Autogenous Iliac Cancellous Bone Research Articles

Comprehensive three-dimensional cone beam computed tomography assessment unilateral alveolar cleft reconstruction using autologous iliac cancellous bone combined with deproteinized bovine bone: A clinical retrospective evaluation

Large-volume autologous iliac cancellous bone grafting for alveolar cleft may lead to undesirable bone resorption and susceptible donor-site morbidity, whereas the addition of deproteinized bovine bone (DBB) could optimize outcomes. This study aimed to evaluate the effectiveness of combining autologous iliac bone with DBB using three-dimensional cone beam computed tomography (3D-CBCT) for better analysis of bone generation than conventional evaluation methods. Thirty-six patients with unilateral alveolar cleft were assigned into two groups. Group A (n = 21) underwent autogenous cancellous bone graft harvested from the anterior iliac crests, while Group B (n = 15) received a composite of autogenous iliac cancellous bone and DBB. Patients in Group B displayed higher bone filling rates (P < 0.0001) and lower bone absorption rates (P < 0.001) than those in Group A at both 6 months and 1 year postoperatively. Additionally, there were directional differences in bone absorption within the bone grafts, with more absorption observed on the alveolar crest and palatal sides than that on the nasal and labial sides (P < 0.001). This study demonstrates that employing a combination of DBB and autologous bone in alveolar cleft repair achieves better outcomes of bone grafting.

Arthrodesis of the carpometacarpal joint of the thumb with plate fixation and bone grafting: a retrospective review

BackgroundArthrodesis of the carpometacarpal (CM) joint of the thumb has been recognized as a common technique that gives pain relief, stability, and strength, but it has some disadvantages, such as nonunion, pantrapezial osteoarthritis, and reduced mobility. MethodsThirteen thumbs of 12 patients with CM joint arthritis who underwent CM joint arthrodesis were reviewed retrospectively. The average age of the patientswas 61.0 years. The follow-up period ranged from 2 to 5 years. Arthrodesis was performed with a T-plate and an autogenous iliac cancellous bone graft for all patients. ResultsAll thumbs had radiographic evidence of union,and there was no nonunion. No reduction of motion of the interphalangeal and metacarpophalangeal joint of the thumb was found after surgery. Postoperatively, scaphotrapeziotrapezoid arthritis and metacarpophalangeal arthritis progressed in two joints each. The Disabilities of the Arm, Shoulder, and Hand score improved from 39.9 (range 8–69) to 11.1 (range 0–23.1). All patients had no or slight problems of the thumb and no complaints related to the pelvis in daily living and were either very satisfied or satisfied with the surgery. ConclusionsArthrodesis of the thumb CM joint with a plate and bone graft achieved satisfactory results in all cases with very few complications. This procedure is a valuable tool in middle-aged and elderly patients with thumbCM joint arthritis.

Nostril Base Augmentation Effect of Alveolar Bone Graft

BackgroundThe aims of alveolar bone grafting are closure of the fistula, stabilization of the maxillary arch, support for the roots of the teeth adjacent to the cleft on each side. We observed nostril base augmentation in patients with alveolar clefts after alveolar bone grafting. The purpose of this study was to evaluate the nostril base augmentation effect of secondary alveolar bone grafting in patients with unilateral alveolar cleft.MethodsRecords of 15 children with alveolar clefts who underwent secondary alveolar bone grafting with autogenous iliac cancellous bone between March of 2011 and May of 2012 were reviewed. Preoperative and postoperative worm's-eye view photographs and reconstructed three-dimensional computed tomography (CT) scans were used for photogrammetry. The depression of the nostril base and thickness of the philtrum on the cleft side were measured in comparison to the normal side. The depression of the cleft side pyriform aperture was measured in comparison to the normal side on reconstructed three-dimensional CT.ResultsSignificant changes were seen in the nostril base (P=0.005), the philtrum length (P=0.013), and the angle (P=0.006). The CT measurements showed significant changes in the pyriform aperture (P<0.001) and the angle (P<0.001).ConclusionsAn alveolar bone graft not only fills the gap in the alveolar process but also augments the nostril base after surgery. In this study, only an alveolar bone graft was performed to prevent bias from other procedures. Nostril base augmentation can be achieved by performing alveolar bone grafts in children, in whom invasive methods are not advised.

Comparison of the osteogenic potential of bone dust and iliac bone chip

Background contextThere is no comparative study of the in vitro and in vivo osteogenic potential of iliac bone chips (autogenous iliac cancellous bone chips) compared with bone dusts generated during the decortication process with a high-speed burr in spine fracture or fusion surgery. PurposeTo compare the osteogenic potential of three sizes of bone dusts with iliac bone chips and to determine whether bone dusts can be used as a bone graft substitute. Study designIn vitro and in vivo study. MethodsBone chips were harvested from the posterior superior iliac spine and bone dusts from the vertebrae of 15 patients who underwent spinal fracture surgery. Bone dust was divided into three groups: small (3 mm), middle (4 mm), and large (5 mm) according to the size of the burr tip. A comparison was made using a cell proliferation assay, alkaline phosphatase (ALP) activity, the degree of mineralization in an in vitro model, and radiographic and histologic studies (the change of absorbable area and tissue density) after implantation of the various materials into back muscles of nude mice. ResultsAlthough all three bone dust groups were less active with regard to cell proliferation, ALP activity, and the degree of mineralization, than were bone chips, they still exhibited osteogenic potential. Furthermore, there was no significant difference among the three bone dust groups. The three bone dust groups did show greater absorbable area and change of the tissue density than did the iliac bone chip group. Again, there was no significant difference among the three bone dust groups in this regard. Histologically, specimens from the bone dust groups had a higher osteoclast cell number than specimens from the iliac bone chip group. ConclusionsThe osteogenic potential of bone dusts is lower than that of iliac bone chips, and the absorption speed of bone dusts in vivo is faster than that of iliac bone chips. The increased resorption speed appeared to result from an increase in osteoclast cell number. Therefore, caution needs to be used when surgeons employ bone dust as a bone graft substitute.

An Alternative Approach for Mandible Reconstruction

The regeneration of bony defects of the mandible using free vascularized bone grafts has become a reliable procedure during the last few years. Various donor sites are available to provide vascularized bone grafts for mandibular reconstruction such as the fibula flap, the iliac flap, and the scapula flap; the fibula flap has become the most popular workhorse flap to reconstruct the lower jaw for extensive surgical defects. It is a challenge for head and neck reconstructive surgeons if the patient (mostly the manual worker) refuses to use fibular flap to reconstruct an extensive mandible defect or the patients have contraindication to harvest fibular flap. We have performed 7 cases using computer-aided design and computer-aided manufacturing prefabricated titanium mesh combined with autogenous iliac cancellous bone graft plus with/without boiled nontumorous mandible bone to reconstruct such cases. Primary wound healing was achieved in all patients without complication, and reconstructive complications were not observed during the follow-up period. The patients were satisfied with the results both esthetically and functionally. This preliminary clinical study and cases demonstrate that it is a feasible alternative method to reconstruct mandibular defects, especially when vascularized bone grafting is not available.

Distal Radius Osteotomy with Volar Locking Plates Based on Computer Simulation

Corrective osteotomy using dorsal plates and structural bone graft usually has been used for treating symptomatic distal radius malunions. However, the procedure is technically demanding and requires an extensive dorsal approach. Residual deformity is a relatively frequent complication of this technique. We evaluated the clinical applicability of a three-dimensional osteotomy using computer-aided design and manufacturing techniques with volar locking plates for distal radius malunions. Ten patients with metaphyseal radius malunions were treated. Corrective osteotomy was simulated with the help of three-dimensional bone surface models created using CT data. We simulated the most appropriate screw holes in the deformed radius using computer-aided design data of a locking plate. During surgery, using a custom-made surgical template, we predrilled the screw holes as simulated. After osteotomy, plate fixation using predrilled screw holes enabled automatic reduction of the distal radial fragment. Autogenous iliac cancellous bone was grafted after plate fixation. The median volar tilt, radial inclination, and ulnar variance improved from -20°, 13°, and 6 mm, respectively, before surgery to 12°, 24°, and 1 mm, respectively, after surgery. The median wrist flexion improved from 33° before surgery to 60° after surgery. The median wrist extension was 70° before surgery and 65° after surgery. All patients experienced wrist pain before surgery, which disappeared or decreased after surgery. Surgeons can operate precisely and easily using this advanced technique. It is a new treatment option for malunion of distal radius fractures.

Reconstruction of the Orbital Floor With Sheets of Autogenous Iliac Cancellous Bone

Various autografts and synthetic materials such as titanium plates have been used for orbital floor reconstruction; however, no consensus on reconstruction methods has been reached. We have used iliac cancellous bone for this reconstruction with good results. Patients (n = 101) enrolled in this study underwent orbital floor reconstruction of pure blowout fracture with an approximate 1 mm thinned and trimmed iliac cancellous bone without fixation of the graft. The results were assessed by CT; diplopia exceeding an angle of 45 degrees was evaluated as a poor outcome. Postoperatively, diplopia appeared in 15 patients and disappeared in 86 patients. At 6-month follow-up, CT showed that the morphology of the orbit was well maintained and no shedding or improper positioning of the grafted bone was observed in any of the patients. Moreover, CT images demonstrated ossification of the transplanted bone graft. The method encompassing the use of the medulla of the iliac bone has several merits: 1) the graft bone is sufficiently pliable and flexible to fit the gently curving orbital floor; 2) being soft, it is easy to cut. Furthermore, no complication attributable to its fragility is observed at short- and long-term follow-up. The 1 mm thin medullar bone graft derives its robustness from its beamed structure. We consider the medulla of the iliac bone fitting autosomal material for the reconstruction of the orbital floor.

Coralline hydroxyapatite and laminectomy-derived bone as adjuvant graft material for lumbar posterolateral fusion

The purpose of this study was to evaluate the effectiveness of coralline hydroxyapatite (CHA) and laminectomy-derived bone as an adjuvant graft material when combined with autogenous iliac bone graft (AIBG) in posterolateral fusion (PLF). This prospective, case-control study involved 58 patients who underwent lumbar instrumentation-augmented PLF for degenerative spinal stenosis-induced segmental instability between July 2000 and June 2001. The patients were divided into three groups. Laminectomy bone and AIBG were placed in the right intertransverse process space in Group 1 (20 patients), CHA and AIBG were placed in Group 2 (19 patients), and laminectomy bone and CHA were placed in Group 3 (19 patients). Pure autogenous iliac cancellous bone graft was placed in the left intertransverse process space in all three groups of patients. Successful fusion was determined by two spine surgeons after examining the plain, anteroposterior, bilateral oblique, and lateral flexion-extension radiographs. If the examiners did not agree on fusion status, fine-cut computerized tomography scans of the fusion mass were used to make the final decision. The chi-square test was used to compare the fusion rate at different time intervals among the three groups. Pure AIBG placed in left intertransverse process space was associated with the best fusion rate. After 6 months, CHA produced a comparable result to laminectomy-derived bone when combined with AIBG. When laminectomy bone was mixed with CHA, the combination failed to yield a satisfactory fusion rate (57.9%) even 1 year after surgery if no AIBG was added.

Management of femoral diaphyseal infected nonunion with antibiotic beads local therapy, external skeletal fixation, and staged bone grafting.

Fifteen patients with femoral shaft fractures complicated by infected nonunions were treated with a two-stage protocol. In the first stage, radical debridement was performed along with antibiotic bead chains local therapy and external skeletal fixation. In the second stage, the debrided nonunion site was repaired with bone grafting and the external skeletal fixator was used until bony union was achieved. The time between the first and second stages of treatment was 2 to 6 weeks. The debrided bone defects ranged from 0.5 to 15 cm. Autogenous iliac cancellous bone grafting was performed in 11 patients, and microvascularized osteoseptocutaneous fibular transfer was performed in 4 patients. Wound healing and bone union were achieved in all 15 cases. The duration of external fixation of these patients ranged from 7 to 15 months, with an average of 9 months. Minor pin-track infection was seen in seven patients. Postoperative infection after the second-stage bone grafting occurred in three patients. These three infections were arrested by limited debridement along with 2 to 4 weeks of parenteral antibiotic therapy. In one case, stress fracture occurred at 11 months after microvascularized fibular transfer; this was managed with another 5 months of external skeletal fixation. With an aggressive physical therapy program, 10 patients achieved nearly full range of knee motion and 5 patients had relevant knee flexion deficits. The follow-up averaged 58 months (range, 40-76 months); no recurrence of osteomyelitis was observed even at 76 months. We have found that our two-stage treatment with antibiotic beads local therapy, definitive external skeletal fixation, and staged bone grafting is an acceptable treatment protocol for the management of femoral diaphyseal infected nonunion. It results in rapid recovery from osteomyelitis and a predictable recovery from nonunion.

Treatment of the Femoral Neck and Trochanteric Benign Lesions

Thirty-five patients with a benign lesion of the femoral neck or trochanter were treated and seen in followup at the authors' institution from 1988 to 1991. Sixteen men and 19 women between the ages of 18 and 54 years (average, 27 years) were seen at an average followup of 3 years 6 months (range, 2-5 years). Eight patients had aneurysmal bone cyst; 14 had monostotic fibrous dysplasias; 2 had giant cell tumors; and 11 had simple bone cysts. Eleven patients had pathologic fractures. All patients were treated with curettage and bone grafting in conjunction with a sliding hip compression screw and plate. The bone grafting included a combination of a deep frozen allogenic cortical strut with autogenous iliac cancellous bone to fill the remaining defect space after lag screw and cortical strut had been implanted. At followup, all patients had good bony healing and incorporation of the implanted graft. There were no complications and no local recurrences. All of the functional results were excellent.

Treatment of enchondromas of the hand with allograft bone

We investigated whether cortico-cancellous allograft obtained from cadaveric banked bone is effective in the treatment of enchondroma of the hand. Twelve patients had 15 operations on 19 enchondromas using allograft bone. These patients were compared with 16 patients with enchondroma treated with autogenous iliac cancellous bone. The distribution of tumors was similar in both groups. There was no significant difference in the patient's age, their occupations, or whether the operation involved the dominant hand. In both groups, immobilization was maintained until clinical union was obtained. The duration of immobilization for both groups was identical. There were no recurrences, refractures, or complications in patients treated with allograft bone. The grafts incorporated and remodeled in all patients. We concluded that a allograft cortico-cancellous bone can be used effectively in the treatment of enchondromas of the hand. It is especially useful in the treatment of patients with multiple tumors.

Effect of implants on healing of experimental furcation defects in dogs.

The present study was performed to find out whether implants placed around periodontally involved teeth during reconstructive surgery would support replaced flaps and prolong gingival coverage of the treated root surfaces facilitating new attachment. Through-and-through furcation defects were made in the mandibular second, third, and fourth premolars of 10 beagle dogs. Bone was surgically removed from the furcation and from the circumference of each tooth to a level 3 to 4 mm apical to the cementoenamel junction. Steel wires were passed through the furcations and ligated to enhance plaque formation. At 6 weeks, the wires were removed. At 12 weeks, during reconstructive surgery, 4 dogs received implants of autogenous intraoral cancellous bone, 2 of autogenous iliac cancellous bone and marrow, 2 of Proplast, and 2 of Avitene. The results demonstrated that none of 12 teeth implanted with Avitene or Proplast showed new attachment. Only 2 of 6 teeth implanted with autogenous iliac bone showed new attachment, combined with extensive root resorption and ankylosis. Of 12 teeth implanted with autogenous intraoral bone, 6 showed new attachment. Our findings suggest that flap support by intraoral cancellous bone implants may facilitate new attachment. A more predictable technique, however, needs to be developed.

Effect of Fluoride on Autogenous Iliac Cancellous Bone and Marrow Transplants in Surgically Created Intrabony Pockets in Dogs

The effect of the osteogenic capacity of fluoride on autogenous iliac cancellous bone and marrow transplants was studied in experimentally created periodontal defects. Eight dogs, 2 years old, weighing between 10 to 15 kg each, were used. The right side of the upper jaw served for creation of the experimental (fluoride-treated) pockets and the left side for the control (saline-treated) pockets. Fluoride treatment was carried out by a single topical application of a high concentration of fluoride in the periodontal defects and by application of a low concentration of fluoride to the bone marrow transplants. Intraoral periapical radiographs were taken immediately after implantation, and at time of sacrifice. Changes during bone healing were assessed histologically and by radioopacity measurements. The newly formed bone in the control and fluoride-treated areas did not differ in quality. Radioopacity in the experimental defects was significantly higher in comparison with that found in the control areas. The increase was probably due to greater bone formation in the fluoride-treated defects. The difference decreased with the duration of the healing intervals. Cementum was deposited in both control and experimental sites.