leader of the Traumatology Direction at
Dobrobut Medical Center, and since 2023, he has also been Associate Professor
at the Dobrobut Academy. He is the author of seven scientific articles and six
conference presentations on tibial fracture nonunion, and since 2022, based on
extensive experience with combat injuries, has been conducting research on the
treatment of critical limb bone defects, having treated over 100 patients,
published three articles, and delivered six presentations, including works in
SCOPUS-indexed journals, while actively participating in related scientific
research. He is the organizer of two annual scientific conferences on “Current
Issues in the Treatment of Combat Injury Consequences” at Dobrobut Medical
Center in Kyiv, regularly takes part in international conferences, including
the 24th European Congress of Trauma and Emergency Surgery (April 13–15, 2025,
Aachen), and is a member of the All-Ukrainian Association of Damage Surgery and
Rehabilitation.
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