Allograft Bone Graft Research Articles

Giant Cell Tumor of the Phalanx of Finger: Case Reports

Background: Giant cell tumor (GCT) of bone arising from aphalanx of finger is extremely rare. Although, the occurrence of GCT in the hands is a rare, it has been reported that GCT of the small bones (small-bone GCT) carries a higher risk of local recurrence and metastasis than conventional GCT. Subjects and Method: We report two cases of GCT arising from a phalanx of a hand finger. First patient was treated with wide excision of the tumor and fusion with fibular bone graft with the help of a K-wire. Second patient was treated by excision of tumour (Curretage) with allograft bonegraft for bone defect. Results: At their most recent follow-ups (4 months, respectively), both were recurrence free and had returned to their previous occupational and recreational activities. Conclusion: The effectiveness of these methods in the treatment and prevention of recurrence is still under discussion and there is no gold standard for treating GCT. Keyword s : GCT, phalanx of finger, excision, illiac crest bonegraft, allograft Correspondence: Pamudji Utomo. Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Central Java. Email: utomodr@yahoo.com. Indonesian Journal of Medicine (2019), 4(1): 65-74 https://doi.org/10.26911/theijmed.2019.04.01.11

WITHDRAWN: Allograft for the treatment of massive bone loss in open and infected IIIA fracture of the distal femur: a case report

Abstract Infection and bone loss after local debridement in high grade open fractures are two difficult issues. The treatment of bone infection needs a wide “oncological” debridement that leaves a segmental bone defect. Once the infection is deleted, the defect may be treated with different surgical techniques: bone graft, bone transport, Masquelet’s two stage reconstructions, allograft or vascularised fibular transplant. In literature these options are described only for bone loss less than 15 cm. We describe a case of a lady with an open IIIA fracture of the right distal femur with 25 cm of infected bone loss, treated with wide multistaged debridement, Masquelet technique and ORIF with massive allograft and autologous bone graft. This case gives the possibility to discuss the following principles: wide debridement, biological chamber, two stage reconstruction, internal stable fixation in infected bone.

Rapidly Progressive Osteolysis and a Large Cystic Lesion that Destroyed the Inner Table of the Iliac Bone Following Cementless Total Hip Arthroplasty: A Case Report.

We report a case of rapidly progressive osteolysis and a very large cystic lesion that destroyed the inner table of the iliac bone following cementless total hip arthroplasty (THA). A 59-year-old female patient developed left hip pain at 11 years after THA. Osteolysis surrounding the acetabular cup was pointed out. She was brought to our hospital by ambulance due to severe left hip pain at 12 years after THA. Computed tomography (CT) showed that a cystic lesion in the pelvic cavity had destroyed the inner table of the iliac bone. Magnetic resonance imaging (MRI) showed a high signal intensity area of the hemorrhagic cystic lesion in the iliac bone in both T1-weighted and T2-weighted images. She underwent a liner and femoral head exchange, and required bone grafting and revision of the cup. The cystic lesion was removed and block-like allograft bone grafts were stuffed into the bone defects. If osteolysis and cystic lesions occur at the same time, not only the bone area around the implant but also a distant area like the inner table of the iliac bone may be destroyed. Additional tests such as CT or MRI may be useful to detect the presence of distant or cystic lesions. Early diagnosis and treatment are important because severe complications may occur in cases where osteolysis and cystic lesions coexist after THA.

The treatment of Tillaux bone block in the Ruedi-Allgower type Ⅲ Pilon fractures

To analyze the importance and effectiveness of Tillaux bone block in Ruedi-Allgower type Ⅲ of Pilon fracture surgery. Twenty-one patients with Pilon fractures with Tillaux dislocation were treated between February 2010 and September 2013. There were 17 males and 4 females, aged from 28 to 68 years with an average age of 42.9 years. The causes of injury included falling from height in 13 cases, falls injury in 4 cases, crush injury in 2 cases, and sprained injury in 2 cases. X-ray film and CT examination showed that all 21 patients had fibula fracture and Tillaux bone block had obvious displacement. According to AO/OTA classification, there were 3 cases of type C1.2, 1 case of type C1.3, 10 cases of type C2, and 7 cases of type C3. The duration from injury to operation ranged from 4 to 31 days, with an average of 10 days. All cases of Pilon fracture were treated with open reduction and plate internal fixation. Steel plate or screw was used to fixation for Tillaux block; allograft bone graft was selected for compression of fracture. There were 2 cases of skin necrosis at the corner of wound after operation, and the wound healed after corresponding treatment; the wound healed at first intention in the other 19 cases. The effect of surgical reduction was evaluated by Burwell-Chamley imaging scoring system within 72 hours after operation, there were 19 cases of anatomical reduction and 2 cases of general reduction. All the 21 patients were followed up 18-48 months, with an average of 24.9 months. No complication such as nerve injury, loosening of internal fixation, or periprosthetic fracture was found during follow-up. All fractures obtained bone healing, which lasted from 4 to 8 months, with an average of 6 months. The ankle and hindfoot scores of the American Orthopaedic Foot and Ankle Society (AOFAS) were used to evaluate the ankle and hindfoot function at 1 year after operation or at last follow-up, the results were excellent in 13 cases, good in 6 cases, and fair in 2 cases, with an excellent and good rate of 90.5%. Internal fixator was removed from 19 patients at 15-19 months after operation. There were 17 cases of joint hyperplasia and 4 cases of osteoarthritis. All joint mobility was restored. The functional recovery of the ankle joint was evaluated according to the Olerud-Molander ankle fracture score standard, the results were good in 6 cases, fair in 8 cases, and poor in 7 cases at postoperative full weight training; and after 1 year of full weight training, the results were excellent in 10 cases, good in 3 cases, fair in 6 cases, and poor in 2 cases. The Tillaux bone block is a reliable marker for the reduction of complex Pilon fractures. The reconstruction of the Tillaux can improve the effectiveness of complex Pilon fractures.

The Role of Circular Frames in the Management of Tibial Fractures.

IntroductionThe purpose of this study is to evaluate the factors that impact the clinical and radiographic outcomes in a patient cohort undergoing external fixation for tibial fractures. We also aim to investigate the use of autograft, allograft, and synthetic bone graft in varying combinations in the setting of tibial bone loss with respect to optimal times to union.MethodsThis was a retrospective study, including 46 patients treated with a circular external fixator for the management of acute tibial fractures. The study was carried out over a 10-year period, between 2007 and 2017, at our institution. The mean follow-up at the time of review was 4.6 years. Primary outcome measures were ‘time to union,’ ‘delayed union’ (> 6 months), ‘infection,’ and ‘duration of external fixation.’ Secondary outcomes included 'length of hospital stay' and functional scores using the 'Short Form-12 (SF-12).' The statistical analysis included both univariate and multivariate analyses to control for confounding variables when assessing predictors of delayed union and infection.ResultsForty-six patients fulfilled the study criteria. Fifteen fractures were classified as open. The mean number of procedures per patient was 3.8 and the mean length of stay per patient was 33 days. The mean time to union was 8.6 months overall. Significant predictors of prolonged time to union were the ‘number of interventions’ (p<0.01) the patient underwent and the ‘bone graft type’ (p<0.01) used. The time to union in the presence of either autograft or allograft was lengthened by the addition of synthetic graft. Five patients developed a deep tissue infection. The use of synthetic bone graft was significantly associated with infection (p<0.05). On subgroup analysis, it was found that the use of synthetic graft in any combination leads to significantly higher rates of deep tissue infection (p<0.05). The mean time to full weight bearing was 10.6 months (s=9.78, 3-36). The majority (57%) were using walking aids and 67% reported that the injury was still affecting their lifestyle.ConclusionTibial fractures with bone loss are a complex group of injuries that often require multiple surgical interventions, prolonged hospital inpatient stay, and suboptimal functional outcomes in many cases. The best times to union are achieved when autograft is used alone without any other combination of bone graft type. The use of synthetic bone graft also significantly increases the rate of deep tissue infection in this cohort. We recommend the use of autograft alone when treating bone defects in tibial fractures with external fixators.

Recent research progress of bioactivity mechanism and application of bone repair materials

Large bone defect repair is a difficult problem to be solved urgently in orthopaedic field, and the application of bone repair materials is a feasible method to solve this problem. Therefore, bone repair materials have been continuously developed, and have evolved from autogenous bone grafts, allograft bone grafts, and inert materials to highly active and multifunctional bone tissue engineering scaffold materials. In this paper, the related mechanism of bone repair materials, the application of bone repair materials, and the exploration of new bone repair materials are introduced to present the research status and advance of the bone repair materials, and the development direction is also prospected.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P142. Are allografts safe and effective in the treatment of spinal infectious diseases? A multicenter retrospective study

BACKGROUND CONTEXT Despite significant advances in antibiotic treatments, spinal infections are still a serious challenge for surgeons. This is particularly relevant for surgeons selecting an appropriate bone graft after debridement in spinal infectious diseases. Different scholars have different views. Some scholars believe that the autogenous bone is the best choice, while other scholars think that cage is the most suitable materials. Due to the particularity of infection and the allografts, surgeons usually faced a dilemma in the application of allografts as bone grafting. For example, aggravating infection, iatrogenic infection, nonunion and other adverse consequences. Until now, there is still no consensus in academia. PURPOSE We evaluated the clinical efficacy and fusion characteristics of allografts in spinal infectious diseases. STUDY DESIGN/SETTING A retrospective cohort study. PATIENT SAMPLE A total of 731 patients. OUTCOME MEASURES Clinical outcome, laboratory indices and radiological results. METHODS This study reviewed 1,196 patients with spinal infection who were treated at six institutions, from January 2000 to January 2016. A total of 731 patients were enrolled in this research; all patients underwent debridement, decompression, allograft bone grafting and instrumentation. Among these, 624 patients had spinal tuberculosis, 50 had brucellosis, 43 had spinal osteomyelitis and 14 had spinal fungal or cryptococcus infection. All patients received anti-inflammatory therapy and were fixed by a brace for 3-9 months postoperatively. Clinical outcome, laboratory indices and radiological results were analyzed. RESULTS All cases were followed up for 12–60 months. Erythrocyte sedimentation rate returned to normal levels at the final follow-up. Pain was relieved in all patients and 87.6% of cases were painless. At the 9 and 12 month follow-up, the fusion rate of allografts was 34.2% and 97.9%, respectively. At the final follow-up, the fusion rate was 100%. CONCLUSIONS The clinical efficacy and safety of allografts for the treatment of spinal infection was satisfactory. Allografts can replace autografts in surgeries for spinal infection.

Feasibility of using allograft bone with resorbable collagen membrane for alveolar ridge vertical defect augmentation for dental implant placement in Patient with Aggressive Periodontitis: A case report

PurposeThis case report demonstrates the feasibility of using allograft bone with a resorbable collagen membrane to correct an alveolar ridge defect and achieve a highly esthetic restoration. Case presentationA 30-year-old woman with generalized aggressive periodontitis and advanced periodontal vertical bone loss in periodontally hopeless upper left right premolar which required a fixed restoration. A staged surgical strategy was devised. First, a resorbable collagen membrane and allograft bone grafts were used to guide bone regeneration in the vertical alveolar defect. After 6 months, complete bone regeneration was achieved and the dental implants were submerged in the bone. Three months later, the implants were exposed and subsequently restored with a crown. ConclusionThe vertical guided bone regeneration strategy of using allograft bone and a resorbable collagen membrane has the potential to eliminate the need for additional procedures, which are required with non-resorbable membranes, sinus lift procedures, and extensive block graft procedures.

Treatment of thoracolumbar tuberculosis by transforaminal endoscopic debridement combined with allograft and percutaneous internal fixation

Objective To discuss the feasibility, the advantages and disadvantages, the clinical efficacy and the indications of minimally invasive transforaminal endoscopic debridement combined with allograft and posterial percutaneous internal fixation for thoracolumbar spinal tuberculosis. Methods All of 22 patients with thoracolumbar tuberculosis treated in our department from January 2012 to December 2013 were retrospectively reviewed. There are 11 male and female cases separately, with an average age of 54.1 ±10.2 years and with an average disease duration of 5.3 ± 1.9 months. Endoscopic lesion removal and allograft bone grafting combined with posterial percutaneous immobilization were performed on all these cases. The data of these patients were complete, and all patients had been followed up for more than 36 months. The clinical and radiographic results were recorded and analyzed. Results In this group, 22 patients were followed-up for 41.9±2.5 months(36-48 months). The spinal kyphosis was not improved 3 months after surgery (t=0.3546, P=0.7029), but the amount of blood loss (30.5±7.9 ml) was less in the operation, the amount of postoperative analgesics(0.3±0.1 g) was low and the bed time(1.5±0.3 days) was short. No recurrence and no internal fixation failure was found after long term follow-up. Good clinical outcomes were achieved with the fusion rate reached above grade 2 in all patients(95.5%) except one. The neuralgia was relieved, and the spinal cord injury was recovered to ASIA E. The VAS score and SF-36 score which were recorded 1 month and 3 months after operative were all improved significantly compared with those before operation, and patients’ life quality in the early period after operation was excellent. The incidence of complications was low (9.0%) , and the patients were satisfied with the treatment process. Conclusion It may be a potential way to treat spinal tuberculosis with minimally invasive transforaminal endoscopic debridement combined with allograft and percutaneous internal fixation, which could be a powerful supplement to other therapeutic measures, and is worthy of further research and development. Key words: Thoracic vertebrae; Lumbar vertebrae; Tuberculosis, spinal; Endoscopy; Spinal fusion

A Systematic Review of Clinical Studies Investigating Mesenchymal Stem Cells for Fracture Non-Union and Bone Defects.

Fracture non-union is a significant problem with a wide range demographic and massive socioeconomic elements, as well as the clinical difficulties it presents. Conventional treatments with autograft and allograft bone grafting pose serious difficulties, thus, it is necessary to develop novel techniques with our ever increasing knowledge of bioengineering using natural materials. To search for current evidence regarding the treatment of fracture non-union or bone defects using mesenchymal stem cells (MSCs). The results presented in this review show that the use of mesenchymal stem cells for the treatment of non-union and bone defects is optimistic. Several papers had positive outcomes to report. There is a need for higher level evidence. A strong need of clinical results is required to further progress in cell therapy. Launched trials will hopefully provide this information in the near future. If clinical trials are positive, further development of complex tissue engineering techniques may be developed to treat large bone defects.

Application of BMP-2 bone graftting material in nonunion after femoral intramedullary nail

Objective To investigate the clinical efficacy of bone grafts containing bone morphogenetic protein 2 (Bone Conduction) treating of nonunion of femoral fracture after intramedullary nailing. Methods The clinical data of 49 patients with nonunion of femoral fracture after intramedullary nailing from August 2008 to August 2016 were analyzed retrospectively. They were divided into experimental group and control group according to different bone grafting methods. The experimental group (n=23) was treated with Bone Conduction combined with allograft bone grafting. The control group (n=26) was treated with autogenous bone grafting. The autogenous bone was taken from the ipsilateral ilium. The two groups were compared operative time, intraoperative blood loss, postoperative wound complications, hospitalization time, postoperative visual analog scale, mean image healing time and the score for distal femoral fractures after the operation. All patients were followed up for 12 to 24 months. Follow-up methods were divided into telephone follow-up and outpatient follow-up. The patients were followed up for outpatients before fracture healing. The patients were followed up by telephone after fracture healing. The healing time of fracture, the flexion and extension activities of the knee joint at 9 months after operation were recorded.SPSS19.0 statistical software was used to analyze the data. Measurement data were expressed as (±s). The independent sample t test was adopted in measurement data and the counting data was tested by Chi-squared test. Result In the experimental group, operative time was (138.7±34.6) minutes, intraoperative blood loss was (315.4±52.8) ml, postoperative wound complications was 0 case, hospitalization time was (8±3) days, postoperative visual analog scale was 5 scores, but in the control group, operative time was (170.5±32.5) minutes, intraoperative blood loss was (367.2±56.4)ml, postoperative wound complications was 3 cases, hospitalization time was (13±2) days, postoperative visual analog scale was 8 scores.There were significant differences between the two groups, P 0.05. Conclusions Bone graft material containing bone morphogenetic protein 2 (Bone Conduction) has the advantages of simple operation, less trauma, less complications, high osteogenic activity and good bone graft effect are equalled with iliac bone graft, the bone graft material containing bone morphogene protein is an effective method to treat nonunion of femoral fracture after intramedullary nail. Key words: Fracture fixation, intramedullary; Femur; Bone transplantation

Bone graft materials for posterolateral fusion made simple: a systematic review.

Iliac crest has long been the gold standard for lumbar fusion, but concerns over donor site morbidity have led to a wide variety of bone graft substitutes. Despite prolific research, a general consensus is yet to be reached on bone graft materials that lead to optimal fusion. The purpose of this review is to evaluate the current literature for bone graft material options that maximize fusion rate in posterolateral lumbar fusion surgery. Systematic Review. A PRISMA-compliant systematic review of PubMed, EMBASE, and the Web of Science was conducted. Included studies were published from January 2000 to July 2015, were clinical human research studies involving available autograft, allograft, or synthetic bone graft options in posterolateral lumbar spine fusion, and reported radiographic fusion rate as a primary end outcome. This research had no funding source and the authors have no conflicts to declare. 81 articles underwent full-text review, and 48 were included in this study. 18 studies assessed fusion rate by plain radiographs alone (37.5%), while 6 used CT scan (12.5%), and 24 used both (50.0%). 45 studies looked at ICBG in conjunction with LAG (29), BCP(1), APC (2), BMPs (6), or DBM (1). Aggregate mean fusion rates among these ranged from 68.0 to 91.5%. 22 studies evaluated fusion rates of LAG, either isolated (3) or combined with ceramic extenders (8), DBM (4), BMP (1), BMA (4), APC (1), or ICBG(1). Aggregate mean fusion rate ranged from 75 to 95.5%. With the exception of studies involving allograft (mean fusion rate 40.0%), the mean fusion rate for all other graft combinations exceeded 70.0%. While our results find that LAG+BMA provided highest fusion rate, most material options analyzed in this study provide comparable fusion outcomes. The ideal graft option must incorporate a combination of materials with osteoconductive, osteoinductive, and osteogenic properties. Our results represent the robust and dynamic nature of the current state of lumbar graft technology. These slides can be retrieved under Electronic Supplementary Material.

Research progress of Masquelet technique in the treatment of bone defects

Bone defects are usually resulted from traumatic injuries, infections, and bone tumors. The treatments mainly include autologous bone graft, allograft bone graft, distraction osteogenesis, vascularized bone grafting and amputation. All of the procedures show their inherent limitations due to different operative indications and different surgical techniques. The emergence of Masquelet technique provides a simple, safe, and more cost-effective solution in treating bone defects. The present article reviews the relevant literatures and summarizes the progress of Masquelet technique in the treatment of bone defects. The technique mainly includes two-step process which involves the induction of the induced membrane prior to the introduction of graft material into induced membrane. The first stage involves radical debridement of all infected or necrotic tissue, fracture stabilization, and filling the segmental bone defect with a cement spacer, composed of polymethyl methacrylate (PMMA) cement. Based on the results of culture performed on the wound samples, the sensitive antibiotics are mixed with cement for the infected bone defect. The second stage of bone grafting is performed within 6-8 weeks after the primary surgery. A longitudinal incision is performed through the induced membrane. The cement spacer is removed carefully and autogenous cancellous bone graft is placed to fill the bone defect and to close the induced membrane. A large number of experimental studies and clinical observations show that the induced membrane is a highly vascularized biological membrane rich in vascular endothelial growth factor (VEGF), transforming growth factor-β1(TGF-β1), bone morphogenetic protein 2 (BMP-2) and other growth factors, which can promote bone regeneration and repair. Masquelet technique can effectively treat multiple parts of posttraumatic bone defects, infectious bone defects, bone defects after tumor resection, congenital tibial pseudarthrosis, and so on. Masquelet provide a choice to treat bone defect for maxillofacial. The complications of Masquelet technique include infection recurrence, bone graft absorption, nonunion and pseudarthrosis. This study is to summarize the recent development of Masquelet technique, and to provide theoretical guidance for the application of Masquelet technique.

Vertical Ridge Augmentation of Atrophic Anterior Mandible with Autogenic Tibia Grafts Compared Allogenic Grafts

Aim: Ridge augmentation for the atrophied mandible or for supporting dental implants is, an effective treatment in patients with alveolar defects that preserve bone height for the placement of implants or desirable appearance. Two common substans for bone augmentation are autografts and allografts. However, it is difficult to demonstrate that one surgical procedure offers better outcomes than another. Our study aimed to address and compare changes in ridge augmentation following autograft and allograft bone grafting within a 6-month follow up period. Materials and Methods: In a randomized blinded clinical trial, 18 patients who were candidates for mandible bone grafts were randomly divided into two autograft (tibia graft) (n = 9) and allograft (n = 9) groups. In the autograft group demineralized frozen dried bone was used. Height of three local points on graft replacement (Right, Middle and Left points) were measured based on the OPG preoperatively and also 3 and 6 months after the grafting. Results: In all patient, the trend of ridge augmentation change was significant within 6 months following grafting; however no difference was observed in height changes between the autograft and allograft procedures. Conclusion: From the clinical point of view, these two procedures appear to have similar efficacies for treating localized mandibular ridge defects. Clinical Significances: Comparison the success rate and increase the anterior of mandibular height between autogenous bone graft and allogeneic bone graft.

Categorization of the Usage of Adjunctive Structural Allograft Bone Graft in Extremity Surgery for Patients with Osteogenesis Imperfecta.

Structural allograft bone plays a role in orthopedic surgery. Our purpose is to describe the methods of using structural allograft in extremity reconstruction surgery in patients with osteogenesis imperfecta (OI) and create a classification of usage with a single-center review of OI extremity cases from January 2002 to February 2017. Structural allograft was used in 19 bone segments in 15 patients with type III OI. Four categories of usage were defined: (1) interpositional, (2) onlay, (3) inlay, and (4) blocking to prevent rod migration. The mean time to incorporation was 5.4 months (range 1-16). Structural allograft bone incorporates into OI bone and may be a supplement to intramedullary fixation.

Clavicle aseptic nonunion: is there a place for cortical allogenic strut graft?

We investigated functional and radiological outcome in 57 cases of midshaft clavicle nonunion treated with open reduction and internal fixation with plate and screws over a 13 year-period. Intercalary bone graft was used in 42 patients; opposite autologous strut graft was used in 31 cases to provide mechanical support to the host bone. Patients were analysed using chart and radiological review and assessed with DASH questionnaire obtained at the latest follow-up.37 patients were male while 20 were females, with a mean age of 35 years (63–17). All cases were of nonunion, 35 atrophic and 22 hypertrophic. The dominant side was injured in 32 cases and the non dominant in 25 cases. Primarily, 43 cases were treated conservatively with a figure of eight bandage. Time between fracture and our operative treatment was on average 44 months (13–72 months). Only those patients who were symptomatic were included in this study. We used straight reconstruction LCP and low profile precontoured plates. By reviewing patients charts all the cases but one of nonunion progressed to osseous healing at a mean time of 14 weeks (range 12–16). The patient with non-union refused further surgery. 49 patients were available for a final follow up. DASH score was 16.7 at an average of 42 months. Open surgery and internal fixation, using plate and screws in a compression construct is the treatment of choice for symptomatic clavicular non-unions. Intercalary autologous or allograft bone graft should be used especially in patient with significant bone loss; autologous cortical strut graft provides optimum mechanical stability, thus assuring optimal screw purchase and allowing immediate limb movement.

Long term results of impaction Bone grafting using a synthetic graft (Apapore) in revision hip surgery

IntroductionImpaction Bone grafting (IBG) in Revision THR is challenging and places demands on allograft stores. Identifying a potential synthetic replacement that works in the longer term was the aim of this study. MethodsWe retrospectively reviewed 21 sequential patients who had undergone revision THR using IBG. They were randomised to receive either combined allograft and synthetic graft or Allograft alone. Among the surviving 15 patients, there were total of 25 procedures were carried out. 15 hips underwent IBG in the acetabulum and 10 hips underwent femoral IBG. Eight patients received a 50/50 mixture of allograft and synthetic Bone graft (Apapore) and seven allograft alone. Bone loss was classified using Paprosky classification. The average follow up was 10 years. ResultsOf the 21 patients, 6 had died of unrelated causes and were excluded. There were 3 re-operations but no revision of the original components. There was no significant implant migration detected. 3 acetabular components had confluent lucent lines in zone-1 which remained stable on long term follow up. 2 patients sustained femoral peri-prosthetic fractures after a simple fall and one patient who developed deep infection treated by DAIR. The modified oxford hip score post-operatively was 18 in allograft group and 22 in Apapore group ConclusionLong-term results indicate that the combined use of synthetic graft in Impaction Bone grafting is an effective substitute

Intraoperative culture positive allograft bone and subsequent postoperative infections: a retrospective review

Obtaining intraoperative cultures of allograft bone just before use in orthopedic procedures is standard practice in many centres; however, the association between positive cultures and subsequent surgical infections is unknown. Our study had 3 goals: to determine the prevalence of positive intraoperative allograft culture and subsequent infection; to determine if, in cases of subsequent infection, organisms isolated at reoperation were the same as those cultured from the allograft at the time of the index procedure; and to assess the costs associated with performing intraoperative allograft cultures. In this retrospective case series, we obtained data on patients receiving allograft bone between 2009 and 2012. Patients receiving allograft with positive cultures were reviewed to identify cases of significant infection. Organisms isolated at reoperation were compared with the allograft culture taken at the time of implantation, and we performed a cost assessment. Of the 996 allograft bone grafts used, 43 (4.3%) had positive intraoperative cultures and significant postoperative infections developed in 2, requiring reoperation. Antibiotics based on culture results were prescribed in 24% of cases. Organisms cultured at the time of reoperation differed from those isolated initially. The cost of performing 996 allograft cultures was $169 320. This series suggests that rates of positive intraoperative bone allograft culture are low, and subsequent infection is rare. In cases of postoperative infection, primary allograft culture and secondary tissue cultures isolated different organisms. Costs associated with performing cultures are high. Eliminating initial culture testing could save $42 500 per year in our health region.

Controlled Release of Vanadium from a Composite Scaffold Stimulates Mesenchymal Stem Cell Osteochondrogenesis.

Large bone defects often require the use of autograft, allograft, or synthetic bone graft augmentation; however, these treatments can result in delayed osseous integration. A tissue engineering strategy would be the use of a scaffold that could promote the normal fracture healing process of endochondral ossification, where an intermediate cartilage phase is later transformed to bone. This study investigated vanadyl acetylacetonate (VAC), an insulin mimetic, combined with a fibrous composite scaffold, consisting of polycaprolactone with nanoparticles of hydroxyapatite and beta-tricalcium phosphate, as a potential bone tissue engineering scaffold. The differentiation of human mesenchymal stem cells (MSCs) was evaluated on 0.05 and 0.025wt% VAC containing composite scaffolds (VAC composites) in vitro using three different induction media: osteogenic (OS), chondrogenic (CCM), and chondrogenic/osteogenic (C/O) media, which mimics endochondral ossification. The controlled release of VAC was achieved over 28days for the VAC composites, where approximately 30% of the VAC was released over this period. MSCs cultured on the VAC composites in C/O media had increased alkaline phosphatase activity, osteocalcin production, and collagen synthesis over the composite scaffold without VAC. In addition, gene expressions for chondrogenesis (Sox9) and hypertrophic markers (VEGF, MMP-13, and collagen X) were the highest on VAC composites. Almost a 1000-fold increase in VEGF gene expression and VEGF formation, as indicated by immunostaining, was achieved for cells cultured on VAC composites in C/O media, suggesting VAC will promote angiogenesis in vivo. These results demonstrate the potential of VAC composite scaffolds in supporting endochondral ossification as a bone tissue engineering strategy.

Topical bisphosphonate augments fixation of bone-grafted hydroxyapatite coated implants, BMP-2 causes resorption-based decrease in bone

Bone allograft is used in total joint arthroplasties in order to enhance implant fixation. BMPs are known to stimulate new bone formation within allograft, but also known to accelerate graft resorption. Bisphosphonates are strong inhibitor of bone resorption. The aim of this study was to investigate whether the bisphosphonate zoledronate was able to counteract the accelerated graft resorption without interfering with the BMP induced bone formation. In the present study the two drugs alone and in combination were studied in our canine model of impaction bone grafting. We included 10 dogs in this study. Cancellous allograft bone grafts were soaked in either saline or zoledronate solution (0.005mg/mL) and then vehicle or BMP2 (0.15mg rhBMP2) was added. This produced four treatment groups: A) control, B) BMP2, C) zoledronate and D) BMP2+zoledronate. The allograft treated with A, B, C or D was impacted into a circumferential defect of 2.5mm around HA-coated porous Ti implants. Each dog received all four treatment groups with two implants in the distal part of each femur. The group with allograft soaked in zoledronate (C) showed better biomechanical fixation than all other groups (p<0.05). It had less allograft resorption compared to all other groups (p<0.005) without any statistically significant change in new bone formation. The addition of BMP2 to the allograft did not increase new bone formation significantly, but did accelerate allograft resorption. This was also the case where the allograft was treated with BMP2 and zoledronate in combination (D). This caused a decrease in mechanical implant fixation in both these groups compared to the control group, however only statistically significant for the BMP2 group compared to control. The study shows that topical zoledronate can be a valuable tool for augmenting bone grafts when administered optimally. The use of BMP2 in bone grafting procedures seems associated with a high risk of bone resorption and mechanical weakening.