Showing papers on "Iliac crest published in 1992"

Chronic Donor Site Pain Complicating Bone Graft Harvesting From the Posterior Iliac Crest for Spinal Fusion

Abstract: To explore the relationship between surgical approach and chronic posterior iliac crest donor site pain, 151 bone graft harvests with follow-up periods longer than 1 year were evaluated using a detailed questionnaire and follow-up clinical visits. There was no difference in the incidence of chronic donor site pain between harvests performed through the primary midline incision versus a separate lateral oblique incision (28 vs 31%). Twice as many donor sites harvested for reconstructive spinal procedures were reported as having chronic pain as compared with those harvested for spinal trauma, regardless of approach used (39 vs 18%). The association of chronic donor site pain with residual back pain was also greater in the spinal reconstructive group. Thus, it appears that incidence of chronic donor site pain is more dependent on diagnosis than on surgical approach.

Maxillary alveolar ridge augmentation with onlay bone-grafts and immediate endosseous implants

Abstract: Management of the atrophic maxilla can be a taxing surgical problems. One treatment alternative is to use autogenous bone transplants and immediate titanium fixture implantation. Despite the extensive literature on routine implant treatment of the edentulous jaws, only very few reports have dealt with the outcome of bone graft reconstructive surgery as part of the dental implant restoration. This study presents the treatment and healing results of 8 consecutive patients, who, over a period of 2 years and 8 months, were treated using onlay iliac bone grafts to atrophic maxillary alveolar ridges with immediate implant insertion. The patients were followed for 32-64 months. 83% of the fixtures (n = 46) were well-integrated. Two fixtures in each of 2 patients were lost due to traumatic bone-graft fractures. Palpatory bone-graft volume and prosthetic function were, with the exception of 1 patient, good. Radiological examination demonstrated preservation of the major part of the vertical dimension of the grafted bone. Patient's assessment was of good aesthetics and intraoral function; 2 patients had minor phonetic problems. In conclusion, similar success to routine maxillary implant treatment can be achieved in the event of extreme maxillary bone deficiency, by bone grafting and immediate fixture insertion.

The combined sensate radial forearm and iliac crest free flaps for reconstruction of significant glossectomy-mandibulectomy defects

Abstract: The loss of motor and sensory function of the tongue following ablative surgery has a devastating effect on oral function. At the present time, there is no way to restore lost tongue musculature following partial glossectomy. The use of sensate cutaneous flaps has been shown to restore sensory feedback to reconstructed areas of the oral cavity. No single composite flap supplies a sensate soft-tissue component together with an osseous component of sufficient bone stock for functional mastication. In this article, the combination of the radial forearm free flap with the iliac crest osteocutaneous or osteomyocutaneous free flap is reported. The radial forearm free flap was used to resurface the resected portion of the tongue to provide maximum mobility and sensation. The lingual nerve was the recipient nerve for anastomosis to the antebrachial cutaneous nerves in all but one case. The iliac bone was used to reconstruct the mandible, with the iliac skin paddle or the internal oblique muscle used to reconstruct the neoridge. This combination of flaps was used in 10 patients. There was one flap failure due to vascular kinking from "piggybacking" the iliac crest to the distal end of the radial forearm flap. As a result, the use of two separate sets of recipient vessels is now advocated. Although a single composite free flap offers an excellent form of oromandibular reconstruction in most cases, it has been shown that oral function deteriorates when large areas of anesthesia are present in the oral cavity. We believe that this combination of two free flaps offers an opportunity for superior function in select patients with significant glossectomy and/or large mucosal defects.

The combined sensate radial forearm and iliac crest free flaps for reconstruction of significant glossectomy-mandibulectomy defects

Abstract: The loss of motor and sensory function of the tongue following ablative surgery has a devastating effect on oral function. At the present time, there is no way to restore lost tongue musculature following partial glossectomy. The use of sensate cutaneous flaps has been shown to restore sensory feedback to reconstructed areas of the oral cavity. No single composite flap supplies a sensate soft-tissue component together with an osseous component of sufficient bone stock for functional mastication. In this article, the combination of the radial forearm free flap with the iliac crest osteocutaneous or osteomyocutaneous free flap is reported. The radial forearm free flap was used to resurface the resected portion of the tongue to provide maximum mobility and sensation. The lingual nerve was the recipient nerve for anastomosis to the antebrachial cutaneous nerves in all but one case. The iliac bone was used to reconstruct the mandible, with the iliac skin paddle or the internal oblique muscle used to reconstruct the neoridge. This combination of flaps was used in 10 patients. There was one flap failure due to vascular kinking from "piggybacking" the iliac crest to the distal end of the radial forearm flap. As a result, the use of two separate sets of recipient vessels is now advocated. Although a single composite free flap offers an excellent form of oromandibular reconstruction in most cases, it has been shown that oral function deteriorates when large areas of anesthesia are present in the oral cavity. We believe that this combination of two free flaps offers an opportunity for superior function in select patients with significant glossectomy and/or large mucosal defects.

Bone tissue response to four-month antiorthostatic bedrest: a bone histomorphometric study.

Abstract: A histomorphometric analysis were made on iliac crest biopsies from eight healthy male volunteers submitted to a 4-month antiorthostatic bedrest. Bone mass and bone cell parameters, reflecting resorption and formation activities, were measured before and after the bedrest period. Trabecular bone volume and mean cortical thickness were not modified despite a decreased number of trabeculae and nonsignificant increase of the trabecular thickness; total and active resorption surfaces and the number of osteollast per mm2 of trabecular surfaces do not vary significantly. Osteoid thickness does not vary but we found a reduced osteoid surface and a nonsignificant decreased osteoid volume. Our results suggest that bone architecture may be more affected by the reduction of mechanical forces than the bone mass. These modifications were supposed to be the result of an accelerated bone turnover in the early stage of immobilization. In this study, we failed to find disuse osteoporosis; however, we must point out that the new organization of the trabecutae could affect the bone mechanical properties.

Correction of deep gluteal depression by autologous fat grafting.

Abstract: In the past, the traditional method of contouring the iliac crest and lateral femoral areas has been liposuction or the surgical removal of the bulges. Unfortunately, this method fails to correct the deep gluteal depression juxtaposed at these two sites. Since we use autologous fat grafts to correct contouring deficiencies elsewhere, it seems logical to investigate whether this technique is applicable to correcting this deformity. We have performed autologous fat grafting to the gluteal depression on 12 patients who underwent lipoplasty of the iliac crest and lateral femoral sites. The longest followup was one year. We have found that this method corrects the deep gluteal depression and yields an improved aesthetic contour. This article describes the technique, addresses the problems encountered, and shows postoperative results.

Segmental fixation of lumbar burst fractures with Cotrel-Dubousset instrumentation.

Abstract: A retrospective review of 17 patients who underwent bilateral transpedicular decompression, instrumentation with a Cotrel-Dubousset construct, and posterolateral fusion with iliac crest bone graft for treatment of lumbar burst fracture is presented. All patients were followed to fusion with an average follow-up of 18.9 months. Fifteen of sixteen patients returned to preinjury occupation and/or activity. All patients reported good to excellent clinical results. The average postoperative progression of kyphosis was 11.9 degrees. There was no significant change in anterior vertebral height between the preoperative and postoperative periods. We conclude that although excellent early clinical results can be obtained using this operative strategy, the long-term effect of residual kyphosis at the fracture site is unknown.

Acute and long-term benefits of iliac crest donor site perfusion with local anesthetics.

Abstract: he operative site associated with most discomfort after orthopedic vertebral decompression T and fusion with autogenous bone often is the donor site (i.e., the iliac crest). The purpose of this report is to relate our experience in treating this pain with postoperative bupivacaine infusion through a catheter whose tip is located at the iliac crest bone donor site. In addition, we sought to apply recent findings that effective perioperative analgesia may decrease the incidence and severity of long-term discomfort (1).

The radial forearm flap: a biomechanical study of donor-site morbidity utilizing sheep tibia.

Abstract: The use of vascularized bone grafts to reconstruct extremity and mandibular defects is now commonplace in reconstructive surgery. Fibula, scapula, iliac crest, rib, and metatarsal as well as the radial forearm osseocutaneous flaps have all been utilized for this purpose. Troublesome spiral fractures of the distal radius are the most common fractures associated with the use of the distal radius as a vascularized bone-graft donor site. This study was proposed to investigate the effect of donor-site bone loss on the strength of the radius under torsional (rotational) loading. Previous clinical series and experimental studies have not examined this aspect of distal radius loading after harvesting the bone graft. Fifty pairs of sheep tibiae were utilized in the experiment. Five pairs were used in a pilot study and 45 pairs were used in the main experiment. Five pairs of human radii were used for the control in the pilot study. The pilot study attempted to make a comparison between the human radius and the sheep tibia for experimental purposes. For the biomechanical study of donor-site defects, four study groups were examined with random assignment and matched pairs. The control group (group 1) had no alteration to the bone. Each test condition included five matched pairs of sheep tibiae. Experiment 1 compared the difference in the depth of the osteotomy defect. In doing this, one-third of the total length of the bone was removed in each of the following specimens to include (1a) 30 percent of the cross-sectional area of the total bone, (1b) 37 percent of the cross-sectional area of the total bone, and (1c) 50 percent of the cross-sectional area of the total bone. In experiment 2, the osteotomy shape was varied. Instead of the ends of the cuts being squared, the ends were beveled or rounded. Experiment 3 compared different lengths of bone removed in the osteotomy defect and included the following: In experiment 3a the diameter of the sheep tibia was measured at the incisura fibularis. This dimension was one diameter of bone, and a one-diameter length of bone was removed. In experiment 3b, a two-diameter length of bone was removed. In experiment 3c, a three-diameter length of bone was removed. In experiment 3d, a four-diameter length of bone was removed.(ABSTRACT TRUNCATED AT 400 WORDS)

Bone abnormalities and severe arthritis in pachydermoperiostosis.

Abstract: Two patients with pachydermoperiostosis were studied in whom the predominant features at presentation were severe and disabling knee and ankle joint pain in association with distal long bone pain. Analysis of synovial fluid from the knee joints showed non-inflammatory changes. In one patient a bicortical iliac crest bone biopsy specimen, taken after labelling with demeclocycline, showed appositional rates which were increased in cortical bone but reduced in trabecular bone. This mismatching resulted in trabecular osteoporosis, which occurred in association with increased numbers of osteoclasts, findings which suggest differential functional changes affecting the two bony envelopes.

Bone marrow necrosis in lymphoma studied by magnetic resonance imaging.

Abstract: We used magnetic resonance imaging (MRI) to examine the extent of necrosis in the marrow space in three patients with lymphoma who had necrosis in bone marrow biopsies taken from the posterior iliac crest Two of the patients had multiple focal lesions observed in the spine, pelvis, and femurs These lesions had MRI characteristics of fluid-filled necrosis within marrow or lymphoma The third patient exhibited a unique pattern of anatomically extensive marginated lesions otherwise typical of avascular necrosis of bone These cases provide evidence that MRI can document the extent of necrosis within the marrow space and can differentiate two distinct patterns of necrosis

Trabecular spacing in post-menopausal Australian women with and without vertebral fractures.

Abstract: Histomorphometric measurements were made from iliac crest biopsies of 32 women with vertebral fractures and 37 women without fracture. All were post-menopausal Australian women who had presented with back pain to a hospital out-patient endocrinology clinic Bone from the fracture cases was characterised by loss of individual trabccular elements, with the remaining trabeculac being spaced further apart than those in the non-fracture women (p <0.0001). This resulted in a significant decrease in trabecular bone volume (p <0.01). In addition osteoid surface was reduced (p <0.01). Dynamic parameters of bone turnover were not significantly different between the two groups. These data should be useful for the assessment of iliac bone histomorphometry in Australian post-menopausal women suspected of having osteoporosis. (Aust NZ J Med 1992; 22: 269–273.)

Long-term follow-up of vascularized bone grafts for the reconstruction of tibial nonunion: evaluation with computed tomographic scanning.

Abstract: Ten cases of reconstruction of the tibia with vascularized bone grafts were evaluated by computed tomographic (CT) scanning. In all cases the grafts were placed because of pseudarthrosis. The patients ranged in age from 20 to 64 years. The duration of follow-up was 1-9 years. In six cases fibular grafts were used to bridge the defect and in four cases iliac crest grafts were used. No additional bone grafts were placed after the initial operation. The pseudarthroses were classified into three types: type N--no bony defect (4 cases); type P--partial bony defect (3 cases); and type C--complete segmental bone loss (3 cases). Our evaluation showed that the grafts used to treat the type N and type P pseudarthroses were the same shape and size as at the time of placement. The grafts used to treat the type C pseudarthroses were hypertrophied, although the medullary canal of the graft remained the same size as at the time of placement. Hypertrophy was a result of an extraperiosteal reaction. The fibular grafts were square rather than triangular in cross section. It was concluded that mechanical loading is important in promoting hypertrophy of the graft.

Long-term follow-up of vascularized bone grafts for the reconstruction of tibial nonunion : evaluation with computed tomographic scanning

Abstract: Ten cases of reconstruction of the tibia with vascularized bone grafts were evaluated by computed tomographic (CT) scanning. In all cases the grafts were placed because of pseudarthrosis. The patients ranged in age from 20 to 64 years. The duration of follow-up was 1-9 years. In six cases fibular grafts were used to bridge the defect and in four cases iliac crest grafts were used. No additional bone grafts were placed after the initial operation. The pseudarthroses were classified into three types: type N--no bony defect (4 cases); type P--partial bony defect (3 cases); and type C--complete segmental bone loss (3 cases). Our evaluation showed that the grafts used to treat the type N and type P pseudarthroses were the same shape and size as at the time of placement. The grafts used to treat the type C pseudarthroses were hypertrophied, although the medullary canal of the graft remained the same size as at the time of placement. Hypertrophy was a result of an extraperiosteal reaction. The fibular grafts were square rather than triangular in cross section. It was concluded that mechanical loading is important in promoting hypertrophy of the graft.

Bone mass and bone cellular variations after five months of physical training in rhesus monkeys: histomorphometric study.

Abstract: Five Rhesus Monkeys (Maccaca mulatta), a suitable nonhuman model, performed 5 months of ropeclimbing exercise. Duration of the training sessions was progressively increased to reach 1 hour/day after 1 month of training and was maintained until the end of the experiment. Bone mass parameters, bone resorption, and bone formation activity were measured by histomorphometric analysis on iliac crest bone biopsies before and after the experiment. Mineral apposition rate was measured in cortices and trabecular bone after double calcein labeling. Five months of rope-climbing exercise had determined a significant decrease of bone volume with a slight decrease of the number and thickness of trabeculae. This might induce an alteration of biomechanical properties of bone. These architectural modifications were associated with a nonsignificant decrease of bone resorption activity. But the main effect of training was an important decrease of bone formation activity without change of the mineral apposition rate. Endurance exercise at low intensity has determined a decreased bone turnover with osteoblastic depression. This animal experiment points out that exercise modalities might be important in the bone response to training and should be carefully defined for preventive use in humans.

Effect of calcitonin on bone histomorphometry and bone metabolism in rheumatoid arthritis.

Abstract: Twenty-four women (mean age±SD 49±13 years) with classical or definite rheumatoid arthritis (disease duration 15±8 years) were treated with synthetic salmon calcitonin (SCT) nasal spray 200 IU three times a week for 3 months. Bone biopsies from the iliac crest were taken before and after SCT treatment. Histomorphometrical quantification of undecalcified bone sections was made using the manual point-counting method. SCT decreased the resorption surface of trabecular bone (ES/BS) significantly (P< 0.001). There was also a significant increase (P< 0.05) in trabecular bone volume (BV/TV) after 3 months of treatment, whereas no statistically significant changes were found in osteoid parameters. There were no significant changes in biochemical analyses of bone metabolism. We conclude that SCT might be useful in the prevention of bone loss in RA.

Bone histomorphometry of the iliac crest, and spinal fracture prevalence in atrophic and hypertrophic osteoarthritis of the hip.

Abstract: While some authors report high bone density in osteoarthritis (OA), surgical experience with total hip arthroplasty (THA) for primary OA suggests the existence of osteoporotic subsets of patients. To identify these we analysed 107 iliac crest bone biopsies, taken at THA, by routine histomorphometry for trabecular structural and bone turnover features, and examined radiographs of the spine for vertebral fractures. Patients were grouped by hip osteophyte size (none, atrophic; small, hypotrophic; moderate, supertrophic; large, hypertrophic OA), and by major architectural disorganization of the hip (hip joint destruction, protrusio). We found hip joint destruction to be 3 times more common in atrophic than in supertrophic and hypertrophic OA (p<0.05). Overall, the OA patients had lower bone volume (p<0.05) and thinner trabeculae (p<0.05) than controls. Worst affected were patients with hip joint destruction and with protrusio: they also had fewer and more widely spaced trabeculae than controls (p<0.05). The spinal fracture prevalence was highest in patients with hip joint destruction (higher than in the general population), intermediate in those with protrusio or atrophic OA, and lowest in patients with supertrophic or hypertrophic OA. We conclude that OA hip patients with joint destruction or protrusio have a high prevalence of generalized osteoporosis, and that the larger the hip osteophytes, the lower is the prevalence of generalized osteoporosis. Our findings suggest that the generalized bone status may influence the outcome of OA of the hip.

Cement wedge replacing iliac graft in tibial wedge osteotomy

Abstract: The authors report their experience in substituting cement for full-thickness iliac crest wedge in medial tibial wedge osteotomy using buttress plate fixation. A review of 107 osteotomies performed between January 1985 and March 1989, demonstrated that using cement wedge do not expose to any special complication and raise the accuracy of frontal mechanical axes correction. At last, cement wedge seems not to evolve as a stranger corpus able to give long or mean terms complications; it perhaps make unnecessary bone substitute or allografts wedges.

Iliac crest versus spinous process grafts in posttraumatic spinal fusions.

Abstract: Results of posttraumatic spine fusions in 34 patients who had autogenous iliac crest grafts were compared with those of 70 patients who had autogenous spinous process grafts. The two groups of patients were otherwise homogenous, and fusion occurred in 32 (94%) of the iliac crest graft patients and 70 (100%) spinous process graft patients. However, average operative time (225 vs. 200 minutes) and operative blood loss (1371 vs. 1136 cc) were significantly higher in iliac crest graft patients (P less than 0.05), and five iliac crest graft patients had significant donor site complications. Use of spinous process grafts eliminated donor site problems, reduced operative time and blood loss, and produced a rate of arthrodesis equal to that of iliac crest grafts.

Intraoperative distraction in the treatment of complex nonunions of the radius

Abstract: Two unique cases of complex nonunions of the radius are presented. Each was characterized by bone loss, disruption of the distal radioulnar joint, and loss of axial alignment. Indirect reduction and lengthening of the radius were accomplished intraoperatively with the use of a femoral distractor, and the nonunion was treated with autogenous iliac crest graft and a long AO/ASIF dynamic compression plate. A functional result occurred in each case.

Anterior surgery of the upper cervical spine.

Abstract: The authors report the results obtained in a series of more than 80 cases submitted to 76 operations of the upper cervical spine by transoral approach with a minimum follow-up of two years. The cases include: 15 unstable fractures or non-union of the odontoid processes; 28 cases of post-traumatic instability of C1-C2 level without fracture of the odontoid process; 13 cases of rheumatoid arthritis with instability at C1-C2; 14 cases of severe anomalies of the craniovertebral junction, often associated with basilar impression and spinal cord compression, of which 7 cases presented with tetraparesis; 6 malignant tumors. The method used involves an anterior transoral approach, more often without tracheotomy, and with exposure of the anterior aspect of the atlas and of the odontoid process by means of a midline incision of the posterior wall of the pharynx. When spinal cord lesion was present, decompression and reconstruction by bone grafts taken from the iliac crest were performed. In nearly all of the cases osteosynthesis with an anterior plate was used. Complications were mild. There were two cases of infection, observed at the onset of our experience, which were resolved after removal of the instrumentation. There was loosening of a screw in three cases; this was eliminated through the digestive tube with no consequences. There were no early intra- or postoperative deaths. Consolidation was obtained in most of the patients, and only in three cases did we observe a loss of postoperative reduction. Among patients affected with tetraparesis we observed many cases of neurological recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

Vascularized fibula transfer. A review

Abstract: The first vascularized fibula transfer was done by Ueba et al (1983) in 1974 and has since become a standard technique for special indications in the English, French, Japanese and Chinese-world Within the last 5 years this technique has received more and more attention in the German-speaking countries The vascularized fibula transfer is successfully used to reconstruct segmental bone defects larger than 5 to 8 cm that are caused by trauma, tumor, pseudarthrosis or congenital defects When used to treat osteomyelitis, the vascularized fibula transfer failed to fulfill expectations Bone defects smaller than 10 cm can also be treated by vascularized iliac crest transfer To achieve rapid healing, the following points must be followed carefully: when treating osteomyelitis, the infection must be healed--negative cultures and good granulation tissue--prior to bone transplantation Application of systemic or local antibiotics and aggressive debridement of necrotic bone and soft tissue must be carried out until the cultures taken from the wound are negative Soft tissue defects must be treated by soft tissue transfer in order to facilitate wound closure with well-vascularized tissue Vascularized bone transfer should be the treatment of choice for the femur and upper extremities Precise preoperative planning, especially in high-energy trauma cases, reduces the complication rate Rigid internal fixation of the bone graft with the recipient site by a smaller proximal and distal plate or by a plate bridging the whole bone defect running parallel to the fibula graft leads to rapid healing without malalignment(ABSTRACT TRUNCATED AT 250 WORDS)

Reconstructing the atrophic mandible with inferior border grafting and implants: a preliminary report.

Abstract: Advanced mandibular atrophy is a serious surgical reconstruction challenge. Previous experience with an inferior border approach has been favorable. Predictably successful osseointegrated implants ultimately allow loading of the healed grafts. The technique described uses a freeze-dried, gamma-irradiated cadaver mandible packed with autogenous iliac crest bone. An extraoral approach allows augmentation without disrupting use of an intraoral prosthesis during healing. The incidence of infection and resorption can be reduced. Fewer problems with neurosensory disturbances common with some of the superior border, or sandwich osteotomy, grafting techniques were experienced. The use of implants to ultimately load the bone should result in less resorption than in those techniques using a conventional removable prosthesis.

Reconstruction of large infected tibia defects.

Abstract: Twenty-nine patients are reported who underwent free tissue transfer reconstruction of contaminated tibia defects with both soft tissue defects and osteomyelitis. Infection was controlled through the use of a two-stage composite tissue reconstruction. In the first stage, the wounds were closed with the free muscle or skin flap. Bone defects were bridged with vascularized bone grafts within 6 to 12 weeks after soft tissue closure. Twenty patients underwent reconstruction using iliac crest, whereas nine patients were treated with fibular transfer. The follow-up period for 28 patients ranged from 10 months to 6 years until bone union was completed. The bone united smoothly in 22 patients, but union of the other six grafts was delayed and required additional cancellous bone grafting.