In this blog a team from the School of Mechanical, Aerospace and Civil Engineering at The University of Manchester introduce their innovative pilot project ‘Bone Bricks’ which demonstrates how advanced materials can play a key part in providing solutions to global challenges.
- The Bone Bricks pilot project was born, seeking a solution to the kinds of bone injuries caused by explosions which can result in contaminated wounds, shattered bones and substantial bone loss.
- Universities are uniquely placed to be at the centre of a global network that allows channelling of overseas aid towards frontline innovation in areas of conflict.
- The benefits from products made from advanced materials should not just be for developed nations.
- To get this innovation manufactured and distributed worldwide, a separate, follow-on project will be funded by the Scientific and Technological Research Council of Turkey.
- Bone Bricks is an example of how overseas aid can drive innovation both for those in conflict zones and back in the UK.
Bomb blast injuries can cause devastating damage to bones, damage that is extremely difficult to fix. In response, we led a team that combines biomaterials excellence with limb injury expertise to develop a revolutionary ‘Legolike’ brick system for bone repair. We believe this pioneering project, which takes a radical concept from the lab – and places it into the hands of clinicians on the frontline – provides a strong model for the UK’s strategy to meet global challenges through research and innovation. It demonstrates how advanced materials can play a key part in providing solutions to the challenges we face. As well as showing how integral universities are in finding those solutions by pushing forward innovation with unique collaborations across the world.
A problem that needed a solution
When you see the damage of what a blast injury can do to a person – to a child – it’s a shock and very sad and upsetting to see. We first became fully aware of this type of injury when Amer Shoaib, a consultant orthopaedic surgeon at Manchester Royal Infirmary, came to the University to discuss his experience of treating barrel bomb blast injuries in Syrian refugees. Mr Shoaib is a limb injury expert with experience of working on the frontline of various conflicts as a humanitarian worker. When he described how the after-effects of blast injuries were sometimes untreatable in Turkey’s refugee camps, we all wanted to help and apply our expertise to the problem. We continued our discussion late into the evening and this developed into the idea of ‘Bone Bricks’, and led us on a journey to Turkey where we met with academics, surgeons and medical companies.
Bone injury & a new biomaterials ‘brick’ approach
The Bone Bricks pilot project was born, seeking a solution to the kinds of bone injuries caused by explosions which can result in contaminated wounds, shattered bones and substantial bone loss.
We have treated similar injuries in the UK, for example following terrorist attacks. In our hospitals, such patients can access expert orthopaedic surgery and equally important aftercare. However, in a remote border clinic with limited resources, this is just not possible. Amputation – an irreversible act which has a sudden and emotionally devastating impact on the patient – is unfortunately a frequent outcome in many of these cases.
With many blast injuries, the bone defects are impossible to heal on their own. What our project is doing is to create a temporary structure using ‘bricks’ made of polymer and ceramic materials, which can be clicked together like Lego to make a kind of medical scaffold which then allows new tissue to grow. Our pioneering structure will support weight like a normal bone and induce new bone growth as the degradable Bone Bricks dissolve. These interchangeable Bone Bricks also feature a specialist filler that has infection-fighting properties, vastly improving the chances of success.
The idea is that the surgeon can open a bag of bricks and piece them together to fit a particular defect. We will also be developing software to allow the clinician to select the exact number, shape and size of Bone Bricks, based on the individual defect, along with information how to assemble them.
A year into the project the impact of blast injuries was brought cruelly to our own doorstep following the devastating Manchester Arena attack in 2017. This incident involved a shrapnel-laden homemade bomb being detonated just as people were leaving the packed Arena complex following a concert by the American pop singer Ariana Grande. A total of 23 people died, including the attacker, and 139 were wounded – more than half of these were children.
We didn’t expect this so close to home – but the kind of technology we are currently developing would have been very helpful for many of those victims.
Innovation and the role of universities
Our project is an example of innovation on the frontline and we believe this is something only universities can do. Populations in crisis or living in the poorer parts of a developing region may encounter a number of agencies offering support. For example, the British Council, part of the Foreign and Commonwealth Office, can help with education and skills training while NGOs may provide aid or build operational infrastructure. But what universities can do is focus on a major issue affecting a hotspot and look to develop a bespoke solution that is based on rigorous research, and future-proofed.
Global challenges, British research
The Bone Bricks project is now an established partnership between The University of Manchester, University of Portsmouth, Manchester Royal Infirmary and Turkey’s Sabanci University. It has received approximately £0.85 million in funding, following backing from the Global Challenges Research Fund (GCRF), a £1.5 billion pot provided by the UK government to support cuttingedge research that specifically addresses the challenges faced by developing countries.
This globalisation of British research has been underpinned by the International Research and Innovation Strategy which sets out how the UK will develop international research and innovation partnerships to address global challenges while working towards the targets of the domestic Industrial Strategy. One of the strategy’s primary objectives is to connect researchers and entrepreneurs in a bid to “support their development and the translation of their ideas.”
The GCRF fund wants to support disciplinary and interdisciplinary research, including an expectation that researchers will consider an application of their research in an area they never previously considered. That was definitely the case for our Bone Bricks project; until we encountered Amer and his frontline work with those suffering catastrophic bone injuries, this was not a challenge we had considered for our work in biomaterials. It took time to fully appreciate the complexity in terms of the clinical challenges in the field, the wider geo-political impact, the potential commercial and intellectual property opportunities, as well the potential legacy applications for both developing and developed nations.
This type of complexity has led to concerns that ‘global challenge’ innovation is at risk from a range of factors. These include a lack of buy-in from target communities; poor coordination between delivery partners which could lead to duplication of efforts; poor portfolio management resulting in a package of discrete projects rather than a coherent set of responses to specific challenges; being able to demonstrate value-for-money; and, perhaps worst of all, a failure to create real impact in developing countries.
However, our project can avoid these risks because we will be applying the lessons learnt from the Manchester Model of lab-to-market innovation, developed by The University of Manchester’s advanced materials community.
Our project will be:
- Engaging with frontline clinicians and potential endusers to design a best solution rather than making do with existing products or procedures that are not fit-for-purpose
- Applying Manchester’s world-wide leadership in materials science and bioengineering to a global challenge
- Using Industry 4.0 technologies to accelerate concept development, for example using computer modelling and digitally-based manufacture techniques, such as 3D printing
- Ready to trial on patients soon after completing the three-project life-cycle
- Complying with health care regulatory regimes while the academic team is working with commercial partners to scale-up and bring the product to market
Looking to the future
In terms of next steps, to get this innovation manufactured and distributed worldwide, a separate, follow-on project will be funded by the Scientific and Technological Research Council of Turkey. Working with Sabanci University in Turkey and orthopedic innovators Response Ortho, a clinical trial will run on about 20 patients with large bone loss who have no other possible treatment other than amputation, subject to strict ethical scrutiny and approval.
Intellectual property (IP) will be jointly managed between all of the project partners and any revenue generated from this will be used either to further develop the product or to develop similar medical devices for other countries.
The Syrian conflict has displaced around three million refugees into Turkey, which provides free of-charge healthcare services to Syrians. The burden on the healthcare system is significant, with 940,000 patients treated, 780,000 operations carried out and 20.2 million outpatient services used. The hope is that this UK innovation can in some way make a contribution to this crisis. More broadly, with innovation and research like this, universities are uniquely positioned at the centre of a global network. They can support the channelling of overseas aid towards frontline innovation in areas of conflict. The benefits from products made from advanced materials should not just be for developed nations, where funding is often more readily available and supply chains are already more established.
The long-term vision for the project is that Bone Bricks will help in conflict situations and healthcare emergencies more widely, for example, in road traffic accidents in both developing and developed nations. The Bone Brick solution is much more cost effective than the current methods of treatment available, at less than £200 for a typical 100mm defect, compared to upwards of £6,000 per limb reconstruction procedure. Also saving limbs as opposed to amputation will equate to an estimated reduction of two thirds of the treatment costs. The project could also reduce the need for expensive surgical reconstruction for bone loss, as well as reducing the losses to the economy of extended periods of rehabilitation.
Bone Bricks is a sustainable, cost-effective, cross sector initiative that takes cutting-edge research from the lab to where it’s needed most. It is an example of pioneering innovation in the fast-changing field of advanced materials. But more than that, it is an example of how overseas aid can drive innovation both for those in conflict zones and back in the UK.
