Autogenous Cancellous Graft Research Articles

The use of Irradiated Allografts in Posterior Spinal Fusion for Healed Tubercular Kyphosis in Children.

Post-tubercular spinal kyphosis in children is not only cosmetically unacceptable but functionally disabling as well, as with the progression of the deformity there is a very significant risk of late onset paraplegia. We present our preliminary results in a prospective study of 12 cases of healed post-tubercular kyphosis in children treated with isolated posterior spinal fusion using irradiated allografts and autogenous cancellous grafts.The study included 12 patients of healed post-tubercular kyphosis documented by clinical, radiological and haematological criteria, with >2 spine at risk signs radiologically. The mean age was 7 years. In situ posterior spinal fusion with irradiated allografts and autogenous cancellous bone graft without any instrumentation was done for all the patients. The total follow-up is 5 years (mean 2.8 years).Eight patients (66%) showed a correction of the kyphosis, 3 patients (25%) were static and only 1 patient showed worsening of the deformity. Eleven patients had sound fusion and 1 patient had good fusion but a pseudoarthrosis at the lower vertebral level.Good posterior fusion was achieved because of the judicious use of morcellised, irradiated cancellous allografts with autogenous cancellous grafts. The proposed mechanism of correction is selective anterior column growth vis-à-vis posterior fused mass leading to gradual self-correction and remodelling.Conclusion. In situ posterior spinal fusion with irradiated allografts is a simple, safe, easily reproducible, less morbid surgical procedure with good results which may alter the long term disability of the patients.

Management of small infected tibial defects with antibiotic-impregnated autogenic cancellous bone grafting.

Between January of 1991 and December of 1993, 36 patients who had tibia fractures complicated by small infected tibia defects were treated at the authors' service. The group included 30 men and 6 women whose average age was 36.5 years (range, 18-72 years). The average follow-up period was 3.7 years. By using the Cierney-Mader staging classification of chronic osteomyelitis, 26 of 36 patients (72%) were stage 4A and 10 of 36 patients (28%) were stage 4B. Ten patients required muscle transfer. All patients were treated with a two-stage protocol. In the first stage, antibiotic-impregnated polymethylmethacrylate bead chains were used to obliterate the debrided osseous defect. In the second stage, the beads were removed, and the defects were reconstructed with antibiotic-impregnated autogenic cancellous bone graft. The time between the first and second stage was 2 to 8 weeks for patients without muscle transfer and 8 to 12 weeks for the patients with muscle transfer. The bone defects ranged from 2 to 4 cm. Wound healing and bony union were achieved in all patients. Only two patients had recurrent infections. The infection arrest rate was 94.4%. Minor pin tract infection of the external skeletal fixation was seen in two patients. Two patients developed skin rashes secondary to antibiotic therapy. Radiographs at an average follow-up of 3.7 years showed good consolidation and hypertrophy of grafted bones in all patients. After 3 to 5 years of follow-up, our results suggest that the use of impregnating antibiotics have no adverse effects on autogenic cancellous bone graft incorporation and may help to eliminate infection. This treatment protocol provided rapid recovery from osteomyelitis. The use of antibiotic-impregnated autogenic bone graft seems to be an effective and safe method for the management of small infected tibial defects.

Effects of a Bone Inducing Agent Derived from a Cultured Human Osteosarcoma Cell Line after Orthotopic and Heterotopic Implantation in the Dog

SummaryBIA, a Bone Inducing Agent extracted from a cultured human osteosarcoma cell line (Saos–2), is highly osteoinductive in the skeletal muscle of athymic mice and promotes early osseous union of stabilized femoral non-unions in rats. To evaluate its effect in dogs, ten milligrams of BIA mixed with an equal amount of pure bovine collagen type I was compared with 20 mg of bovine collagen alone, a gelatin capsule alone, and fresh autogenous cancellous graft, after orthotopic and heterotopic implantation in Beagles.For osteoinductive bioassays, each implant was placed in the latissimus dorsi muscle of five Beagles for six weeks. Bone formation was evaluated by thoracic radiographs every two weeks and by high detail radiographs and histology six weeks after implantation. To evaluate the effects of BIA after orthotopic implantation, four cortical defects were created in each left femur of four Beagles. One defect on each femur was randomly filled with BIA plus collagen, collagen alone, a gelatin capsule alone, or autogenous cancellous graft. Radiographic evaluation of the femurs was performed every two weeks for eight weeks. Healing of the defects was assessed with high detail radiographs, dual energy X-ray absorptiometry, histology and histomorphometry eight weeks after implantation.Ten mg of BIA did not induce bone formation six weeks after heterotopic implantation and did not promote bone healing after orthotopic implantation in the dogs. The discrepancy between these results and those obtained in rodents may be related to immunogenic factors or to the dose of BIA used in this study.BIA, a Bone Inducing Agent extracted from a cultured osteosarcoma cell line is highly osteoinductive in rodents. BIA was evaluated and compared with autogenous cancellous bone graft and bovine collagen after orthotopic and heterotopic implantation in Beagles. Each implant was placed in the latissimus dorsi muscle of five Beagles and in femoral cortical defects of four Beagles. Bone formation was evaluated by radiography, dual energy X-ray absorptiometry, histology and histo-morphometry. BIA did not induce bone formation after heterotopic implantation and did not promote bone healing after orthotopic implantation in dogs.

Aneurysmal Bone Cyst: the Role of Fibular Graft in its Treatment

Aneurysmal bone cyst is a relatively uncommon benign bone lesion for which curettage and cancellous bone grafting is a widely accepted method of treatment. This paper presents a report of eight patients with aneurysmal bone cysts; four in the humerus, three in the femur and one in the proximal phalanx of the index finger. Seven patients were treated by curettage and cancellous bone graft and one by autogenous fibular graft combined with cancellous allograft. Patients treated by cancellous bone grafting developed recurrence within a year. Three of these recurrent cysts were then treated by autogenous fibular graft combined with allograft. All four patients treated by fibular graft showed satisfactory healing of the cysts with no recurrence at three years' follow-up. Analysis of these patients suggests that recurrence of the aneurysmal bone cyst is very frequent after curettage and cancellous bone grafting. It is recommended that where total excision of the cyst is not feasible, the treatment of choice should be curettage and autogenous fibular bone grafting combined with cancellous bone graft. Removal of the fibula form its middle third does not cause any disability and the fibula regenerates completely within a period of three months.

Bone and Cartilage Transplantation

SummaryBone and cartilage transplantation have included autogenic, allogenic, and xenogenic tissues. Non-vascular cortical bone grafts are incorporated through a process of resorption, vascular invasion, and new bone deposition. Cancellous grafts are incorporated through a process of bone deposition followed by resorption. A variety of proteins, enzymes and enzyme inhibitors, collectively termed osteogenins, have been identified to have osteo-inductive activity. The incorporation of cartilage grafts differs from that of bone in several ways, largely due to differences in nutrition of the graft and biology of the incorporation process. The completeness of allograft incorporation is restricted in part by the immune response due to genetic disparity between donor and recipient tissues. Effective methods of sterilizing the graft, to prevent transmission of pathogens from donor to recipient, are important. Veterinary applications of graft material are expanding. While autogenous cancellous grafts to augment fracture repair remain the area of greatest use, segmental allografts for repair of large fracture defects in small animals are also utilized. The application of cartilage and osteochondral grafts in horses represent another area of active research.The use of bone and cartilage transplantation in veterinary surgery continues to expand. What follows is a review of the biologic principles relating to graft incorporation, the effects different storage and handling techniques have on graft incorporation, and the clinical relevance of current research to veterinary application of bone and cartilage transplantation.

The surgical treatment of instability of the upper part of the cervical spine in children and adolescents.

Low back pain is the most common complaint expressed by adult patients in the primary care setting, and the incidence of low back pain in adolescents is rising. Adolescents who are involved in athletics most commonly suffer from spondylolysis, spondylolisthesis, mechanical low back pain, and herniated disks, whereas adult athletes most commonly suffer from lumbosacral strain and herniated or degenerative disks. Initial nonsurgical management aims to reduce inflammation and noninvasively strengthen damaged tissues. Although most patients who have low back pain will return to sports after nonsurgical treatment, surgery may be required in patients who have persistent or progressive neurologic symptoms.

Effects of autogenous cancellous bone on healing of homogenous cortical bone grafts.

ABSTRACTA comparative clinical and histological study was made of the effects of autogenous cancellous grafts on the rate of healing of homogenous cortical bone grafts in dogs: their right foreleg received homogenous bone grafts and their left foreleg received pre‐drilled homogenous bone grafts filled with autogenous cancellous bone. Histologically, the use of homogenous cortical grafts with pre‐drilled holes and autogenous cancellous bone appeared to accelerate reorganization and development of these grafts. This was seen particularly 1–2 months post‐operatively and at nine months when the graft in the left leg was made up of spongy bone marrow; whereas the right leg graft still contained compact dead bone and the marrow was filled with fibrous tissue.

CANCELLOUS BONE GRAFTS FROM THE DISTAL RADIUS FOR USE IN HAND SURGERY

A method of obtaining small autogenous cancellous grafts for hand surgery from the volar side of the distal radius is presented.

TREATMENT OF NON-UNION IN COMPOUND FRACTURES WITH INFECTION

A method of bone grafting has been used successfully in nine of ten difficult cases of ununited fractures, in eight of which infection was present. Multiple autogenous cancellous iliac-bone grafts are advocated for this procedure, because they are rapidly revascularized and are readily incorporated into the host bone. They do not tend to sequestrate in the presence of infection. Adequate treatment of associated soft-tissue wounds and infection is most important. Our procedure has been: (1) to attempt to control the infection; (2) to replace devitalized scar with adequate skin; (3) to proceed with bone-grafting.