{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T10:05:18Z","timestamp":1793095518060,"version":"4.5.0"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100016036","name":"Health~Holland","doi-asserted-by":"publisher","award":["LSHM202206"],"award-info":[{"award-number":["LSHM202206"]}],"id":[{"id":"10.13039\/100016036","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016036","name":"Health~Holland","doi-asserted-by":"publisher","award":["LSHM202206"],"award-info":[{"award-number":["LSHM202206"]}],"id":[{"id":"10.13039\/100016036","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016036","name":"Health~Holland","doi-asserted-by":"publisher","award":["LSHM202206"],"award-info":[{"award-number":["LSHM202206"]}],"id":[{"id":"10.13039\/100016036","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016036","name":"Health~Holland","doi-asserted-by":"publisher","award":["LSHM202206"],"award-info":[{"award-number":["LSHM202206"]}],"id":[{"id":"10.13039\/100016036","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016036","name":"Health~Holland","doi-asserted-by":"publisher","award":["LSHM202206"],"award-info":[{"award-number":["LSHM202206"]}],"id":[{"id":"10.13039\/100016036","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Induced Membrane Technique (IMT) combined with autologous bone grafting has proven effective in achieving union in many cases of non-healing bone defects. However, this treatment strategy remainschallenging in very large defects (\u2265\u200910\u00a0cm). Although the addition of a 3D-printed scaffold could enhance osteoconductivity and retention of cancellous bone, cells, and bioactive materials in the defect, the long-term outcomes of this innovative approach are not yet known. We therefore reviewed all patients with a very large posttraumatic segmental defect of a long bone treated with the IMT using a 3D-printed scaffold, cancellous bone, cells, and bioactive materials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From 2018 to 2024, all consecutive patients with a large segmental defect who received a 3D printed scaffold were identified. All patients were treated with the two-stage IMT procedure. The defects were filled in the second stage procedure with a 3D printed scaffold made from poly-\u03b5-caprolactone and Tricalcium Phosphate (PCL\/TCP), autologous bone graft (bone marrow aspirate concentrate and RIA-autograft), and biomaterials(P-15 +\/- bioactive glass). In the event of complications, samples from the defect site with the PCL\/TCP scaffold were collected for analysis using scanning electron microscopy and histology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of ten patients were treated for a segmental bone defect median of 10.5\u00a0cm (IQR 3.25) of the femur (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093) or tibia (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20097). Follow-up of the patients ranges between one and four years. The median age of the patients is 46 (range 23\u201362). Complications occurred in seven patients (one femur, six tibia). All patients with complications required additional surgeries. One patient had a local osteomyelitis infection at the defect site with complete integration of the scaffold into the proximal and distal tibia; one required negative pressure wound therapy for a soft tissue infection; and five required a revision of the first stage procedure due to surgical site infection (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093) or failure of the fracture fixation material (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092). Remarkably, scanning electron microscopy and histology showed limited formation and incorporation of newly formed bone into the scaffold. After revision surgery, all patients are currently improving, and no amputations have been performed so far.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reconstructive treatment of large bone defects remains challenging. The short-term follow-up of this treatment strategy showed promising results with progress in clinical and radiological follow-up. However, in this small cohort a lack of bone growth at the defect site was found in some of the cases that were clinically performing well. The use of PCL\/TCP scaffolds remains a valuable treatment strategy in very large bone defects for retention and extension of the autologous bone and cells, though improvements in fixation, composition or structural properties could enhance their feasibility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-025-02982-9","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T16:33:24Z","timestamp":1763138004000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Long-term follow-up of patients with large segmental bone defects treated with 3D-printed polycaprolactone\/tricalcium phosphate scaffolds"],"prefix":"10.1007","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3091-4009","authenticated-orcid":false,"given":"Anna J. L.","family":"Lodewijks","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margot M.R.","family":"Warin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2006-5053","authenticated-orcid":false,"given":"Lotte C. A.","family":"van der Broeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9304-1554","authenticated-orcid":false,"given":"Maria Gabriella","family":"Fois","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9356-4109","authenticated-orcid":false,"given":"Carmen","family":"Lopez-Iglesias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3601-3458","authenticated-orcid":false,"given":"Taco J.","family":"Blokhuis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5104-9881","authenticated-orcid":false,"given":"Martijn","family":"van Griensven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5005-1285","authenticated-orcid":false,"given":"Martijn","family":"Poeze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"issue":"7","key":"2982_CR1","doi-asserted-by":"publisher","first-page":"1215","DOI":"10.1007\/s00402-020-03525-0","volume":"141","author":"H Bezstarosti","year":"2021","unstructured":"Bezstarosti H, Metsemakers WJ, van Lieshout EMM, Voskamp LW, Kortram K, McNally MA, et al. Management of critical-sized bone defects in the treatment of fracture-related infection: a systematic review and pooled analysis. Arch Orthop Trauma Surg. 2021;141(7):1215\u201330. https:\/\/doi.org\/10.1007\/s00402-020-03525-0.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"1","key":"2982_CR2","doi-asserted-by":"publisher","first-page":"9098","DOI":"10.1038\/s41598-022-12140-5","volume":"12","author":"P Feltri","year":"2022","unstructured":"Feltri P, Solaro L, Di Martino A, Candrian C, Errani C, Filardo G. Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis. Sci Rep. 2022;12(1):9098.","journal-title":"Sci Rep"},{"key":"2982_CR3","unstructured":"Masquelet A, Fitoussi F, Begue T, Muller G. Reconstruction of the long bones by the induced membrane and spongy autograft. In Annales de chirurgie plastique et esthetique, 2000 (Vol. 45, pp. 346\u2013353, Vol. 3)."},{"key":"2982_CR4","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjtee.2024.04.003","author":"J-H Wu","year":"2024","unstructured":"Wu J-H, Bao Q-W, Wang S-K, Zhou P-Y, Xu S-G. Mechanisms of the masquelet technique to promote bone defect repair and its influencing factors. Chin J Traumatol. 2024. https:\/\/doi.org\/10.1016\/j.cjtee.2024.04.003.","journal-title":"Chin J Traumatol"},{"issue":"10","key":"2982_CR5","doi-asserted-by":"publisher","first-page":"110923","DOI":"10.1016\/j.injury.2023.110923","volume":"54","author":"J Frese","year":"2023","unstructured":"Frese J, Schulz AP, Kowald B, Gerlach UJ, Frosch KH, Schoop R. Treatment outcome of the masquelet technique in 195 infected bone defects-a single-center, retrospective case series. Injury. 2023;54(10):110923. https:\/\/doi.org\/10.1016\/j.injury.2023.110923.","journal-title":"Injury"},{"issue":"3","key":"2982_CR6","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1007\/s00590-017-2063-0","volume":"28","author":"E Roddy","year":"2018","unstructured":"Roddy E, DeBaun MR, Daoud-Gray A, Yang YP, Gardner MJ. Treatment of critical-sized bone defects: clinical and tissue engineering perspectives. Eur J Orthop Surg Traumatol. 2018;28(3):351\u201362. https:\/\/doi.org\/10.1007\/s00590-017-2063-0.","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"2982_CR7","doi-asserted-by":"publisher","DOI":"10.1088\/1748-605X\/ad967c","author":"A Garimella","year":"2024","unstructured":"Garimella A, Ghosh SB, Bandyopadhyay-Ghosh S. Biomaterials for bone tissue engineering: achievements to date and future directions. Biomed Mater. 2024. https:\/\/doi.org\/10.1088\/1748-605X\/ad967c.","journal-title":"Biomed Mater"},{"issue":"9","key":"2982_CR8","doi-asserted-by":"publisher","DOI":"10.3390\/jfb15090243","volume":"15","author":"H-Y Liang","year":"2024","unstructured":"Liang H-Y, Lee W-K, Hsu J-T, Shih J-Y, Ma T-L, Vo TTT, et al. Polycaprolactone in bone tissue engineering: a comprehensive review of innovations in scaffold fabrication and surface modifications. J Funct Biomater. 2024;15(9):243.","journal-title":"J Funct Biomater"},{"issue":"12","key":"2982_CR9","doi-asserted-by":"publisher","first-page":"4256","DOI":"10.1021\/bm201126j","volume":"12","author":"SH Ahn","year":"2011","unstructured":"Ahn SH, Lee HJ, Kim GH. Polycaprolactone scaffolds fabricated with an advanced electrohydrodynamic direct-printing method for bone tissue regeneration. Biomacromolecules. 2011;12(12):4256\u201363. https:\/\/doi.org\/10.1021\/bm201126j.","journal-title":"Biomacromolecules"},{"issue":"3","key":"2982_CR10","doi-asserted-by":"publisher","first-page":"181","DOI":"10.7181\/acfs.2018.01879","volume":"19","author":"H Park","year":"2018","unstructured":"Park H, Kim JS, Oh EJ, Kim TJ, Kim HM, Shim JH, et al. Effects of three-dimensionally printed polycaprolactone\/\u03b2-tricalcium phosphate scaffold on osteogenic differentiation of adipose tissue- and bone marrow-derived stem cells. Arch Craniofac Surg. 2018;19(3):181\u20139. https:\/\/doi.org\/10.7181\/acfs.2018.01879.","journal-title":"Arch Craniofac Surg"},{"issue":"22","key":"2982_CR11","doi-asserted-by":"publisher","first-page":"5647","DOI":"10.1016\/j.biomaterials.2014.03.075","volume":"35","author":"Y Li","year":"2014","unstructured":"Li Y, Wu ZG, Li XK, Guo Z, Wu SH, Zhang YQ, et al. A polycaprolactone-tricalcium phosphate composite scaffold as an autograft-free spinal fusion cage in a sheep model. Biomaterials. 2014;35(22):5647\u201359. https:\/\/doi.org\/10.1016\/j.biomaterials.2014.03.075.","journal-title":"Biomaterials"},{"issue":"6","key":"2982_CR12","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1055\/s-0030-1248310","volume":"42","author":"FA Probst","year":"2010","unstructured":"Probst FA, Hutmacher DW, M\u00fcller DF, Machens HG, Schantz JT. [Calvarial reconstruction by customized bioactive implant]. Handchir Mikrochir Plast Chir. 2010;42(6):369\u201373. https:\/\/doi.org\/10.1055\/s-0030-1248310.","journal-title":"Handchir Mikrochir Plast Chir"},{"issue":"4","key":"2982_CR13","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1002\/jbm.a.31142","volume":"81","author":"B Rai","year":"2007","unstructured":"Rai B, Oest ME, Dupont KM, Ho KH, Teoh SH, Guldberg RE. Combination of platelet-rich plasma with polycaprolactone-tricalcium phosphate scaffolds for segmental bone defect repair. J Biomed Mater Res A. 2007;81(4):888\u201399. https:\/\/doi.org\/10.1002\/jbm.a.31142.","journal-title":"J Biomed Mater Res A"},{"key":"2982_CR14","doi-asserted-by":"publisher","DOI":"10.3390\/polym13152552","author":"CM Chen","year":"2021","unstructured":"Chen CM, Chen SM, Lin SF, Liang HC, Wu CC. Clinical efficacy of polycaprolactone \u03b2-calcium triphosphate composite for osteoconduction in rabbit bone defect model. Polymers. 2021. https:\/\/doi.org\/10.3390\/polym13152552.","journal-title":"Polymers"},{"issue":"1","key":"2982_CR15","doi-asserted-by":"publisher","first-page":"4979","DOI":"10.1038\/s41598-020-61944-w","volume":"10","author":"S Lee","year":"2020","unstructured":"Lee S, Choi D, Shim J-H, Nam W. Efficacy of three-dimensionally printed polycaprolactone\/beta tricalcium phosphate scaffold on mandibular reconstruction. Sci Rep. 2020;10(1):4979. https:\/\/doi.org\/10.1038\/s41598-020-61944-w.","journal-title":"Sci Rep"},{"issue":"6","key":"2982_CR16","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1002\/pi.2195","volume":"56","author":"CX Lam","year":"2007","unstructured":"Lam CX, Teoh SH, Hutmacher DW. Comparison of the degradation of polycaprolactone and polycaprolactone\u2013(\u03b2-tricalcium phosphate) scaffolds in alkaline medium. Polym Int. 2007;56(6):718\u201328.","journal-title":"Polym Int"},{"issue":"1","key":"2982_CR17","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1002\/jbm.a.31454","volume":"84A","author":"A Yeo","year":"2008","unstructured":"Yeo A, Rai B, Sju E, Cheong JJ, Teoh SH. The degradation profile of novel, bioresorbable PCL\u2013TCP scaffolds: an in vitro and in vivo study. J Biomed Mater Res A. 2008;84A(1):208\u201318. https:\/\/doi.org\/10.1002\/jbm.a.31454.","journal-title":"J Biomed Mater Res A"},{"issue":"8","key":"2982_CR18","doi-asserted-by":"publisher","first-page":"e66256","DOI":"10.7759\/cureus.66256","volume":"16","author":"A Lodewijks","year":"2024","unstructured":"Lodewijks A, Blokhuis T, van Griensven M, Poeze M. The treatment of very large traumatic bone defects of the tibia with a polycaprolactone-tricalcium phosphate 3D-printed cage: a review of three cases. Cureus. 2024;16(8):e66256. https:\/\/doi.org\/10.7759\/cureus.66256.","journal-title":"Cureus"},{"key":"2982_CR19","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.jot.2022.04.004","volume":"34","author":"M Laubach","year":"2022","unstructured":"Laubach M, Suresh S, Herath B, Wille ML, Delbr\u00fcck H, Alabdulrahman H, et al. Clinical translation of a patient-specific scaffold-guided bone regeneration concept in four cases with large long bone defects. J Orthop Transl. 2022;34:73\u201384. https:\/\/doi.org\/10.1016\/j.jot.2022.04.004.","journal-title":"J Orthop Transl"},{"key":"2982_CR20","unstructured":"Blokhuis J. The osteogenic capacity of a novel bone graft substitute. University of Twente; 2024."},{"issue":"1","key":"2982_CR21","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/s00264-006-0087-x","volume":"31","author":"F Gomar","year":"2007","unstructured":"Gomar F, Orozco R, Villar JL, Arrizabalaga F. P-15 small peptide bone graft substitute in the treatment of non-unions and delayed union. A pilot clinical trial. Int Orthop. 2007;31(1):93\u20139. https:\/\/doi.org\/10.1007\/s00264-006-0087-x.","journal-title":"Int Orthop"},{"key":"2982_CR22","doi-asserted-by":"publisher","unstructured":"van Gestel NA, Geurts J, Hulsen DJ, van Rietbergen B, Hofmann S, Arts JJ. Clinical applications of S53P4 bioactive glass in bone healing and osteomyelitic treatment: A literature review. Biomed Res Int. 2015;2015(684826). https:\/\/doi.org\/10.1155\/2015\/684826.","DOI":"10.1155\/2015\/684826"},{"issue":"6","key":"2982_CR23","doi-asserted-by":"publisher","first-page":"825","DOI":"10.3349\/ymj.2009.50.6.825","volume":"50","author":"SJ Kim","year":"2009","unstructured":"Kim SJ, Kim MR, Oh JS, Han I, Shin SW. Effects of polycaprolactone-tricalcium phosphate, recombinant human bone morphogenetic protein-2 and dog mesenchymal stem cells on bone formation: pilot study in dogs. Yonsei Med J. 2009;50(6):825\u201331. https:\/\/doi.org\/10.3349\/ymj.2009.50.6.825.","journal-title":"Yonsei Med J"},{"issue":"1","key":"2982_CR24","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/s40001-020-00471-w","volume":"25","author":"P Kobbe","year":"2020","unstructured":"Kobbe P, Laubach M, Hutmacher DW, Alabdulrahman H, Sellei RM, Hildebrand F. Convergence of scaffold-guided bone regeneration and RIA bone grafting for the treatment of a critical-sized bone defect of the femoral shaft. Eur J Med Res. 2020;25(1):70. https:\/\/doi.org\/10.1186\/s40001-020-00471-w.","journal-title":"Eur J Med Res"},{"issue":"13","key":"2982_CR25","doi-asserted-by":"publisher","first-page":"2479","DOI":"10.1016\/j.biomaterials.2008.12.055","volume":"30","author":"AA Sawyer","year":"2009","unstructured":"Sawyer AA, Song SJ, Susanto E, Chuan P, Lam CXF, Woodruff MA, et al. The stimulation of healing within a rat calvarial defect by mPCL\u2013TCP\/collagen scaffolds loaded with rhBMP-2. Biomaterials. 2009;30(13):2479\u201388. https:\/\/doi.org\/10.1016\/j.biomaterials.2008.12.055.","journal-title":"Biomaterials"},{"key":"2982_CR26","doi-asserted-by":"publisher","first-page":"116163","DOI":"10.1016\/j.bone.2021.116163","volume":"153","author":"J Henkel","year":"2021","unstructured":"Henkel J, Medeiros Savi F, Berner A, Fountain S, Saifzadeh S, Steck R, et al. Scaffold-guided bone regeneration in large volume tibial segmental defects. Bone. 2021;153:116163. https:\/\/doi.org\/10.1016\/j.bone.2021.116163.","journal-title":"Bone"},{"key":"2982_CR27","doi-asserted-by":"crossref","unstructured":"Haines NM, Lack WD, Seymour RB, Bosse MJ. (2016). Defining the lower limit of a critical bone defect in open diaphyseal tibial fractures. J Orthop Trauma, 30(5).","DOI":"10.1097\/BOT.0000000000000531"},{"key":"2982_CR28","doi-asserted-by":"crossref","unstructured":"Wang H, Wei X, Liu P, Fu Y-H, Wang P-f, Cong Y-x et al. (2017). Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia. Medicine, 96(45).","DOI":"10.1097\/MD.0000000000008569"},{"issue":"11","key":"2982_CR29","doi-asserted-by":"publisher","first-page":"3498","DOI":"10.1016\/j.injury.2021.08.014","volume":"52","author":"S Hackl","year":"2021","unstructured":"Hackl S, Keppler L, von R\u00fcden C, Friederichs J, Perl M, Hierholzer C. The role of low-grade infection in the pathogenesis of apparently aseptic tibial shaft nonunion. Injury. 2021;52(11):3498\u2013504. https:\/\/doi.org\/10.1016\/j.injury.2021.08.014.","journal-title":"Injury"},{"key":"2982_CR30","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.bone.2015.07.007","volume":"81","author":"E Garc\u00eda-Gareta","year":"2015","unstructured":"Garc\u00eda-Gareta E, Coathup MJ, Blunn GW. Osteoinduction of bone grafting materials for bone repair and regeneration. Bone. 2015;81:112\u201321. https:\/\/doi.org\/10.1016\/j.bone.2015.07.007.","journal-title":"Bone"},{"issue":"6","key":"2982_CR31","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1007\/s007760100014","volume":"6","author":"T Yamaji","year":"2001","unstructured":"Yamaji T, Ando K, Wolf S, Augat P, Claes L. The effect of micromovement on callus formation. J Orthop Sci. 2001;6(6):571\u20135. https:\/\/doi.org\/10.1007\/s007760100014.","journal-title":"J Orthop Sci"},{"issue":"5","key":"2982_CR32","doi-asserted-by":"publisher","first-page":"6663","DOI":"10.1016\/j.actbio.2013.01.014","volume":"9","author":"RM Wazen","year":"2013","unstructured":"Wazen RM, Currey JA, Guo H, Brunski JB, Helms JA, Nanci A. Micromotion-induced strain fields influence early stages of repair at bone-implant interfaces. Acta Biomater. 2013;9(5):6663\u201374. https:\/\/doi.org\/10.1016\/j.actbio.2013.01.014.","journal-title":"Acta Biomater"},{"issue":"1","key":"2982_CR33","doi-asserted-by":"publisher","first-page":"10797","DOI":"10.1038\/s41598-021-90142-5","volume":"11","author":"N Kohli","year":"2021","unstructured":"Kohli N, Stoddart JC, van Arkel RJ. The limit of tolerable micromotion for implant osseointegration: a systematic review. Sci Rep. 2021;11(1):10797. https:\/\/doi.org\/10.1038\/s41598-021-90142-5.","journal-title":"Sci Rep"},{"issue":"8","key":"2982_CR34","doi-asserted-by":"publisher","first-page":"11755","DOI":"10.1021\/acsnano.2c03776","volume":"16","author":"K Hayashi","year":"2022","unstructured":"Hayashi K, Yanagisawa T, Kishida R, Ishikawa K. Effects of scaffold shape on bone regeneration: tiny shape differences affect the entire system. ACS Nano. 2022;16(8):11755\u201368. https:\/\/doi.org\/10.1021\/acsnano.2c03776.","journal-title":"ACS Nano"},{"key":"2982_CR35","doi-asserted-by":"publisher","DOI":"10.1016\/j.addma.2022.102740","volume":"54","author":"RL Reyes","year":"2022","unstructured":"Reyes RL, Ghim M-S, Kang N-U, Park J-W, Gwak S-J, Cho Y-S. Development and assessment of modified-honeycomb-structure scaffold for bone tissue engineering. Addit Manuf. 2022;54:102740. https:\/\/doi.org\/10.1016\/j.addma.2022.102740.","journal-title":"Addit Manuf"},{"issue":"9","key":"2982_CR36","doi-asserted-by":"publisher","first-page":"1664","DOI":"10.1016\/j.biomaterials.2006.11.024","volume":"28","author":"SH Oh","year":"2007","unstructured":"Oh SH, Park IK, Kim JM, Lee JH. In vitro and in vivo characteristics of PCL scaffolds with pore size gradient fabricated by a centrifugation method. Biomaterials. 2007;28(9):1664\u201371. https:\/\/doi.org\/10.1016\/j.biomaterials.2006.11.024.","journal-title":"Biomaterials"},{"issue":"1","key":"2982_CR37","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/j.polymdegradstab.2012.10.008","volume":"98","author":"Q Zhang","year":"2013","unstructured":"Zhang Q, Jiang Y, Zhang Y, Ye Z, Tan W, Lang M. Effect of porosity on long-term degradation of poly (\u03b5-caprolactone) scaffolds and their cellular response. Polym Degrad Stab. 2013;98(1):209\u201318. https:\/\/doi.org\/10.1016\/j.polymdegradstab.2012.10.008.","journal-title":"Polym Degrad Stab"},{"issue":"14","key":"2982_CR38","doi-asserted-by":"publisher","first-page":"1948","DOI":"10.1557\/jmr.2018.112","volume":"33","author":"A Bruyas","year":"2018","unstructured":"Bruyas A, Lou F, Stahl AM, Gardner M, Maloney W, Goodman S, et al. Systematic characterization of 3D-printed PCL\/\u03b2-TCP scaffolds for biomedical devices and bone tissue engineering: influence of composition and porosity. J Mater Res. 2018;33(14):1948\u201359. https:\/\/doi.org\/10.1557\/jmr.2018.112.","journal-title":"J Mater Res"},{"issue":"6","key":"2982_CR39","doi-asserted-by":"publisher","first-page":"065002","DOI":"10.1088\/1748-605X\/ab38c6","volume":"14","author":"D Valainis","year":"2019","unstructured":"Valainis D, Dondl P, Foehr P, Burgkart R, Kalkhof S, Duda GN, et al. Integrated additive design and manufacturing approach for the bioengineering of bone scaffolds for favorable mechanical and biological properties. Biomed Mater. 2019;14(6):065002. https:\/\/doi.org\/10.1088\/1748-605X\/ab38c6.","journal-title":"Biomed Mater"},{"issue":"1","key":"2982_CR40","doi-asserted-by":"publisher","first-page":"9170","DOI":"10.1038\/s41598-019-44872-2","volume":"9","author":"PSP Poh","year":"2019","unstructured":"Poh PSP, Valainis D, Bhattacharya K, van Griensven M, Dondl P. Optimization of bone scaffold porosity distributions. Sci Rep. 2019;9(1):9170. https:\/\/doi.org\/10.1038\/s41598-019-44872-2.","journal-title":"Sci Rep"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-025-02982-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-025-02982-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-025-02982-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T11:06:04Z","timestamp":1770721564000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-025-02982-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,14]]},"references-count":40,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["2982"],"URL":"https:\/\/doi.org\/10.1007\/s00068-025-02982-9","relation":{},"ISSN":["1863-9933","1863-9941"],"issn-type":[{"value":"1863-9933","type":"print"},{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,14]]},"assertion":[{"value":"10 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The research protocol was approved by the local ethics committee of AzM\/UM Maastricht (METC2024-0387). Specific informed consent was obtained from patients whose images and tissue samples were used. For all other patients included in the study, data was sourced from a larger database, for which prior ethical approval was obtained for the use of injury-related data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"326"}}