{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:09:54Z","timestamp":1791259794686,"version":"4.1.0"},"reference-count":34,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The management of bone defects in pediatric oncology represents a major challenge in orthopedics, as it requires preserving both joint function and skeletal growth. Traditional reconstructive approaches, such as autografts and allografts, are limited by availability, complications, and incomplete biological integration. In this context, xeno-hybrid bone substitutes have emerged as a promising alternative. The aim of this study was to evaluate the safety and effectiveness of SmartBone\u00ae ORTHO in the reconstruction of post-oncological bone defects in children. Methods: Twelve pediatric patients treated at the Centro Traumatologico Ortopedico (CTO) and OIRM Hospital, AOU Citt\u00e0 della Salute e della Scienza of Turin (Italy), between 2016 and 2019 were retrospectively analyzed. Lesions included simple and aneurysmal bone cysts, non-ossifying fibroma, chondroblastoma, and other benign conditions. All patients underwent curettage followed by defect filling with SmartBone\u00ae ORTHO. Results: At clinical and radiological follow-up, nine patients (75%) showed stable graft integration and complete functional recovery. Three patients (25%) developed local recurrence, which was managed with revision surgery and re-implantation of SmartBone\u00ae, with all achieving stable outcomes. Radiographs demonstrated progressive increases in bone density and trabecular thickness, reaching values comparable to those of native bone within 6\u201312 months. Conclusions: SmartBone\u00ae ORTHO proved to be a safe and effective biomaterial for pediatric post-oncological bone reconstruction, promoting rapid osteointegration and physiological bone remodeling without infection or intolerance.<\/jats:p>","DOI":"10.3390\/jcm15062329","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T14:14:05Z","timestamp":1773843245000},"page":"2329","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["New Insight in Pediatric Orthopedic Oncology: The Use of a Xeno-Hybrid Bone Substitute in Loss of Bone Tissue After Oncological Resections, a Case Series"],"prefix":"10.3390","volume":"15","author":[{"given":"Raimondo","family":"Piana","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Oncologic Surgery, Orthopedic Trauma Center (CTO) and Regina Margherita Hospital (OIRM), University Hospital (AOU) Citta\u2019 della Salute e della Scienza of Turin, Via Zuretti 29, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1485-8950","authenticated-orcid":false,"given":"Raffaella","family":"De Pace","sequence":"additional","affiliation":[{"name":"Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Boffano","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Oncologic Surgery, Orthopedic Trauma Center (CTO) and Regina Margherita Hospital (OIRM), University Hospital (AOU) Citta\u2019 della Salute e della Scienza of Turin, Via Zuretti 29, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo F.","family":"Grottoli","sequence":"additional","affiliation":[{"name":"Industrie Biomediche Insubri SA, via Cantonale 67, 6805 Mezzovico-Vira, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Ratto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Oncologic Surgery, Orthopedic Trauma Center (CTO) and Regina Margherita Hospital (OIRM), University Hospital (AOU) Citta\u2019 della Salute e della Scienza of Turin, Via Zuretti 29, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Pellegrino","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Oncologic Surgery, Orthopedic Trauma Center (CTO) and Regina Margherita Hospital (OIRM), University Hospital (AOU) Citta\u2019 della Salute e della Scienza of Turin, Via Zuretti 29, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Chiara","family":"Rossi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Oncologic Surgery, Orthopedic Trauma Center (CTO) and Regina Margherita Hospital (OIRM), University Hospital (AOU) Citta\u2019 della Salute e della Scienza of Turin, Via Zuretti 29, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Perale","sequence":"additional","affiliation":[{"name":"Industrie Biomediche Insubri SA, via Cantonale 67, 6805 Mezzovico-Vira, Switzerland"},{"name":"Faculty of Biomedical Sciences, University of Southern Switzerland (USI), Via G. Buffi 13, 6900 Lugano, Switzerland"},{"name":"Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1097\/PAP.0000000000000293","article-title":"The 2020 WHO Classification of Tumors of Bone: An Updated Review","volume":"28","author":"Choi","year":"2021","journal-title":"Adv. Anat. Pathol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/s00256-022-04093-7","article-title":"The 2020 World Health Organization Classification of Bone Tumors: What Radiologists Should Know","volume":"52","author":"Hwang","year":"2023","journal-title":"Skelet. Radiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1002324","DOI":"10.37349\/etat.2025.1002324","article-title":"Osteosarcoma: Current Insights and Advances","volume":"6","author":"Brar","year":"2025","journal-title":"Explor. Target. Antitumor Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/S0033-8389(22)02856-1","article-title":"Cartilaginous Bone Tumors","volume":"31","author":"Giudici","year":"1993","journal-title":"Radiol. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"104638","DOI":"10.18632\/oncotarget.20136","article-title":"Current Diagnostics and Treatment of Fibrosarcoma\u2014Perspectives for Future Therapeutic Targets and Strategies","volume":"8","author":"Augsburger","year":"2017","journal-title":"Oncotarget"},{"key":"ref_6","first-page":"2","article-title":"Giant Cell Tumor of Bone\u2014An Overview","volume":"4","author":"Sobti","year":"2016","journal-title":"Arch. Bone Jt. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1007\/s00247-022-05396-6","article-title":"Update on Aneurysmal Bone Cyst: Pathophysiology, Histology, Imaging and Treatment","volume":"52","author":"Restrepo","year":"2022","journal-title":"Pediatr. Radiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"295","DOI":"10.4103\/0019-5413.111507","article-title":"Curettage of Benign Bone Tumors and Tumor like Lesions: A Retrospective Analysis","volume":"47","author":"Kundu","year":"2013","journal-title":"Indian J. Orthop."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"107342","DOI":"10.1016\/j.ijscr.2022.107342","article-title":"Adjuvant Denosumab Therapy Following Curettage and External Fixator for a Giant Cell Tumor of the Distal Radius Presenting with a Pathological Fracture: A Case Report","volume":"96","author":"Arulprashanth","year":"2022","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2445","DOI":"10.1007\/s10856-014-5240-2","article-title":"Bone Substitutes in Orthopaedic Surgery: From Basic Science to Clinical Practice","volume":"25","author":"Campana","year":"2014","journal-title":"J. Mater. Sci. Mater. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ghiretti, R., Grottoli, C.F., Molinari, M., Huynh, M.T.D., Bonizzi, C., Giani, C., De Pace, R., and Perale, G. (2025). Bone Selective Remodeling of Xeno-Hybrid Grafts: A Case Series. J. Clin. Med., 14.","DOI":"10.3390\/jcm14134457"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"De Pace, R., Molinari, S., Mazzoni, E., and Perale, G. (2025). Bone Regeneration: A Review of Current Treatment Strategies. J. Clin. Med., 14.","DOI":"10.3390\/jcm14061838"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/j.ijpharm.2016.10.036","article-title":"Bovine Bone Matrix\/Poly( l-Lactic-Co-\u03b5-Caprolactone)\/Gelatin Hybrid Scaffold (SmartBone\u00ae) for Maxillary Sinus Augmentation: A Histologic Study on Bone Regeneration","volume":"523","author":"Perale","year":"2017","journal-title":"Int. J. Pharm."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"w20032","DOI":"10.4414\/smw.2019.20032","article-title":"Tissue Engineering for Paediatric Patients","volume":"149","author":"Mumme","year":"2019","journal-title":"Swiss Med. Wkly."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1097\/CORR.0000000000003414","article-title":"Is Proximal Femur Reconstruction With a Vascularized Fibula and Allograft Successful at Reconstructing a Tumor Resection in Children 6 Years of Age or Younger?","volume":"483","author":"Cevolani","year":"2025","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_16","first-page":"42","article-title":"Chirurgia Dei Tumori Ossei in Et\u00e0 Pediatrica: Nuove Frontiere Ricostruttive","volume":"1","author":"Capanna","year":"2009","journal-title":"Hematol. Meet. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ferracini, R., Bistolfi, A., Garibaldi, R., Furfaro, V., Battista, A., and Perale, G. (2019). Composite Xenohybrid Bovine Bone-Derived Scaffold as Bone Substitute for the Treatment of Tibial Plateau Fractures. Appl. Sci., 9.","DOI":"10.3390\/app9132675"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Grottoli, C.F., Ferracini, R., Compagno, M., Tombolesi, A., Rampado, O., Pilone, L., Bistolfi, A., Borr\u00e8, A., Cingolani, A., and Perale, G. (2019). A Radiological Approach to Evaluate Bone Graft Integration in Reconstructive Surgeries. Appl. Sci., 9.","DOI":"10.3390\/app9071469"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Ghiretti, R., Grottoli, C.F., Cingolani, A., and Perale, G. (2020). Clinical Case Employing Two Different Biomaterials in Bone Regeneration. Appl. Sci., 10.","DOI":"10.3390\/app10134516"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1006\/excr.1995.1225","article-title":"Identification of Integrins Involved in Cell Adhesion to Native and Denatured Type I Collagens and the Phenotypic Transition of Rabbit Arterial Smooth Muscle Cells","volume":"219","author":"Yamamoto","year":"1995","journal-title":"Exp. Cell Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"757","DOI":"10.2741\/A319","article-title":"Integrin-Mediated Signaling in the Regulation of Osteoclast Adhesion and Activation","volume":"3","author":"Duong","year":"1998","journal-title":"Front. Biosci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"151275","DOI":"10.1016\/j.soncn.2022.151275","article-title":"Bone Health Issues in the Pediatric Oncology Patient","volume":"38","author":"Kelly","year":"2022","journal-title":"Semin. Oncol. Nurs."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1097\/00003086-199103000-00017","article-title":"The Management of Malignant Bone Tumors in Children and Adolescents","volume":"264","author":"Mercuri","year":"1991","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_24","first-page":"325","article-title":"Aneurysmal Bone Cyst: A Review of Management","volume":"35","author":"Muratori","year":"2019","journal-title":"Surg. Technol. Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/j.otsr.2018.12.015","article-title":"Assessment of Resection Margins in Bone Sarcoma Treated by Neoadjuvant Chemotherapy: Literature Review and Guidelines of the Bone Group (GROUPOS) of the French Sarcoma Group and Bone Tumor Study Group (GSF-GETO\/RESOS)","volume":"105","author":"Mascard","year":"2019","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Boffano, M., Ratto, N., Conti, A., Pellegrino, P., Rossi, L., Perale, G., and Piana, R. (2020). A Preliminary Study on the Mechanical Reliability and Regeneration Capability of Artificial Bone Grafts in Oncologic Cases, With and Without Osteosynthesis. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051388"},{"key":"ref_27","first-page":"136","article-title":"Composite polymer-coated mineral scaffolds for bone regeneration: From material characterization to human studies","volume":"29","author":"Pertici","year":"2015","journal-title":"J. Biol. Regul. Homeost. Agents"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1097\/00003086-199608000-00037","article-title":"Complications of Iliac Crest Bone Graft Harvesting","volume":"329","author":"Arrington","year":"1996","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1097\/01.blo.0000150371.77314.52","article-title":"Infection in Massive Bone Allografts","volume":"432","author":"Mankin","year":"2005","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1007\/s00223-008-9164-z","article-title":"A Comparison of the Physical and Chemical Differences Between Cancellous and Cortical Bovine Bone Mineral at Two Ages","volume":"83","author":"Kuhn","year":"2008","journal-title":"Calcif. Tissue Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.2174\/1389201020666181129115839","article-title":"Improving Bovine Bone Mechanical Characteristics for the Development of Xenohybrid Bone Grafts","volume":"19","author":"Cingolani","year":"2019","journal-title":"Curr. Pharm. Biotechnol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"012","DOI":"10.29328\/journal.johcs.1001002","article-title":"Evaluation of ImageJ for Relative Bone Density Measurement and Clinical Application","volume":"1","author":"Geiger","year":"2016","journal-title":"J. Oral Health Craniofacial Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1016\/j.sdentj.2021.07.003","article-title":"Analysis of Mandible Trabecular Structure Using Digital Periapical Radiographs to Assess Low Bone Quality in Postmenopausal Women","volume":"33","author":"Diba","year":"2021","journal-title":"Saudi Dent. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.bone.2010.08.023","article-title":"BoneJ: Free and Extensible Bone Image Analysis in ImageJ","volume":"47","author":"Doube","year":"2010","journal-title":"Bone"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2329\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T14:38:11Z","timestamp":1773844691000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2329"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,18]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15062329"],"URL":"https:\/\/doi.org\/10.3390\/jcm15062329","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,18]]}}}