Showing papers on "Iliac crest published in 1986"

A new method for the two-dimensional analysis of bone structure in human iliac crest biopsies

Abstract: A new method is described for the analysis of the two-dimensional structural pattern of trabecular bone in human iliac crest biopsies. 8 microns thick undecalcified sections stained with the von Kossa technique were examined at a magnification of X 9. Using an Ibas II image analyser, the ratio of nodes to free ends and the length of different strut types (cortex to free end, node or cortex, free end to free end and node to node, loop or free end) expressed as a percentage of total strut length were assessed. The reproducibility of the method was good for most of the measured indices but inter-observer and inter-section variation were greater. Comparison of biopsy sections obtained from eleven young healthy control subjects and eleven patients with hepatic osteoporosis revealed a significantly higher node to free end ratio, node to loop and node to node strut length and significantly lower cortex to free end and free end to free end strut length in the controls. No significant differences were seen in node to free end, cortex to cortex or cortex to node strut length. This approach to trabecular bone structure analysis should prove useful in determining patterns of bone loss in health and disease and in examining the effects of treatment on bone structure in osteoporosis.

The use of demineralized bone matrix in the repair of segmental defects. Augmentation with extracted matrix proteins and a comparison with autologous grafts.

Abstract: A soluble protein component of bone, bone morphogenetic protein, and decalcified bone matrix have been shown to induce the formation of bone in extraosseous tissue. Clinical and animal studies investigating the use of these materials as bone grafts have shown radiographic and histological evidence of formation of bone, but the clinical usefulness of these grafts remains unknown. This study compared the healing processes when plasma-coated demineralized bone matrix and autologous cancellous bone were used to graft segmental defects of bone. A standard procedure was used to make a two-centimeter defect bilaterally in the ulna of forty-eight skeletally mature New Zealand White rabbits. In each rabbit, one ulnar defect was grafted with autologous citrated plasma-coated demineralized bone matrix while the other defect served as a control and was grafted with either autologous cancellous bone from the iliac crest, demineralized bone matrix, or demineralized bone matrix augmented with bone proteins that had been extracted with guanidinium hydrochloride. The ulnar defect was stabilized by the intact radius, and no supplemental device was necessary for fixation. To examine spontaneous healing in this model, one group of rabbits had a control defect that was not grafted. The grafts were periodically evaluated by radiographs, and twelve weeks after surgery the grafts were harvested and tested to failure in a standard torsion-test machine. The mechanical parameters were calculated, and histological examination of major fragments of the grafts was performed. The results of the radiographic and histological evaluation showed that all of the grafted ulnae healed, with fusion of the graft to the cut ends of the defect and reformation of approximately normal anatomy. No ungrafted ulnar defects healed. The results from the mechanical tests were evaluated by comparing the defect that was grafted with plasma-coated demineralized bone matrix with the control graft in each animal. These data showed that: twelve weeks after grafting, the normal ulnae were significantly stronger than the ulnae that had been grafted with plasma-coated demineralized bone matrix; the ulnae that had been grafted with plasma-coated demineralized bone matrix and those that had been grafted with autologous bone were equivalent in strength; and twelve weeks after grafting, grafts of demineralized bone matrix that were augmented with extracted bone proteins were significantly stronger than those that had not been so augmented.

Complications following iliac crest bone grafting.

Abstract: Avulsion of the anterior superior iliac spine occurred after procurement of bicortical bone grafts from the anterior superior iliac crest area in two patients. The defect in the anterior ilium with a weak spike of bone created a significant stress riser and led to avulsion of the anterior superior iliac spine by the action of the sartorius and tensor fascia lata. Bicortical grafts should be taken from areas as much as 5 cm posterior to the anterior superior iliac spine to avoid this complication.

Idiopathic familial acroosteolysis: histomorphometric study of bone and literature review of the Hajdu-Cheney syndrome.

Abstract: We describe a 27-year-old man with familial acroosteolysis involving 9 fingers. Bone biopsy of an affected digit showed osteolysis with no tetracycline deposition, rare osteoclasts, increased vascularity, and numerous mast cells. In contrast, the iliac crest bone showed active bone remodeling and normal double-tetracycline labeling. We believe mast cells deserve further study as possible factors in this form of localized osteolysis.

Fibrin sealant in bone transplantation. No effects on blood flow and bone formation in dogs.

Abstract: To study bone formation and regional blood flow following the use of fibrin sealant in autologous cancellous bone transplantation, a dog model was developed. In 18 dogs, a standardized defect in both tibiae was filled with an autologous iliac crest graft. On one side, the bone chips were mixed with fibrin sealant while the other side served as control. After 1, 2 and 3 weeks the blood flow of the transplant was calculated and the new bone formed evaluated histomorphometrically. Generally, the highest blood flow rates and most intensive new bone formation were observed at 2 weeks postoperatively. Fibrin sealant did not alter blood flow or new bone formation, but a tendency to diminished new bone formation was found in some grafts. Our study does not support the application of fibrin sealant in ordinary cancellous bone grafting.

Giant cell tumor of the distal end of the radius treated by the resection and free vascularized iliac crest graft.

Abstract: Juxtaarticular giant cell tumor involving the distal radius presents a special problem of reconstruction after tumor excision. A tailored block of vascularized iliac crest graft with its feeding artery (i.e., the deep circumflex iliac artery) joined to the ulnar artery was used as a replacement for the resected distal radius, thereby creating a new wrist joint. Excellent graft survivals were observed in all four cases. The wrists, when assessed 24-48 months after surgery, were found to have good ranges of movement, although with mild dorsal subluxation. These results compared well with other means of wrist reconstruction (i.e., the vascularized fibular graft). Although conventional means of arthrodesis give acceptable hand function, the absence of wrist motion is unacceptable to the young and active, who may prefer the method described in this article.

Surgical correction of the nose and midface in maxillonasal dysplasia (Binder's syndrome).

Abstract: In 48 patients with maxillonasal dysplasia the retruded nasal base was corrected with onlay cancellous bone grafts after subperiosteal dissection using an oral vestibular approach. Support for the nasal dorsum was achieved in 39 patients with an L-shaped bone graft from the iliac crest introduced through the same approach. The advancement of the nose was found stable on lateral cephalograms; i.e., resorption did not occur. However, the grafts showed considerable remodeling. Half the patients found the stiffness of the nose to be disturbing. In nine patients, the cartilaginous septum was used instead as a support for the nasal dorsum and tip. At operation, the entire cartilaginous septum was mobilized after subperichondrial dissection and rotated forward either pedicled at the nasal dorsum or completely released. Cartilage regenerated in the periochondrial pocket left behind the advanced septum. The anterior transfer of the nose was 6 to 10 mm. The use of septal advancement is preferred over bone implants in the correction of maxillonasal dysplasia in patients in whom the bony nasal dorsum is of adequate height because it results in a soft and flexible nose and the risk of traumatic fracture and resorption is eliminated. The technique has been used in adolescents with promising results.

Clinical anatomy of the internal oblique muscle.

Abstract: In recent years microvascular free tissue transfer has become a well accepted reconstructive technique. The current trend in flap research seems to be the development of more refined flaps to meet specific needs with minimal donor site morbidity. The internal oblique muscle provides a broad, thin, well-vascularized flap which is ideally suited for restoration of contour with excellent aesthetic results. In addition, the iliac crest may be raised in continuity based on the same vascular pedicle, i.e. the deep circumflex iliac vessels. The purpose of this article is to describe the anatomic details necessary for the clinical application of this versatile flap. Thirty specimens of the internal oblique muscle flap were dissected and studied using Microfil injection techniques, including xerograms. In about 80 percent of the flaps, a single ascending branch of the deep circumflex iliac artery (DCIA) enters the undersurface of the muscle, arborizing within the muscle. In the remaining 20 percent, two or three branches enter the muscle separately, originating on the DCIA. The arc of rotation extends into the ipsilateral groin for coverage of exposed femoral vessels, along the pubis and the anterior perineum. The length of the vascular pedicle is to 6 to 7 cm and the vessel diameter is 2.0 to 3.0 mm, making the flap suitable for free tissue transfer.

Correction of a Deep Superior Sulcus With Dermis-Fat Implantation

Abstract: • We describe five patients with deep superior sulcus deformities who had dermis-fat grafts implanted into the preaponeurotic space. Three patients had anophthalmic sockets, and two had normal-seeing eyes. The grafts were taken from the left lower abdominal quadrant above the iliac crest and the donor site was closed primarily. At the time of surgery, an effort was made to overcorrect the deformity. All five patients were improved, although one of the anophthalmic patients developed a slight postoperative ptosis. A follow-up of at least one year has shown no sign of fat absorption.

Anatomic study of the lateral cutaneous rami of the subcostal and iliohypograstric nerves

Abstract: On the supposition that some “pseudocoxalgias” might be due to a neuralgia of the lateral rami leaving the subcostal and iliohypogastric nerves above the lateral edge of the iliac crest, the authors undertook an anatomic study of their pathways and pattern of distribution. These rami supplying the skin below the iliac crest, which they cross close together, the ramus arising from the subcostal nerve by perforating the internal and external oblique abdominal muscles, that arising from the iliohypogastric nerve a little lower, creating a bony groove palpable in thin subjects and transformed into an osseomembranous tunnel by the aponeurosis of these muscles. This arrangement may give rise to anentrapment syndrome. At this intersection, the course is either vertical or “bayonetshaped”, directly subcutaneous, and hence exposed to possible friction and microtraumata (tight clothes). The two rami are of unequal length. Frequently, the ramus arising from the subcostal nerve is short, not exceeding 10 cm, below the iliac crest, thus corresponding to the usual description. That arising from the iliohypogastric nerve descends further, passing 3 to 5 cm anterior to the great trochanter. It ends either at this level or 8 to 10 cm below. This accounts for the distribution of the pain felt when there is irritation of this ramus.

Coralline hydroxyapatite bone-graft substitutes in a canine diaphyseal defect model. Radiographic-histometric correlation.

Abstract: Sartoris DJ, Holmes RE, Bucholz RW, Mooney V, Resnick D. Coralline hydroxyapatite bone-graft substitutes in a canine diaphyseal defect model: radiographic-histometric correlation. Invest Radiol 1986;22:590-596. Radiographic and histometric evaluation of a new form of bonegraft substitute derived from reef-building sea coral was performed in a canine diaphyseal defect model. Comparably sized blocks of this material and iliac crest autograft were placed into bilateral surgically created cortical windows in the distal radial diaphyses of 14 dogs. Representative graft specimens of both types underwent densitometric radiography and harvesting at 3,6,12, 24, and 48 months. Histometric analysis of implant specimens revealed satisfactory union and native osseous ingrowth at all time intervals. Graft specimens exhibited adequate union with scant host bone ingrowth at three months, but subsequent progressive appositional closure of cancellous spaces during the ensuing 45 months. Volume fraction and mean width of host bone remained stable in the implants but increased in the grafts due to neocortex formation. Stereologic distribution of bone was homogeneous in both implant and graft specimens, and no evidence for biodegradation of the former was observed. Corrected transmission density determinations accurately reflected these differences but correlated significantly with volume fractions and tissue widths of bone and soft tissue only in the autografts. These results support the successful early application of coralline hydroxyapatite bone graft substitutes as an alternative to autogenous grafting in the clinical setting and emphasize the potential role of noninvasive densitometric techniques in monitoring the incorporation of bone-graft materials.

Inferior lumbar (Petit's) hernia

Abstract: The inferior lumbar triangle is a normal area of weakness in the posterior abdominal wall. It is bounded by the free border of the latissimus dorsi posteromedially, the external oblique anterolaterally, and the iliac crest infenorly (Fig. 1) [1 ]. Herniation through this triangle is rare and is known as Petit’s hernia or inferior lumbar hernia [2]. The cause may be congenital, spontaneous, postinflammatory, traumatic, or surgical [3]. Case Report

CT demonstration of hernia through an iliac crest defect

Abstract: We recently encountered two patients with an unusual hernia through a defect in the iliac crest secondary to prior bone graft harvesting. The radiographic and CT features of this rare entity are illustrated and pertinent literature reviewed.

Coralline hydroxyapatite bone-graft substitutes in a canine metaphyseal defect model. Radiographic-histometric correlation.

Abstract: Radiographic and biomechanical assessment of a new type of bone graft substitute derived from reef-building sea coral was performed in a canine metaphyseal defect model. Blocks of this material and autogenous iliac crest graft were implanted, respectively, into the right and left proximal tibial metaphyses of eight dogs. Qualitative and quantitative radiographic evaluation was performed in the immediate postoperative period and at 6 months after surgery. Biomechanical testing was carried out on all grafts following harvest at 6 months, as well as on nonimplanted coralline hydroxyapatite and autogenous iliac cancellous bone. In contrast to autografts, incorporation of coralline implants was characterized by predictable osseous growth and apposition with preservation of intrinsic architecture. Greater percent increase in radiographic density, higher ultimate compressive strength, and lower stiffness with incorporation were documented advantages of coralline hydroxyapatite over autogenous graft. Densitometric measurements correlated moderately with strength for both types of graft material (r=-0.65). These promising results have important implications to the clinical application of coralline hydroxyapatite bone graft substitutes as an alternative to autogenous grafting.

Coralline hydroxyapatite bone graft substitutes in a canine metaphyseal defect model: radiographic-biomechanical correlation.

Abstract: Radiographic and biomechanical assessment of a new type of bone graft substitute derived from reef-building sea coral was performed in a canine metaphyseal defect model. Blocks of this material and autogenous iliac crest graft were implanted, respectively, into the right and left proximal tibial metaphyses of eight dogs. Qualitative and quantitative radiographic evaluation was performed in the immediate postoperative period and at 6 months after surgery. Biomechanical testing was carried out on all grafts following harvest at 6 months, as well as on nonimplanted coralline hydroxyapatite and autogenous iliac cancellous bone. In contrast to autografts, incorporation of coralline implants was characterized by predictable osseous growth and apposition with preservation of intrinsic architecture. Greater percent increase in radiographic density, higher ultimate compressive strength, and lower stiffness with incorporation were documented advantages of coralline hydroxyapatite over autogenous graft. Densitometric measurements correlated moderately with strength for both types of graft material (r=-0.65). These promising results have important implications to the clinical application of coralline hydroxyapatite bone graft substitutes as an alternative to autogenous grafting.

The concentration of calcium and phosphorus in trabecular bone from the iliac crest.

Abstract: The concentrations of calcium and phosphorus were determined in central parts of bone trabeculae in the human iliac crest by means of an energy dispersive microanalysis technique. Two age groups, each consisting of six suddenly diseased male subjects, were investigated. It was found that the concentrations of calcium and phosphorus did not differ between young and old men. The obtained mean values were fairly alike and determined to 40 and 17 weight %, respectively.

Latissimus dorsi myocutaneous-iliac bone flap for reconstruction of massive defects of mandible and oral basis.

Abstract: Recent advances in reconstructive surgery for head and neck cancer have improved the cure rate of advanced carcinoma, and the function of the organ. However, it still remains difficult to repair the mandible and oral floor. We devised a combined flap of myocutaneous latissimus dorsi and iliac bone, and applied it to two patients with advanced carcinoma of the oral cavity that invaded to the mandible (T4N3M0). Each patient received preoperative irradiation, totalling 30 Gy and 40 Gy. Two weeks before the extensive resection, a sufficient bony mass for the presumed mandibular defect was taken from the iliac crest and transplanted beneath the latissimus dorsi muscle. Defects of the mandible and oral floor were reconstructed using this combined flap immediately after the resection. The patients began to eat 2 weeks after surgery.

Hematopoiesis in osteoporosis--preliminary report comparing biopsies of the femoral neck and iliac crest.

Abstract: Undecalcified plastic-embedded semithin sections of femoral neck and iliac crest biopsies taken at operation in 44 patients with intracapsular femoral neck fractures were examined for hematopoiesis, osseous remodelling and osteopenia. Osteopenia, osseous remodelling and hematopoiesis were present in over half of the iliac crest biopsies. More than half of the femoral neck biopsies showed osteopenia and replacement of the hematopoiesis by fat cells with virtual absence of osteoblasts and osteoclasts. In these patients, osteopenia in the iliac crest appears to be of the "high turnover type" while that in the femoral neck is of the "low turnover type." These results indicate that the iliac crest biopsy is not necessarily representative of osseous remodeling and hematopoiesis at other skeletal sites.

Routine Reinsertion of the Hump in Rhinoplasty

Abstract: Reinsertion of the hump as a free graft, a technique based on the rhinoplasty described by Skoog, has been performed for more than 10 years in severely deviated noses to hide residual deformities of the septum after rhinoplasty. The results have been so encouraging that this technique is now routinely used in all rhinoplasties requiring a reduction of the profile. Grafting the hump after remodelling gives a natural aspect to the dorsum, especially in patients with thin skin where irregularities of sharp edges of the cut nasal bones are otherwise often seen. The hump is tailored into a thin composite graft (bone + cartilage) 3–4 cm long and 3–5 mm broad. No major complications have been observed. 32 cases have been reviewed after a mean delay of 24 months. 29 show radio-graphic evidence of bone graft survival although no fusion with the nasal bones is observed. It is suggested that facial bone grafts survive better in the nose than grafts taken from the iliac crest or the ribs.

Vascular pedicled iliac crest transplant and its use in the jaw

Abstract: This report gives an overview concerning possibilities and advantages of microsurgically revascularised iliac bone transplants, used for reconstructive purposes in the head and maxillofacial region. Also the vessels' anatomy and variations are discussed.

New method of hip reconstruction.

Abstract: The author recounts his experience over the past nine years, with the use of a large bone graft with an intact vascular pedicle taken from the iliac crest for the reconstruction of large defects in the proximal femoral region and for the solution of a number of difficult problems in which the femoral head is at risk of destruction or collapse. Some of these problems, particularly in the young patient, include large bony defects in the proximal femur after tumor resection, nonunion of the femoral neck fracture and avascular necrosis of the femoral head. The author cites a number of cases, comments on the satisfactory results that were obtained and cites the advantages of the large bone graft with an intact vascular pedicle.

Fibular graft in anterior surgery of cervical spondyloarthrosis myelopathy.

Abstract: A report on the use of fibular graft in 15 cases of myelopathy secondary to cervical spondyloarthrosis with anterior compression of the dural sac at more than two levels. The surgical procedure is based on a midline somatotomy by anterior approach. The fibula appears to be more suitable for the purpose than the iliac crest due to homogeneity of structure throughout its length and to the mechanical strength afforded by its cortical ring.