Showing papers on "Iliac crest published in 2019"
TL;DR: The LatarJet and ICBGT procedures for the treatment of anterior shoulder instability with glenoid bone loss showed no difference in clinical and radiologic outcomes except for significantly worse internal rotation capacity in the Latarjet group and frequently noted donor-site sensory disturbances in the ICB GT group.
98 citations
TL;DR: All three flaps of this study can be performed with awareness of the deep circumflex iliac artery flap being the least reliable alternative, with beneficial knowledge of the advantages and disadvantages of several osseal-free flap alternatives.
Abstract: Background and Aims:This study compared the three most used composite flaps in maxillofacial reconstructions in our institute.Patients and Methods:Between 2000 and 2012, a total of 163 patients wit...
46 citations
TL;DR: The study shows an anatomical link between innervation and bone remodeling in human bone and the association of nerve profiles to bone remodelling events and vascular structures in iliac crest biopsies isolated from patients diagnosed with primary hyperparathyroidism.
Abstract: Mounting evidence from animal studies suggests a role of the nervous system in bone physiology. However, little is known about the nerve fiber localization to human bone compartments and bone surface events. This study reveals the density and distribution of nerves in human bone and the association of nerve profiles to bone remodeling events and vascular structures in iliac crest biopsies isolated from patients diagnosed with primary hyperparathyroidism (PHPT). Bone sections were sequentially double-immunostained for tyrosine hydroxylase (TH), a marker for sympathetic nerves, followed by protein gene product 9.5 (PGP9.5), a pan-neuronal marker, or double-immunostained for either PGP9.5 or TH in combination with CD34, an endothelial marker. In the bone marrow, the nerve profile density was significantly higher above remodeling surfaces as compared to quiescent bone surfaces. Ninety-five percentages of all nerve profiles were associated with vascular structures with the highest association to capillaries and arterioles. Moreover, vasculature with innervation was denser above bone remodeling surfaces. Finally, the nerve profiles density was 5-fold higher in the intracortical pores compared to bone marrow and periosteum. In conclusion, the study shows an anatomical link between innervation and bone remodeling in human bone.
42 citations
TL;DR: The Masquelet technique effectively reconstructed traumatic and posttraumatic segmental defects in the forearm with a low incidence of complication.
Abstract: Purpose The Masquelet technique is a procedure increasingly utilized for addressing segmental bone defects. The technique involves staged procedures consisting of bone debridement and temporary spacer placement to induce membrane formation, followed by delayed bone grafting. This report summarizes our center’s experience with the Masquelet technique to reconstruct bone loss exclusively in the forearm. Methods We reviewed all cases in which the Masquelet technique was used to reconstruct segmental bone defects in the forearm resulting from acute trauma or nonunion, with or without infection, between 2014 and 2017 at a level-1 trauma center. Injury mechanism, prior surgeries, extent of bone defect, and demographic data were collected. Union was assessed along with treatment-related complications or reoperations. Results We identified 9 patients with segmental bony defects in the forearm treated with the Masquelet technique. Among this cohort, 5 patients had bone defects associated with acute open fractures and 4 patients presented with nonunion (1 atrophic and 3 infected nonunions). The median bony defect was 4.7 cm (range, 1.7–5.4 cm) at the time of grafting. Second stage grafting was performed with Reamer Irrigator Aspirator autograft from the femur in 8 patients and iliac crest bone cancellous graft in 1 patient. Union was achieved in all 9 patients. Six patients achieved union by 3-month follow-up, 2 patients by 6 months, and 1 patient by 12 months. One patient required a reoperation for plate fracture prior to union treated with revision internal fixation and grafting. Conclusions The Masquelet technique effectively reconstructed traumatic and posttraumatic segmental defects in the forearm with a low incidence of complication. Type of study/level of evidence Therapeutic V.
40 citations
TL;DR: For the treatment of aseptic long bone nonunion, autograft harvested by the RIA from the nonunion site results in similar union rate and time to union as AIC grafts without additional complications.
Abstract: INTRODUCTION Autologous bone graft is the gold standard for filling bone defects associated with diaphyseal nonunions. It is typically harvested from the anterior iliac crest (AIC) despite the high complication rate. The Reamer/Irrigator/Aspirator System (RIA) was developed to recover the reaming aspirate and use it as autograft. Initially described for harvesting bone from the femur, the bone volume available is similar to the AIC site; however, its use directly at nonunion sites has been studied very little. HYPOTHESES Compared to AIC harvesting, RIA at a non-union site will result in (1) sufficient bone volume, (2) similar time to union and union rate, (3) lower morbidity. RESULTS Two groups of patients received an autograft for aseptic nonunion of the tibia or femur for a bone defect up to 2cm: the RIA group (n=30) was followed prospectively and received an autograft by RIA while the AIC group (n=29) was reviewed retrospectively and received an autograft by AIC. We compared the time to union and union rate, operative time, intake of analgesics, duration of hospital stay and complication rate between groups. The RIA provided sufficient bone, 60cm3 on average in a reliable manner. The union rate was similar between groups: 90% (RIA) and 89.7% (CIA) (p=0.965), while the time to union was shorter in the RIA group (8.63±1.47months vs. 10.08±1.7 months) (p=0.006). The operative time (p<0.0001), analgesic intake (p=0.013), length of stay (p<0.0001) and immediate complication rate (p=0.0195) were higher in the AIC group. DISCUSSION For the treatment of aseptic long bone nonunion, autograft harvested by the RIA from the nonunion site results in similar union rate and time to union as AIC grafts without additional complications. LEVEL OF EVIDENCE IV, comparative retrospective study.
35 citations
TL;DR: Overall, the iliac crest and the vertebral body offer a more reliable tissue source of stromal progenitor cells for cartilage repair strategies compared to femoral head, and gender, donor age, and anatomical site were neither predictive for the total yield nor the population doubling time of in vitro derived BMSC cultures.
Abstract: (1) In vitro, bone marrow-derived stromal cells (BMSCs) demonstrate inter-donor phenotypic variability, which presents challenges for the development of regenerative therapies Here, we investigated whether the frequency of putative BMSC sub-populations within the freshly isolated mononuclear cell fraction of bone marrow is phenotypically predictive for the in vitro derived stromal cell culture (2) Vertebral body, iliac crest, and femoral head bone marrow were acquired from 33 patients (10 female and 23 male, age range 14-91) BMSC sub-populations were identified within freshly isolated mononuclear cell fractions based on cell-surface marker profiles Stromal cells were expanded in monolayer on tissue culture plastic Phenotypic assessment of in vitro derived cell cultures was performed by examining growth kinetics, chondrogenic, osteogenic, and adipogenic differentiation (3) Gender, donor age, and anatomical site were neither predictive for the total yield nor the population doubling time of in vitro derived BMSC cultures The abundance of freshly isolated progenitor sub-populations (CD45-CD34-CD73+, CD45-CD34-CD146+, NG2+CD146+) was not phenotypically predictive of derived stromal cell cultures in terms of growth kinetics nor plasticity BMSCs derived from iliac crest and vertebral body bone marrow were more responsive to chondrogenic induction, forming superior cartilaginous tissue in vitro, compared to those isolated from femoral head (4) The identification of discrete progenitor populations in bone marrow by current cell-surface marker profiling is not predictive for subsequently derived in vitro BMSC cultures Overall, the iliac crest and the vertebral body offer a more reliable tissue source of stromal progenitor cells for cartilage repair strategies compared to femoral head
32 citations
TL;DR: Recurrence of anterior shoulder instability after a failed Latarjet procedure can be successfully treated by an all-arthroscopic Eden-Hybbinette procedure, and suture-button fixation is reliable and permits optimal positioning and predictable healing of the new bone graft.
30 citations
TL;DR: The anatomical topology of the deep branch of the SCIA in fresh cadavers, which has not been reported in detail, was described to give off branches to the sartorius muscle and the iliac bone.
Abstract: Background Harvesting the sartorius muscle and the iliac bone with a superficial circumflex iliac artery (SCIA) perforator flap can be a challenging procedure. The aim of this study was to describe the anatomical topology of the deep branch of the SCIA in fresh cadavers, which has not been reported in detail. Methods Twenty groin regions from 10 fresh cadavers were dissected. The characteristics and landmarks of the SCIA system, including branches to the sartorius muscle and the iliac bone, were examined. Perfusion of the sartorius muscle and the iliac bone by means of the deep branch of the SCIA was evaluated with indocyanine green angiography and computed tomographic angiography. Results The superficial and the deep branches were identifiable in all specimens. In 85 percent of the specimens, the bifurcation point could be seen within 2 cm from a fixed site: 6 cm from the pubic tubercle to the anterior superior iliac spine, and 3 cm caudal from that point. The deep branch in each case gave off branches to the sartorius muscle and the iliac bone. The cephalad portion of the sartorius muscle (up to 8 cm from the anterior superior iliac spine) and the superficial portion of the iliac bone (up to 1.5 cm from the iliac crest) were perfused by the deep branch of the SCIA. Conclusions In all specimens, both the superficial branch and the deep branch of the SCIA were found. The deep branch was found consistently to give off perfusing branches to the sartorius muscle and the iliac bone.
29 citations
TL;DR: Chronic morbidity was lower than previously documented and illustrates that the ICBG remains a viable surgical option, and the authors hope this review will facilitate surgical planning and informed consent.
Abstract: Background The iliac crest bone graft (ICBG) is criticized for high donor site morbidity. Recent research suggests this morbidity is related to the patient population for which the ICBG is harvested. This systematic review is the first to delineate the type and incidence of ICBG donor site complications in craniofacial surgery. Methods Two independent reviewers conducted a systematic review of multiple databases (MEDLINE, EMBASE, CINAHL, PEDRO, and Cochrane Central Register of Controlled Trials) from 1917 to 2017. All studies utilizing the ICBG for craniofacial indications were included. Donor site morbidities, including immediate and chronic pain, hematoma, seroma, infection, hypertrophic/painful scarring, nerve injury, muscle herniation, iliac crest fracture, and gait disturbance, were recorded. A weighted incidence for each morbidity, excluding immediate pain, was calculated. An average visual analog scale score was calculated for immediate pain. Results Forty-four studies, with 2801 patients, were included. Oral and maxillofacial (50%) and cleft reconstruction (40%) were the primary indications for surgery. Average immediate pain visual analog scale scores on postoperative days 1 and 14 were 6.3 and 1.3, respectively. The incidence of donor site morbidities was as follows: acute (45.7%) and chronic (1.5%) gait disturbance, acute (17.8%) and chronic nerve changes (1.4%), hypertrophic/painful scar (9.1%), chronic pain (3.1%), hematoma (2.2%), seroma (2.0%), infection (1.0%), iliac crest fracture (1.2%), and muscle herniation (0%). Conclusions Chronic morbidity was lower than previously documented. Rare chronic morbidity illustrates that the ICBG remains a viable surgical option. The authors hope this review will facilitate surgical planning and informed consent.
28 citations
TL;DR: Routine use of iliac crest autograft cannot be recommended, as no functional advantage was found at 3 or 12 months postoperatively, and no correlations were found between bone healing and functional outcome, body mass index, or smoking status.
Abstract: Medial open wedge high tibial osteotomy (owHTO) is a valuable surgical technique used to manage medial degeneration in varus knees. Iliac crest autograft is considered the gold standard gap-filler. It was hypothesised that iliac crest autograft promotes gap healing and improves functional outcome in owHTO. Between 2005 and 2009, patients scheduled to undergo owHTO stabilised by a medial locking compression plate were randomised to undergo owHTO either with iliac crest autograft (group A) or without bone void filler (group B). Pre- and postoperative leg axes were recorded. At 3 and 12 months postoperatively, the healing of the osteotomy gap was measured as a percentage on CT images, and functional scores were recorded. There were 15 patients in group A, and 25 in group B. The groups were similar in age, sex ratio, knee varus deformity, body mass index, and smoking status. Group A and B had similar preoperative varus (6.9° vs. 7.6°) and postoperative valgus (2.2° vs. 3.0°). Compared with the control group, group A had a significantly greater degree of osseous gap healing after 3 months (40.1% vs. 10.8%, p = 0.045) and 12 months (91.5% vs. 59.1%, p ≤ 0.001). Multiple linear regression analysis found that bone grafting was an independent promoting factor for gap healing, while increased preoperative varus was an independent retardant factor at 3 months (p = 0.004 and p = 0.002, respectively) and 12 months (p ≤ 0.001 and p = 0.003, respectively). Younger age was a promoting factor for gap healing on CT at 3 months (p ≤ 0.001), but not at 12 months. No correlations were found between bone healing and functional outcome, body mass index, or smoking status. Iliac crest autograft significantly increases healing of the osteotomy gap after owHTO. Increased preoperative varus and older patient age are independent factors that delay early healing of the osteotomy. However, no functional advantage was found at 3 or 12 months postoperatively. Therefore, routine use of iliac crest autograft cannot be recommended. II.
28 citations
TL;DR: The reamer-irrigator-aspirator (RIA) autograft provides large volumes of autogenous graft that exhibit excellent osteogenic, osteoinductive, and osteoconductive properties, combined with the relative ease of graft harvest and low donor site morbidity when compared with the gold standard iliac crest bone graft (ICBG).
TL;DR: The injection of the fat graft through the UMIGS at 0° and 10° angles, and through the middle of the buttock at the level of posterior superior iliac crest a -30° angle, reaches the surface needed for gluteal augmentation.
TL;DR: This study shows that harvesting a small amount of iliac crest bone graft for the treatment of distal radius fractures is a safe procedure with a very low complication rate.
Abstract: In distal radius fractures with metaphyseal comminution, bone grafting or the use of a bone substitute may be necessary. Harvesting autologous iliac crest bone graft for other orthopedic procedures has complications. The aim of this study was to evaluate the complication rate after harvesting a small amount of bone as used for the treatment of radius fractures. Patients treated in a single level I trauma center with surgical treatment for distal radius fracture with iliac crest bone graft between January 2008 and December 2012 were included in this retrospective study. Patients’ records were evaluated and clinical evaluation was performed at follow-up. 42 patients (20 females, 22 males, mean age 56.3 ± 15.9 years) were included in this study. Follow-up was mean 6.3 ± 1.2 years. Only minor complications such as hematoma could be identified; in one patient, revision surgery for bleeding was performed. No nerve injuries, long-term pain, fractures, infections or wound healing disturbances could be seen. The use of a drain of hemostyptics, the type of wound closure or pattern of harvested bone did not influence complication rate. This study shows that harvesting a small amount of iliac crest bone graft for the treatment of distal radius fractures is a safe procedure with a very low complication rate.
TL;DR: Bone substitutes as Nano calcium hydroxyapatite and bone marrow stem cells extract showed to be reliable methods for bone grafting than autogenous iliac crest.
Abstract: BACKGROUND: Cleft lip and palate CLP is a frequent congenital malformation that manifests in several varieties including unilateral or bilateral anomalies due to either genetic or acquired causes. Alveolar cleft graft ACG remains controversial as regard timing, grafting materials and surgical techniques. The primary goal of alveolar cleft grafting in ACG patients is to provide an intact bony ridge at the cleft site to allow maxillary continuity for teeth eruption, proper orthodontic treatment for dental arch alignment, oronasal fistula closure and providing alar support for nasal symmetry.
AIM: This study aims to compare different grafting techniques to treat the alveolar cleft defect.
METHODS: This study included 24 cases divided into three groups of patients: Group A was treated with autogenous iliac crest bone; Group B was treated with nano calcium hydroxyapatite with collagen membrane and Group C was treated with tissue engineering method using bone marrow stem cells extract and PRF membrane.
RESULTS: According to clinical and radiographic examination measuring bone density in the CT preoperatively compared to six months postoperatively. Group C with bone marrow stem cells extract showed superior results among all followed by group B, while group A with autogenous iliac crest showed resorption in some cases and gave the least values, in addition to its drawbacks as regard donor site affection with pain & scar formation.
CONCLUSION: Bone substitutes as Nano calcium hydroxyapatite and bone marrow stem cells extract showed to be reliable methods for bone grafting than autogenous iliac crest.
TL;DR: The scapula flap showed the highest incidence of overall donor site morbidity, however, correlation between objective and subjective donor site impairment was weak and the majority of patients experienced only minor limitations.
TL;DR: Comparing the therapeutic potentials of autologous bone marrow aspirate (BMA) and ABG for the repair of ulnar defects in New Zealand White rabbits demonstrates that coagulated BMA can be considered as an alternative autogenous therapy for long bone healing.
Abstract: Objectives Long bone defects often require surgical intervention for functional restoration. The ‘gold standard’ treatment is autologous bone graft (ABG), usually from the patient’s iliac crest. Ho...
TL;DR: Ultrasound-guided quadratus lumborum block is gaining popularity in regional anesthesia for various surgical procedures and has shown reduced opioid requirements for cesarean sections, lower abdominal surgery, and hip surgery.
Abstract: Ultrasound-guided quadratus lumborum block (QLB) is gaining popularity in regional anesthesia for various surgical procedures. The purpose of this review is to understand the relevant clinical anatomy, different mechanisms of actions, and techniques used for the block and clinical evidence so far. The current data suggests a wide dermatomal distribution of the local anesthetic from T7-L2. The evidence regarding its utility is still evolving but has shown reduced opioid requirements for cesarean sections, lower abdominal surgery, and hip surgery. Prolonged analgesia has been reported as compared with more conventional transversus abdominis plane (TAP) block. This block has also been reported for above knee amputation, femoral-pop bypass, lumbar laminectomy and fusion, iliac crest bone graft, and iliac and acetabulum fracture. Quadratus lumborum can be performed through different approaches which requires sound knowledge of anatomy. Further research to determine which approach yields best results is warranted.
TL;DR: Combined use of HAM with mesenchymal stem cells may enhance bone regeneration specifically in the horizontal dimension and reduce the amount of harvested autogenous bone and diminish secondary bone resorption.
Abstract: Background Human amniotic membranes (HAMs), as a biological membrane with healing, osteogenic, and cell therapy potential, has been in the spotlight to enhance the outcomes of treating bone defects. Present study aims to clinically assess the potential of HAM loaded with buccal fat pad-derived stem cells (BFSCs) as an osteogenic coverage for onlay bone grafts to maxillomandibular bone defects. Materials and methods Nine patients with jaw bone defects were enrolled in the present study. The patients were allocated to two study groups: Iliac crest bone graft with HAM coverage (n = 5), and Iliac bone grafts covered with HAM loaded with BFSCs (n = 4). Five months following the grafting and prior to implant placement, cone beam computed tomography was performed for radiomorphometric analysis. Results The mean increase in bone width was found to be significantly greater in the HAM + BFSCs group (4.42 ± 1.03 mm versus 3.07 ± 0.73 mm, p 0.05). Conclusion Combined use of HAM with mesenchymal stem cells may enhance bone regeneration specifically in the horizontal dimension. Moreover, this methodology reduces the amount of harvested autogenous bone and diminish secondary bone resorption.
TL;DR: Implants placed in bone augmented with iliac crest onlay grafts showed high long-term survival rates, and cement-retained restorations were more prone to develop implant failures.
Abstract: Purpose To evaluate the long-term outcome of dental implants placed with a staged procedure in resorbed alveolar ridges reconstructed with iliac crest autogenous onlay grafts. Materials and methods All consecutive patients treated with iliac crest onlay bone grafts and dental implants were retrospectively evaluated. During the appointment, clinical and radiological examinations were conducted to assess implant survival. A survived implant was defined as an implant still stable and in function at the follow-up visit. Implant survival was estimated at the implant level using Kaplan-Meier analyses. The cumulative survival rate was estimated using a life-table analysis. Subgroup analyses were performed for age, position, and type of retention using the log-rank test. A p-value of Results The cohort consisted of 21 female subjects receiving a total of 140 rough-surface titanium implants. Of them, 128 survived and 12 failed, yielding a cumulative survival rate of 91.1% over a median survival time of 312 months. Implants supporting cement-retained prostheses exhibithed lower survival rate compared to screw-retained restorations (p = 0.001). Conclusion Implants placed in bone augmented with iliac crest onlay grafts showed high long-term survival rates. Cement-retained restorations were more prone to develop implant failures.
TL;DR: Maxillary expansion after late SABG may be taken into consideration as a treatment choice in selected unilateral CLP patients to provide bone graft stimulation.
TL;DR: An operative video is presented demonstrating technical nuances of junctional tether "weave" application of anti-PJK techniques for ligamentous augmentation in a 70-yr-old male with prior L2-S1 instrumented fusion with worsening back pain and posture.
Abstract: Proximal junctional kyphosis (PJK) is a common problem after multilevel spine instrumentation for adult spinal deformity. Various anti-PJK techniques such as junctional tethers for ligamentous augmentation have been proposed. We present an operative video demonstrating technical nuances of junctional tether "weave" application. A 70-yr-old male with prior L2-S1 instrumented fusion presented with worsening back pain and posture. Imaging demonstrated pathological loss of lumbar lordosis (flat back deformity), proximal junctional failure, and pseudarthrosis. The patient had severe global and segmental sagittal malalignment, with sagittal vertical axis (SVA, C7-plumbline) measuring 22.3 cm, pelvic incidence (PI) 55°, lumbar lordosis (LL) 8° in kyphosis, pelvic tilt (PT) 30°, and thoracic kyphosis (TK) 6°. The patient gave informed consent for surgery and use of imaging for medical publication. Briefly, surgery first involved re-instrumentation with bilateral pedicle screws from T10 to S1. After right-sided iliac screw fixation (left-sided iliac screw fixation was not performed due to extensive prior iliac crest bone graft harvesting), we then completed a L2-3 Smith-Petersen osteotomy, extended L4 pedicle subtraction osteotomy, and L3-4 interbody arthrodesis with a 12° lordotic cage (9 × 14 × 40 mm). Cobalt Chromium rods were placed spanning the instrumentation bilaterally, and accessory supplemental rods spanning the PSO were attached. An anti-PJK junctional tether "weave" was then implemented using 4.5 mm polyethylene tape (Mersilene tape [Ethicon, Somerville, New Jersey]). Postoperative imaging demonstrated improved alignment (SVA 2.8 cm, PI 55°, LL 53°, PT 25°, TK 45°) and no significant neurological complications occurred during convalescence or at 6 mo postop.
TL;DR: This work describes an arthroscopic technique for anatomical reconstruction of the glenoid that uses a tricortical iliac crest with a metal-free fixation method using 2 ultra-high-strength sutures (FiberTape Cerclage System) and finishing with a capsulolabral reconstruction.
Abstract: Large glenoid bone loss defects are associated with higher failure rates after arthroscopic Bankart repair in cases of glenohumeral anterior instability, further necessitating bone graft reconstruction. Because most techniques use strong initial fixation using metal devices, bone graft resorption considered to be closely related to the presence of metal components is a potential shortcoming of these techniques. We describe an arthroscopic technique for anatomical reconstruction of the glenoid that uses a tricortical iliac crest with a metal-free fixation method using 2 ultra-high-strength sutures (FiberTape Cerclage System; Arthrex, Naples, FL), which provide substantial stability to the graft, and finishing with a capsulolabral reconstruction.
TL;DR: The purpose of this study was to analyze long‐term functional outcomes at the donor site after deep circumflex iliac artery (DCIA) bone flap harvesting.
Abstract: Purpose Free flap surgery can be associated with donor-site morbidity. The purpose of this study was to analyze long-term functional outcomes at the donor site after deep circumflex iliac artery (DCIA) bone flap harvesting. Methods Fourteen patients (8 men and 6 women, mean age 53.9 years; range 22-87 years) with mandible resection (8 carcinomas, 4 ameloblastomas, 1 osteonecrosis, and 1 myxofibroma) and DCIA flap reconstruction were included in an observational study. Ranges of motion in the hip and lumbar spine, Harris hip score (HHS), jumping mechanography, chair rising, and balance testing were performed on a ground force reaction plate (Leonardo Mechanograph, Novotec Medical GmbH, Germany). The primary outcome was the Esslinger fitness index (EFI, maximum peak power in W/kg normalized to age and gender). Results Functional assessment was performed preoperatively and 29.0 months postoperatively (range 12-51 months). Mean DCIA flap length was 6.3 cm (range 3.3-10.1 cm). Jaw reconstruction was successful in all cases. HHS (99.2 vs. 97.7 points, P = .004) and all ranges of motion in the lumbar spine and hip joint except for dorsal extension were significantly reduced postoperatively (range -4° to -11.0°). There was no significant difference between pre- and postoperative EFI (77.9% vs. 74.28%, P = .591) and body sway (1.25 cm2 vs. 2.01 cm2 , P = .806). Sensory deficits (n = 5), load dependent pain (n = 3), and limitations of daily activities (n = 3) were subjective complaints. Conclusion Functional donor site morbidity after DCIA harvesting can be expected to be low in the long-term.
TL;DR: Reconstruction of distal radius bone defects with Iliac crest bone grafting and wrist arthrodesis retains prono-supination while maintaining wrist girth (cosmesis) and the oncologic and functional outcomes make it an acceptable modality in selected cases ofdistal radius tumours with short resection length (≤6 cm).
Abstract: Background Distal radius is third most common site for occurrence of Giant cell tumor (GCT) of bone. Most of Campanacci grade II & III cases require resection. Reconstructions of these defect are challenging. Though fibular arthroplasty provides mobility at wrist but is fraught with complications of donor site morbidity and instability with wrist pain. Wrist arthrodesis with ulna translocation provides stable reconstruction but is cosmetically less appealing. We present a series of 12 cases of GCT of distal radius treated with short segment (6 cm or less) resections and wrist fusion with iliac crest grafting. We evaluated donor site morbidity, functional and oncological outcomes. Objectives To assess time to union, donor site morbidity, functional and oncological outcomes after wrist fusion with iliac crest bone grafting for distal radius resection (≤6 cm). Methods Retrospective analysis was performed from a prospectively maintained database between January 2011 and December 2017, 12 patients (7 male and 5 female; 9 primary and 3 recurrent; all Campanacci grade III) were included. Mean age was 29 years (15–41 years) with mean resection length of 5.1 cm (4.5–6 cm). The dominant hand was involved in 6 patients. Time to union, donor site morbidity, functional and oncologiacal outcomes were evaluated. Functional outcomes were evaluated using Musculo-Skeletal Tumor Society (MSTS) score and Patient Rated Wrist Evaluation (PRWE) score. Grip strength and arc of forearm rotation were also evaluated. Results All patients were available for analysis. No symptomatic donor site morbidity was observed. One patient had prominent implant following a fall and delayed union. Mean time to union for 22 osteotomy sites in rest of 11 patients (both proximal and distal) was 6 months (4–11 months). At median follow up of 45 months (18–78 months) 2 patients had soft tissue recurrence, 1 had a stable pulmonary metastasis. Local Recurrence rate was 17%. All patients returned to their pre surgery activity. Mean MSTS score was 25 (19–29) and PRWE score was 12 (6–28). Grip strength and Prono - supination measurements were available in 10 patients. Grip strength was 69% of non operated limb. Mean supination was 53° (0° to 80°) and mean protonation was 73° (40° to 80°). Mean arc of rotation was 126° (80° to 160°). Conclusion Reconstruction of distal radius bone defects with Iliac crest bone grafting and wrist arthrodesis retains prono-supination while maintaining wrist girth (cosmesis). The oncologic and functional outcomes make it an acceptable modality in selected cases of distal radius tumours with short resection length (≤6 cm).
12 Mar 2019
TL;DR: It is found that there is no significant difference in union rate for long bone nonunions treated with ICBG or BMAC with allograft for nonunion treatment, as well as the heterogeneity of the control group and loss to follow-up.
Abstract: Objectives The purpose of this study was to compare bone marrow aspirate concentrate (BMAC) with cancellous allograft to iliac crest bone graft (ICBG) in the treatment of long bone nonunions. Design Retrospective cohort study. Setting A single level I trauma center. Patients 26 patients with long bone diaphyseal or metaphyseal nonunions with defects >2 mm and treated with open repair and BMAC, compared to 25 patients with long bone diaphyseal or metaphyseal nonunions with defects >2 mm and treated with open repair and ICBG. Intervention Open repair of long bone nonunion using either autologous ICBG or BMAC with cancellous allograft. Main outcome measure Nonunion healing, radiographically measured by the modified Radiographic Union Score for Tibia (mRUST) score. Secondary outcomes included risk factors associated with failed repair. Results The union rates for the BMAC and ICBG cohorts were 75% and 78%, respectively (P = .8). Infection was the only risk factor of statistical significance for failure. Conclusion In this study, we found no significant difference in union rate for long bone nonunions treated with ICBG or BMAC with allograft. BMAC and allograft led to 75% successful healing in this series. Given the heterogeneity of the control group and loss to follow-up, further prospective investigation should be conducted to more rigorously compare BMAC to ICBG for nonunion treatment. Level of evidence III, retrospective cohort.
TL;DR: Geriatric patients can have a form of IIWF caused by low-energy trauma that is a type of fragility fracture of the pelvis, and in these types of fractures, minimally invasive surgical management that includes iliac pillar screw fixation can lead to good outcomes.
Abstract: There have been no prior case series of isolated iliac wing fracture (IIWF) due to low-energy trauma in geriatric patients in the literature. The aim of this study was to describe the characteristics of IIWF in geriatric patients, and to present a case series of IIWF in geriatric patients who underwent our minimally invasive screw fixation technique named ‘iliac pillar screw fixation’. We retrospectively reviewed six geriatric patients over 65 years old who had isolated iliac wing fracture treated with minimally invasive screw fixation technique between January 2006 and April 2016. Six geriatric patients received iliac pillar screw fixation for acute IIWFs. The incidence of IIWFs was approximately 3.5% of geriatric patients with any pelvic bone fractures. The main fracture line exists in common; it extends from a point between the anterosuperior iliac spine and the anteroinferior iliac spine to a point located at the dorsal 1/3 of the iliac crest whether fracture was comminuted or not. Regarding the Koval walking ability, patients who underwent iliac pillar screw fixation technique tended to regain their pre-injury walking including one patient in a previously bedridden state. The visual analog scale score for pain at the last follow-up was quite satisfactory. Union was achieved in all patients at the last follow-up. Geriatric patients can have a form of IIWF caused by low-energy trauma that is a type of fragility fracture of the pelvis. Because subsequent deterioration of their walking status followed by a long period of non-weight bearing in geriatric patients could be as threatening as the fracture itself, the treatment paradigm for IIWF due to low-energy trauma in geriatric patients should differ from that due to high-energy trauma in most patients. In these types of fractures, minimally invasive surgical management that includes iliac pillar screw fixation can lead to good outcomes.
TL;DR: The use of FDBA seems to represent a successful treatment option for AC reconstruction, and the allogenic bone block demonstrated high volume stability with ideal integration and revascularization, resulting in functional bone tissue suitable for implantation and esthetic rehabilitation.
TL;DR: B-TCP is an efficacious and safe autologous bone graft expander in Masquelet's two-stage management of post infective segmental gap nonunion of long bones and should be counseled regarding increased risk of nonunion and need for repeat grafting with its use.
Abstract: Background: Filling bone defect after debridement of infected nonunion is an orthopedic challenge. Since the volume of autologous bone graft available is limited, allograft, demineralized bone matrix, and calcium phosphate ceramic-based bone graft substitutes have come up as potential autograft expanders. This study was conducted to analyze the use of beta tri-calcium phosphate (B-TCP)-based composite ceramic as autologous bone-graft expander in the management of postinfective segmental gap nonunion of long bones managed with two-stage Masquelet's technique. Materials and Methods: 42 consecutive patients with postinfective segmental long bone defects of 4–12 cm managed with Masquelet's-induced membrane technique, operated between February 2012 and June 2015, were included in this prospective case series. During the second stage bone-grafting procedure, iliac crest autograft alone or mixed with B-TCP granules (ratio not exceeding >1:1) was used along with appropriate internal-fixation. Bony union (defined clinicoradiologically as ability to painlessly bear weight on affected limb without support along with bridging of 3 cortices on X-rays) was evaluated. Results: Union was achieved in 80.9% patients (34/42) with index bone grafting. 100% union rate was achieved in patients where only autograft was used (15/15) and in nonsmoker femoral nonunion patients with the use of B-TCP (13/13). The use of B-TCP was associated with higher rate of nonunion in smokers (6/8, 75%) and in tibial nonunions (4/9, 55.5%). All, but one, of 8 patients with nonunion, united after the second-bone grafting procedure. Conclusion: B-TCP is an efficacious and safe autologous bone graft expander in Masquelet's two-stage management of post infective segmental gap nonunion of long bones. Patients should be counseled regarding increased risk of nonunion and need for repeat grafting with its use, especially if they are smokers or site of involvement is tibia.
TL;DR: Twelve studies providing results for a total of 654 patients were included in this qualitative synthesis, finding that minimally invasive bone graft harvest techniques are better than the conventional open iliac bone harvest method because they offer shorter operative time, decreased requirement for pain medications, less pain on discharge, and a shorter hospital stay.
Abstract: This study evaluated and compared the donor site morbidity following minimally invasive and conventional open harvesting of iliac bone for secondary alveolar bone grafting in cleft palate patients. A thorough electronic search of PubMed, Google Scholar, EMBASE, and an institutional library and manual search of various journals was done; Inclusion criteria: 1) full-text articles using a minimally invasive or conventional open harvesting technique for iliac bone for secondary alveolar grafting in cleft palate patients and 2) articles published between January 1, 2001 and June 30, 2017 and Exclusion criteria: 1) articles published in languages other than English, 2) case reports, case series, animal studies, in vitro studies, and letters to the editor, and 3) full-text article unavailable even after writing to the authors. Preliminary screening of 274 studies excluded 223 studies for not meeting the eligibility criteria. Of the remaining 51 studies, 19 were removed for being duplicates. Of the remaining 32 studies, 15 were excluded after reading the abstract. Of the 17 studies that were left, 2 were excluded because they were in a language other than English, and 2 were excluded because the study group did not mention cleft palate patients. Thus, 13 studies providing results for a total of 654 patients were included in this qualitative synthesis. Minimally invasive bone graft harvest techniques are better than the conventional open iliac bone harvest method because they offer shorter operative time, decreased requirement for pain medications, less pain on discharge, and a shorter hospital stay.