Showing papers on "Iliac crest published in 2018"

A Multicentric, Open-Label, Randomized, Comparative Clinical Trial of Two Different Doses of Expanded hBM-MSCs Plus Biomaterial versus Iliac Crest Autograft, for Bone Healing in Nonunions after Long Bone Fractures: Study Protocol

Abstract: ORTHOUNION is a multicentre, open, comparative, three-arm, randomized clinical trial (EudraCT number 2015-000431-32) to compare the efficacy, at one and two years, of autologous human bone marrow-derived expanded mesenchymal stromal cell (hBM-MSC) treatments versus iliac crest autograft (ICA) to enhance bone healing in patients with diaphyseal and/or metaphysodiaphyseal fracture (femur, tibia, and humerus) status of atrophic or oligotrophic nonunion (more than 9 months after the acute fracture, including recalcitrant cases after failed treatments). The primary objective is to determine if the treatment with hBM-MSCs combined with biomaterial is superior to ICA in obtaining bone healing. If confirmed, a secondary objective is set to determine if the dose of 100 × 106 hBM-MSCs is noninferior to that of 200 × 106 hBM-MSCs. The participants (n = 108) will be randomly assigned to either the experimental low dose (n = 36), the experimental high dose (n = 36), or the comparator arm (n = 36) using a central randomization service. The trial will be conducted in 20 clinical centres in Spain, France, Germany, and Italy under the same clinical protocol. The confirmation of superiority for the proposed ATMP in nonunions may foster the future of bone regenerative medicine in this indication. On the contrary, absence of superiority may underline its limitations in clinical use.

Combining autologous bone marrow mononuclear cells seeded on collagen sponge with Nano Hydroxyapatite, and platelet-rich fibrin: Reporting a novel strategy for alveolar cleft bone regeneration.

Abstract: Introduction The aim of this study was to examine and assess the use of autologous bone marrow mononuclear cells (BMMNCs) combined with platelet-rich fibrin (PRF) and nanohydroxyapatite for bone regeneration as an effective technique for alveolar cleft repair. Patients and methods This study included 20 patients with unilateral alveolar cleft defects and with an age range of 8–15 years. They were divided equally into two groups: Group A, received treatment via the regenerative approach which includes; autologous BMMNCs seeded on a collagen sponge in combination with nanohydroxyapatite and autologous PRF. Group B, received the standard alveolar bone grafting with iliac crest bone. The effectiveness of the new technique was evaluated and compared to the standard grafting technique through a 12-month follow-up via clinical and radiographic assessments. Results During the 12-month follow-up, Group A exhibited less donor site complications, faster and better soft tissue healing, and less postoperative pain, when compared to group B. 90% of the cases in group A, exhibited complete alveolar bone union verses 70% only in group B. Conclusion Combination of BMMNCs, nanohydroxyapatite, and PRF greatly promote bone regeneration in alveolar cleft defects providing an alternative novel therapeutic strategy to the standard alveolar bone grafting.

Ultrasound-guided lateral-medial transmuscular quadratus lumborum block for analgesia following anterior iliac crest bone graft harvesting: a clinical and anatomical study

Abstract: The anterior iliac crest (AIC) is one of the most common sites for harvesting autologous bone, but the associated postoperative pain can result in significant morbidity. Recently, the transmuscular quadratus lumborum block (TQL) has been described to anesthetize the thoraco-lumbar nerves. This study utilizes a combination of cadaveric models and clinical case studies to evaluate the dermatomal coverage and analgesic utility of TQL for AIC bone graft donor site analgesia. Ten ultrasound-guided TQL injections were performed in five cadaver specimens using a lateral-to-medial transmuscular approach. Twenty mL of 0.5% methylcellulose was injected on each side after ultrasound confirmation of the needle tip ventral to the quadratus lumborum muscle (QLM). Cranio-caudal and medial-lateral extent of the dye spread in relation to musculoskeletal anatomy and direct staining of the thoraco-lumbar nerves were recorded. Following the anatomical findings, continuous catheter TQL blocks were performed in four patients undergoing ankle surgery with autologous AIC bone graft. The dermatomal anesthesia and postoperative analgesic consumption were recorded. In the anatomical component of the study, 9/10 specimens showed a lateral spread anterior to the transversalis fascia and medially between the QLM and psoas major muscle. Direct staining of the branches of the T12, L1, and L2 nerves was noted ventral to the QLM, while variable staining of the T9-T11 nerves was seen laterally in the transversus abdominis plane and the transversalis fascia. The vertical spread of injectate anterior to the QLM was T12 to the iliac crest (n = 5/10) and L1 to the iliac crest (n = 4/10). In the four patients who received TQL, the T9-L2 dermatomal anesthesia correlated with the injectate spread seen in the cadavers and provided effective analgesia at the bone graft donor site. Ultrasound-guided TQL injections consistently cover the thoraco-lumbar innervation relevant to the AIC graft donor site. The injectate spread seen in anatomical dissections correlated with the dermatomal anesthesia clinically. The TQL has the potential to provide reliable analgesia for patients undergoing AIC bone graft harvesting.

Management of septic non-union of the tibia by the induced membrane technique. What factors could improve results?

Abstract: Introduction Management of septic non-union of the tibia requires debridement and excision of all infected bone and soft tissues. Various surgical techniques have been described to fill the bone defect. The “Induced Membrane” technique, described by A. C. Masquelet in 1986, is a two-step procedure using a PMMA cement spacer around which an induced membrane develops, to be used in the second step as a bone graft holder for the bone graft. The purpose of this study was to assess our clinical and radiological results with this technique in a series managed in our department. Material and method Nineteen traumatic septic non-unions of the tibia were included in a retrospective single-center study between November 2007 and November 2014. All patients were followed up clinically and radiologically to assess bone union time. Multivariate analysis was used to identify factors influencing union. Results The series comprised 4 women and 14 men (19 legs); mean age was 53.9 years. Vascularized flap transfer was required in 26% of cases before the first stage of treatment. All patients underwent a two-step procedure, with a mean interval of 7.9 weeks. Mean bone defect after the first step was 52.4 mm. The bone graft was harvested from the iliac crest in the majority of cases (18/19). The bone was stabilized with an external fixator, locking plate or plaster cast after the second step. Mean follow-up was 34 months. Bony union rate was 89% (17/19), at a mean 16 months after step 2. Eleven patients underwent one or more (mean 2.1) complementary procedures. Severity of index fracture skin opening was significantly correlated with union time (Gustilo III vs. Gustilo I or II, p = 0.028). A trend was found for negative impact of smoking on union (p = 0.06). Bone defect size did not correlate with union rate or time. Discussion The union rate was acceptable, at 89%, but with longer union time than reported in the literature. Many factors could explain this: lack of rigid fixation after step 2 (in case of plaster cast or external fixator), or failure to cease smoking. The results showed that the induced membrane technique is effective in treating tibial septic non-union, but could be improved by stable fixation after the second step and by cessation of smoking. Level of evidence IV, Retrospective study.

Cleft Alveolus Reconstruction Using a Three-Dimensional Printed Bioresorbable Scaffold With Human Bone Marrow Cells.

Abstract: Bone tissue engineering technology based on scaffold has been applied for cleft lip and palate treatment. However, clinical applications of patient-specific three-dimensional (3D) scaffolds have rarely been performed. In this study, a clinical case using patient-specific 3D-printed bioresorbable scaffold with bone marrow stromal cells collected from iliac crest in the operating room has been introduced. At 6-month after transplantation, the bone volume of the newly regenerated bone was approximately 45% of the total defect volume. Bone mineral density of the newly regenerated bone was about 75% compared to the surrounding bone. The Hounsfield unit value was higher than that of cancellous maxillary alveolar bone and lower than that of the cortical maxillary alveolar bone. Bone-marrow-derived mesenchymal stem cells-seeded 3D-printed patient-specific polycaprolactone scaffolds offer a promising alternative for alveolar cleft reconstruction and other bony defects.

Clinical and Radiological Long-term Results After Implant-Free, Autologous, Iliac Crest Bone Graft Procedure for the Treatment of Anterior Shoulder Instability:

Abstract: Background:The implant-free, autologous, iliac crest bone graft procedure (J-bone graft) for the treatment of anterior shoulder instability shows low rates of recurrent dislocations and moderate pr...

The biological basis for concentrated iliac crest aspirate to enhance core decompression in the treatment of osteonecrosis.

Abstract: Core decompression is a surgical procedure that is capable of salvaging the patient's own natural joint, if the operation is performed in the early stages of osteonecrosis, in which the articular surface has not collapsed. The addition of concentrated cells, aspirated from the iliac crest, to the core tract has been shown to enhance the viability of the femoral head, although large, prospective, randomized, blinded multicentre studies are lacking. The rationale for adding these cells to the core decompression tract is to provide osteoprogenitor and vascular progenitor cells to the area of decompressed dead bone, in order to facilitate tissue regeneration and repair. It has become increasingly evident that vast discrepancies exist in different series in regard to the criteria for patient selection, the surgical technique of core decompression, the methods for harvesting, processing, and injecting the cells, and the methodology for determining success or failure in a specific patient cohort. This paper reviews the salient points relevant to the treatment of osteonecrosis by core decompression with addition of concentrated iliac crest aspirates and poses important questions regarding the future successful application of this technique.

Superficial Circumflex Iliac Artery-Based Iliac Bone Flap Transfer for Reconstruction of Bony Defects.

Abstract: Background The superficial circumflex iliac artery (SCIA)-based iliac bone flap has yet to be widely used. The purpose of this article is to validate the feasibility of SCIA-based iliac bone flap transfers for reconstruction of small to moderate-sized bony defects. Retrospective outcome comparisons between SCIA-based iliac bone flaps and fibula flaps were made. Methods Twenty-six patients with bony tissue defects underwent reconstructions using either free SCIA-based iliac bone flaps (13) or fibula flaps (13). Outcomes were evaluated 9 months after the reconstruction on the following basis: bone length, pedicle length, skin paddle area, bone union, donor-site complications, skin paddle survival, and complications at the reconstructed site. Results There was no statistically significant difference in pedicle length (iliac bone vs. fibula; 5.5 ± 1.8 vs. 4.1 ± 1.5 cm; p = 0.181), in bone union rate (iliac bone vs. fibula; 100 vs 92.3%; p = 0.308), in donor-site complication rate (iliac bone vs. fibula; 0 vs. 7.7%; p = 0.308), or in skin paddle complete survival rate (iliac bone vs. fibula; 100 vs. 83.3%; p = 0.125). Statistically significant differences were observed in bone flap length (iliac bone vs. fibula; 4.8 ± 2.2 vs. 11.1 ± 4.8 cm; p = 0.0005), in skin paddle area (superficial circumflex iliac artery perforator flap vs. peroneal artery perforator flap; 58.8 ± 35.6 vs. 27.7 ± 17.5 cm2; p = 0.0343), and in reconstructed site complication rate (iliac bone vs. fibula; 0 vs. 30.8%; p = 0.030). Conclusion In our series of SCIA-based iliac bone flap transfers, up to 8 × 3 cm could be procured along the iliac crest. When compared with fibula flap transfers, there were no significant statistical differences in pedicle length or in bone union rate; the SCIA-based iliac bone flap may be a feasible option for bony defects of small to moderate size.

Fixation of proximal pole scaphoid nonunion with non-vascularized cancellous autograft:

Abstract: We present 20 patients with established proximal pole scaphoid nonunions treated with curettage and cancellous autograft from the distal radius and screw fixation. Fractures with significant proximal pole fragmentation were excluded. Patients were treated at a mean of 26 weeks after injury (range 12–72). Union occurred in 18 of 20 patients (90%) based on computed tomographic imaging. The two nonunions that did not heal were treated with repeat curettage and debridement and iliac crest bone grafting without revision of fixation. Union was achieved in both at a mean of 11 weeks after the revision procedures. Our findings suggest that non-vascularized cancellous autograft and antegrade fixation is a useful option for the treatment of proximal pole scaphoid nonunions.Level of evidence: IV

Subcrestal Iliac-Screw: A Technical Note Describing a Free Hand, In-line, Low Profile Iliac Screw Insertion Technique to Avoid Side-connector Use and Reduce Implant Complications.

Abstract: Study design Case-series Objective To report our modified iliac-screw insertion technique and its clinical outcomes Summary of background data Iliac-screws are one of the preferred methods for modern spinopelvic-fixation However, the technique is not without complications, predominantly because of iliac-screw head prominence, leading to pain and revisions Conventional iliac-screw entry point is sited superficially at the posterior-superior-iliac-spine (PSIS) contributing to screw-head prominence We propose a more low-profile, subcrestal entry point that is more medial and inferior to the PSIS at the medial wall of the iliac crest, lying underneath the crest but above the sacroiliac joint This position keeps the screw-head low profile and in-line with proximal instrumentation to ease rod engagement Methods Ten consecutive patients who underwent spinal deformity correction surgery using the modified iliac-screw entry point fixations were enrolled Clinical, radiological, and surgical parameters were reviewed Results Five males and five females with average age of 66 years and average follow up of 29 months were reviewed Mean preoperative Cobb angle and C7-SVA were 321° and 103 cm, respectively Surgical indication was progressive deformity and neurogenic claudication in eight cases and fracture in two cases Twenty noncannulated, polyaxial iliac-screws with median dimension of 75 x 75 mm were inserted free hand Bilateral S1 screws were used in all except two cases Only five out of 16 iliac-screws with concomitant S1 screws needed side-connectors At the last follow up only one iliac-screw head was felt to be prominent but without pain in a Parkinson's patient None of the 10 patients had cases of revision, breakages, or sacroiliac pain Conclusion Subcrestal iliac-screw insertion is feasible, safe, and has the potential to reduce screw-head complications and avoid the use of side-connectors, lowering construct complexity and cost The technique has the advantage of both the low-profile S2 alar iliac screw and the ease of free-hand insertion of the traditional iliac-screw Level of evidence 4

Non-vascularized iliac bone grafting for scaphoid nonunion with avascular necrosis:

Abstract: We present the surgical outcomes of non-vascularized bone grafting taken from the iliac crest in 24 patients with scaphoid nonunion and avascular necrosis. The Fisk-Fernandez technique was used in 11 patients, and cancellous bone grafting was used in 13 patients. Bony union was achieved in 22 of the 24 patients. Non-vascularized iliac bone grafting can be used for the surgical management of scaphoid nonunion with avascular necrosis. Although revascularization of the proximal fragment after surgery was not evaluated, bony union was confirmed in nearly all patients.Level of evidence: IV

Apophyseal avulsion fractures of the pelvis. A review.

Abstract: Background and aim of the work: Fractures of the pelvis classically occur in adolescent during sports activities with forceful and repetitive contractions or passive lengthening acting on not yet ossified growth plates. Their misdiagnosis lead to disability, chronic pain and decrease of performances. Evidence based treatment guidelines do not exist; aim of this paper is to point out clinical outcomes, return to sport rates and complications of surgical and conservative approach. Methods: A systematic search based on MEDLINE database was performed in August 2017 to identify all published articles from 2010 to 2017 reporting outcomes, return to sport and complications rates after surgical and non-operative treatment of avulsion fractures of the pelvis. Results: Mean age was 14,5 years with anterior inferior iliac spine avulsion representing the most common injury (46%), followed by anterior superior iliac spine avulsion (32%), ischial tuberosity avulsion (12%) and iliac crest avulsion (11%). Rates of excellent outcome and return to sports at pre-injury levels were higher after surgical treatment; surgery has a higher risk of heterotopic ossification (9%) compared to conservative treatment (1,8%), whereas the risk of non-unions is lower (0% versus 2,5%). Conclusions: Surgery is preferred for major dislocations and fragment sizes, providing a faster return to pre-injury level of activity, decreasing the risk of pseudoarthrosis. Conservative treatment is advisable for minimally displaced fractures when a rapid recovery is not required; patient and his family should be informed on the risk of non-unions and the eventuality of a delayed surgical approach. (www.actabiomedica.it)

Mid-term clinical results of an arthroscopic glenoid rim reconstruction technique for recurrent anterior shoulder instability.

Abstract: Glenoid bone loss in recurrent anterior instability of the shoulder needs to be addressed to restore joint stability. Over the last years, several arthroscopic methods have been described to treat this condition. However, no clinical mid-term results have been presented for arthroscopic iliac crest bone grafting procedures. We included 32 patients with significant glenoid bone loss and repetitive dislocations of the shoulder who were treated in our shoulder unit with a previously described all-arthroscopic reconstruction technique. All patients filled out a questionnaire evaluating repetitive dislocations, consumption of pain medicine, Constant Score (CS, adapted to age and gender), activities of daily living (ADL), visual analogue scale for pain (VAS) as well as the Western Ontario Shoulder Instability Index (WOSI). Additionally, all complications were recorded. After a mean follow-up of 42 months, three traumatic dislocations had been observed. With an ADL of 25 points (95% CI 24–27), a WOSI of 71% (95% CI 65–76) and CS of 87 points (95% CI 82–92), our patients showed good functional results. The VAS result for pain was 2.1 (95% CI 1.5–2.6). No patient reported the regular usage of pain medicine related to the shoulder instability at final follow-up. The all-arthroscopic glenoid reconstruction using iliac crest grafts shows good functional results with a recurrence rate of 9%. At final follow-up 42 months after surgery, our patients showed low pain levels and acceptable complications.

Deep circumflex iliac artery perforator flap with iliac crest for oromandibular reconstruction

Abstract: When combined with iliac bone, perforator flaps are more chimeric, and there is increased mobile skin island to reconstruct soft tissue defects in the oral and maxillofacial region. This study examined oromandibular defects reconstructed using deep circumflex iliac artery perforator flap with iliac crest (DCIAPF). We retrospectively reviewed records of 23 patients with mandibular defects received DCIAPFs after oncological resection for oromandibular reconstruction from November 2015 to August 2016. All perforators, identified before surgery by Doppler examination, were terminal perforators of DCIA. DCIAPFs were successfully harvested in all patients. The flap survival rate was 95.6% (22/23); one flap failed due to artery spasm. Three patients developed slight skinedge necrosis in the skin island. Anatomical reconstruction contour of the mandible and sufficient bone length and height were achieved, with no serious donor-site complications during the follow-up period. The results demonstrated that DCIAPF is a favorable single-flap option for oromandibular reconstruction after oncological resection with fewer donor-site complications because of its adequate bone tissue and satisfactory soft tissue, with a constant location of the perforator.

Single-stage treatment of infected tibial non-unions and osteomyelitis with bone marrow granulocytes precursors protecting bone graft

Abstract: Infected non-unions present a clinical challenge, especially with risk of recurrent infection. Bone marrow contains granulocyte precursors identified in vitro as colony forming units-granulocyte macrophage (CFU-GM) have a prophylactic action against infection. We therefore tested the hypothesis that bone marrow concentrated granulocytes precursors added to a standard bone graft could decrease the risk of recurrence of infection when single-stage treatment of infected tibial non-unions is performed with bone graft. During a single-stage procedure 40 patients with infected tibial non-union received a spongious bone graft supercharged with granulocytes precursors after debridement (study group). A control group (40 patients) was treated in a single stage with local debridement and standard bone graft obtained from the iliac crest. The antibiotic therapy protocol was the same (60 days) in the two groups. CFU-GM progenitors were harvested from bone marrow aspirated on the opposite iliac crest of the site where the cancellous bone was obtained. Union (radiographs and CT scan), a recurrence of clinical infection, and need for subsequent surgery were evaluated. Thirty-eight (95%) patients who received graft supercharged with granulocytes precursors achieved successful union without recurrence of infection during the seven-year follow-up versus 28 (70%) control patients; for the control group the mean graft resorption volume was 40%, while no bone graft resorption was found for the study group. Supercharging the cancellous bone graft with bone marrow granulocytes precursors protect the site of infected non-union from recurrence of infection and bone resorption of the graft.

Treatment of Mandibular Ameloblastoma Involving the Mandibular Condyle: Resection and Concomitant Reconstruction With a Custom Hybrid Total Joint Prosthesis and Iliac Bone Graft.

Abstract: Aim To describe the treatment of ameloblastoma involving the mandibular body and condyle in 3 patients. Methods This report describes 3 patients with large ameloblastomas (2 were second recurrences) treated by partial mandibular resection. Involvement of the mandibular condyle in these 3 patients made the reconstruction more challenging. Reconstruction included immediate temporomandibular joint replacement by a custom-made alloplastic total joint and mandibular body (Zimmer-Biomet, Jacksonville, FL). These devices were designed using virtual surgical planning software. The 3 patients underwent concomitant bone graft reconstruction using autogenous-free corticocancellous block bone grafts from the iliac crest. This facilitated later dental implant placement and full dental rehabilitation. Direct inferior alveolar nerve repair or nerve graft reconstruction with allograft was also carried out for all 3 patients. Maxillomandibular fixation was not used in all 3 patients. Results All the 3 patients underwent successful surgery and recovery. Mandibular function was preserved. The concomitant bone graft allowed successful dental implant placement for subsequent planned restorative dentistry. Conclusion Ameloblastoma involving the mandibular condyle can be successfully treated by resection and concomitant total joint replacement with an alloplastic device. This technique shows promise in that there is rapid return to excellent function thanks to rigid fixation of the construct. Mirroring software used in the prosthesis design facilitates excellent cosmetic outcomes.

Stem cell therapy in early post-traumatic talus osteonecrosis.

Abstract: Avascular necrosis of the talus is one of the most notable complications associated with talar neck fractures with frequent evolution of the osteonecrosis into a difficult arthrodesis. We tested whether the injection of bone marrow mesenchymal stem cells (MSCs) could improve the repair process of the osteonecrosis. Forty-five early (without collapse) post-traumatic talus osteonecroses (group 1; study group) were treated between 1995 and 2012 with percutaneous injection of progenitor cells (autologous bone marrow concentrate from the iliac crest). The number of MSCs transplanted in each ankle of group 1 was 124 × 103 cells (range 101 × 103 to 164 × 103 cells). The evolution of these osteonecroses treated with autologous bone marrow implantation was compared with the evolution of a control group of 34 talar osteonecroses without collapse and treated with only core decompression (group 2; control group) between 1985 and 1995. The outcome was determined by progression in radiographic stages to collapse, by the need of arthrodesis, and by the time to successfully achieve fusion for patients who needed arthrodesis. For the 45 ankles with autologous concentrate bone marrow grafting, collapse frequency was lower (27%, 12 among 45 versus 71%, 24 among 34; odds ratio 0.1515, 95% CI 0.0563–0.4079; P = 0.0002) and follow-up showed longer duration of survival before collapse or arthrodesis, compared to 34 ankles of the control patients with core decompression alone. Furthermore, the time to successfully achieve fusion after arthrodesis was significantly shorter in patients treated with bone marrow progenitors as compared with the other ankles, which had core decompression alone. In our study the early conservative surgical treatment with autologous bone marrow grafting improved the natural course of the disease as compared with core decompression alone.

Tracking Cell Transplants in Femoral Osteonecrosis with Magnetic Resonance Imaging: A Proof-of-Concept Study in Patients.

Abstract: Purpose: Osteonecrosis is a devastating complication of high-dose corticosteroid therapy in patients with cancer. Core decompression for prevention of bone collapse has been recently combined with the delivery of autologous concentrated bone marrow aspirates. The purpose of our study was to develop an imaging test for the detection of transplanted bone marrow cells in osteonecrosis lesions. Experimental Design: In a prospective proof-of-concept clinical trial (NCT02893293), we performed serial MRI studies of nine hip joints of 7 patients with osteonecrosis before and after core decompression. Twenty-four to 48 hours prior to the surgery, we injected ferumoxytol nanoparticles intravenously to label cells in normal bone marrow with iron oxides. During the surgery, iron-labeled bone marrow cells were aspirated from the iliac crest, concentrated, and then injected into the decompression track. Following surgery, patients received follow-up MRI up to 6 months after bone marrow cell transplantation. Results: Iron-labeled cells could be detected in the access canal by a dark (negative) signal on T2-weighted MR images. T2* relaxation times of iron-labeled cell transplants were significantly lower compared with unlabeled cell transplants of control patients who were not injected with ferumoxytol (P = 0.02). Clinical outcomes of patients who received ferumoxytol-labeled or unlabeled cell transplants were not significantly different (P = 1), suggesting that the added ferumoxytol administration did not negatively affect bone repair. Conclusions: This immediately clinically applicable imaging test could become a powerful new tool to monitor the effect of therapeutic cells on bone repair outcomes after corticosteroid-induced osteonecrosis.

Harvesting Autogenous Cancellous Bone Graft from the Anterior Iliac Crest.

Abstract: Autograft bone graft harvest is an important surgical technique in the armamentarium of the orthopaedic surgeon. The iliac crest can provide a robust amount of bone graft, but using it carries a risk of complications including neurologic injury, gait disturbance, sensory dysesthesia, and ilium fracture. We present a surgical technical involving harvest of cancellous bone graft from the anterior iliac crest that minimizes the complication profile associated with tricortical bone graft harvest. It should be noted that there are differences between the outcomes of anterior and posterior crest harvests. Anterior autograft harvest is associated with a higher complication rate, with more iliac wing fractures, postoperative hematomas, and sensory disturbances. The posterior approach, however, is associated with more postoperative pain than the anterior approach, with the patient often experiencing more pain from the harvest than from the procedure itself. The all-cancellous iliac crest bone graft harvest provides the benefit of a large quantity of autogenous bone for various procedures, ranging from spinal fusion to osseous reconstruction. The major steps of this procedure are (1) offset of the surgical incision, (2) exposure of the iliac crest while avoiding neurologic structures, (3) identifying the location of and performing a corticotomy of the iliac crest, (4) harvesting the cancellous bone graft using curets, (5) obtaining hemostasis, and (6) performing a layered closure. The postoperative course entails immediate weight-bearing as tolerated. There is a potential for complications, which are discussed at the individual points of concern during this video.

Cost-Effectiveness Analysis of Demineralized Bone Matrix and rhBMP-2 versus Autologous Iliac Crest Bone Grafting in Alveolar Cleft Patients.

Abstract: BACKGROUND The standard of care for patients with alveolar cleft deformities is autologous bone grafting using iliac crest bone graft (ICBG) The combination of demineralized bone matrix with recombinant human bone morphogenetic protein-2 (DBX/rhBMP-2), as a substitute for ICGB, has been shown to have similar bony incorporation within the maxilla without donor-site morbidity It has been argued that one of the drawbacks of using DBX/rhBMP-2 is the higher cost The aim of this study was to compare the cost, operative time, and hospital length of stay associated with these two treatment modalities METHODS A chart review was conducted for 71 patients who underwent secondary alveolar cleft reconstruction Forty patients received ICBG and 31 patients underwent reconstruction using DBX/rhBMP-2 Operative costs, operative time, and hospital length of stay were compared between the two groups RESULTS The average total operative cost was $6892 in the ICBG surgery population versus $4836 in the DBX/rhBMP-2 population (p < 001) Statistically significant decreases in anesthesia, pharmacy, and operating room costs were found in patients who underwent the DBX/rhBMP-2 surgery Operative time decreased from an average of 973 minutes to 670 minutes (p < 001), and length of inpatient stay decreased from an average of 298 hours to 93 hours (p < 001) CONCLUSION In the treatment of alveolar cleft deformities, operative material costs were greater in the DBX/rhBMP-2 group but-secondary to decreased hospital, anesthesia, pharmacy, and operating room costs-DBX/rhBMP-2 was more cost-effective than ICBG

Tissue Engineering in Maxillary Bone Defects.

Abstract: Background Restoration of craniofacial bone defects has been a concern for oral and maxillofacial surgeons In this study, the healing effect of fibrin glue scaffold was compared with autologous bone graft in mandibular defects of rabbit Methods Bilateral unicortical osteotomy was performed in the diastema region of 10 male Dutch rabbits The subjects were randomly divided into 2 equal groups The mandibular defect on the right side was treated with fibrin glue scaffold and the defect on the left side with autologous bone graft provided from iliac crest After 4 and 8 weeks, five rabbits from each group were sacrificed and the defects were evaluated morphologically, by coronal computed tomography scanning (CT-scan) and by histological examinations Results The healing effect of fibrin glue scaffold and autologous bone graft was similar with appropriate osteogenesis in comparison to the control group Conclusion Using fibrin glue can be a non-invasive treatment of choice in mandibular defects and maxillofacial surgeries when compared with autologous bone graft

Cartilage Morphological and Histological Findings After Reconstruction of the Glenoid With an Iliac Crest Bone Graft.

Abstract: Background:The J-bone graft is presumably representative of iliac crest bone grafts in general and allows anatomic glenoid reconstruction in cases of bone defects due to recurrent traumatic anterior shoulder dislocations. As a side effect, these grafts have been observed to be covered by some soft, cartilage-like tissue when arthroscopy has been indicated after such procedures.Purpose:To evaluate the soft tissue covering of J-bone grafts by use of magnetic resonance imaging (MRI) and histological analysis.Study Design:Case series; Level of evidence, 4.Methods:Patients underwent MRI at 1 year after the J-bone graft procedures. Radiological data were digitally processed and evaluated by segmentation of axial images. Independent from the MRI analysis, 2 biopsy specimens of J-bone grafts were harvested for descriptive histological analysis.Results:Segmentation of the images revealed that all grafts were covered by soft tissue. This layer had an average thickness of 0.87 mm compared with 1.96 mm at the adjacen...

Proliferative and osteogenic differentiation capacity of mesenchymal stromal cells: Influence of harvesting site and donor age.

Abstract: Human mesenchymal stromal cells (hMSCs) are the cellular source of new bone formation and an essential component of autologous bone grafts. Autologous bone graft harvesting is routinely conducted at the iliac crest, although alternative donor sites with lower complication rates are available. Thus, the aim of this study was to compare hMSCs harvested from the iliac crest and the proximal tibia regarding their proliferative and osteogenic differentiation capacity. Furthermore, we investigated the influence of donor age on these biological properties. HMSCs were isolated from iliac crest or proximal tibia bone grafts of 46 patients. Proliferative capacity was assessed by cumulative population doublings, population doubling time, colony forming units and cell proliferation assays. Osteogenic capacity was assessed by quantification of extracellular calcium deposition and marker gene expression levels. The number of hMSCs per gram harvested tissue was determined. Furthermore, the adipogenic and chondrogenic differentiation capacity were quantified using BODIPY and Safranin Orange staining, respectively. Additional analyses were carried out after grouping young (18-49 years) and aged (≥50 years) donors. HMSCs derived from the proximal tibia featured a comparable proliferative and osteogenic differentiation capacity. No significant differences were found for any analysis conducted, when compared to hMSCs obtained from the iliac crest. Furthermore, no significant differences could be revealed when comparing young and aged donors. This was equally true for hMSCs from both donor sites after comparison within the same age group. Our study demonstrates comparable biological properties of hMSCs derived from both donor sites, the iliac crest and the proximal tibia. Furthermore, aging does not alter proliferative and osteogenic differentiation capacity. Consequently, the proximal tibia should be considered more closely as an alternative donor site in patients of all age groups.

The Evolution of Iliac Bone Graft Donor Site Analgesia in Cleft Patients: Transversus Abdominis Plane Block Is Safe and Efficacious.

Abstract: BackgroundThe transversus abdominis plane (TAP) block has been increasingly used as a means of abdominal wall analgesia This study aims to determine if TAP block analgesia provides a benefit in cleft patients undergoing alveolar bone grafting with iliac crest cancellous bone graftMethodsTwo groups

Arthroscopic Anterior and Posterior Glenoid Bone Augmentation With Capsular Plication for Ehlers-Danlos Syndrome With Multidirectional Instability

Abstract: Recurrent multidirectional shoulder instability is a difficult clinical problem. This can be compounded in patients with connective tissue diseases such as Ehlers-Danlos syndrome. We present an all-arthroscopic technique involving extra-articular anterior and posterior glenoid bone grafting to augment a capsular repair in a patient with Ehlers-Danlos syndrome and recurrent multidirectional shoulder instability. Graft options include either distal tibial allograft or iliac crest autograft. Anterior graft placement uses a dilated far medial portal using an inside-out technique. The posterior graft is placed through a dilated posterior portal. A 1-mm edge of anterior and posterior glenoid rim is denuded of cartilage for later capsular repair, and grafts are secured flush to the osseous surface. A capsular plication is then completed and repaired to the prepared native glenoid surface, using the grafts as extra-articular osseous bumpers.