Autogenous Iliac Crest Bone Graft Research Articles

Bone Grafting Outcomes in Smokers Undergoing High Tibial Osteotomy: A Systematic Review.

This systematic review summarises the findings in the literature available to show outcomes of high tibial osteotomy (HTO) withbone grafting in smokers. It also studies the trend of complications, outcome measures used and overall outcomes like union, non-union or the need to perform revision surgeries. The aim is to find out if HTO done with bone graftingimproves outcomes in smokers. Articles were shortlisted using Population, Intervention, Control, and Outcomes (PICO) search design and quality assessment was completed using Jadad, STROBE (Strengthening the Reporting of Observational studies in Epidemiology), Delphi, and Critical Appraisal Skills Program (CASP) followed by data extraction by two independent authors. There was union in 97.6% of smokers who received HTO with bone grafting. A case of non-union was treated with removal of metalwork and distraction osteogenesis. Three cases of unknown demographics had arthroplasty in the time frame from HTO with bone grafting to follow up. The commonest complication post surgery was metalwork causing soft tissue irritation and lateral proximal tibial cortex fracture. Following this review we can conclude that HTO with bone grafting could be considered as an optionto achieve better outcomes in smokers. Bone grafting helps healing across osteotomy sites in smokers whose healing potential is poor. Autogenous Iliac crest bone grafting is ideal due to its osteoinductive and osteoconductive properties, but has the disadvantage of donor site morbidity.

A Rare Occurrence of Enchondroma in the Head of Femur in an Adult Male: A Case Report

Introduction: Enchondroma is a solitary, benign, and intramedullary cartilaginous tumor occurring most commonly in small bones of hands and feet contributing to 3–10% of all bone tumors. They originate from the growth plate cartilage which later on proliferates to form enchondroma. Lesions are central or eccentric and metaphyseal involvement is most common for long bones. We report a case of atypical occurrence of enchondroma in the head of femur in a young male. Case Report: A 20-year-old male patient presented with a history of pain in the left groin for 5 months. Radiological examination showed a lytic lesion in the head of femur. The patient was managed by safe surgical dislocation of the hip, curettage with autogenous iliac crest bone graft with countersunk screw fixation. Histopathology confirmed the lesion to be enchondroma. At the latest follow-up after 6 months, the patient was symptom-free and there was no evidence of any recurrence. Conclusion: Lytic lesions in the neck femur can have a good prognosis provided timely diagnosis and interventions are done. The present case of enchondroma in the head of femur represents a very rare differential diagnosis for the same and this must be kept in mind. So far, no such case has been reported in the literature. Magnetic resonance imaging and histopathology are of the essence to confirm this entity. Keywords: Enchondroma, atypical presentation, safe surgical dislocation of hip.

Lumbar Interbody Fusion and Osteobiologics for Lumbar Fusion.

Lumbar interbody fusion (LIF) is an excellent treatment option for a number of lumbar diseases. LIF can be performed through posterior, transforaminal, anterior, and lateral or oblique approaches. Each technique has its own pearls and pitfalls. Through LIF, segmental stabilization, neural decompression, and deformity correction can be achieved. Minimally invasive surgery has recently gained popularity and each LIF procedure can be performed using minimally invasive techniques to reduce surgery-related complications and improve early postoperative recovery. Despite advances in surgical technology, surgery-related complications after LIF, such as pseudoarthrosis, have not yet been overcome. Although autogenous iliac crest bone graft is the gold standard for spinal fusion, other bone substitutes are available to enhance fusion rate and reduce complications associated with bone harvest. This article reviews the surgical procedures and characteristics of each LIF and the osteobiologics utilized in LIF based on the available evidence.

A novel bone graft technique combined with plating for aseptic recalcitrant long bone nonunion

BackgroundTo evaluate the outcomes and efficacy of a new technique of autogenous iliac crest bone grafting combined with locking compression plate (LCP) vertical fixation for aseptic recalcitrant long bone nonunion.MethodsFrom July 2010 to September 2020, 36 aseptic recalcitrant long bone nonunions were treated with a bone-forming channel technique and internal LCP fixation. All the patients had received one or more failed treatments. The injury mechanism, nonunion type and duration, and prior treatments were recorded pre-operation. The routine treatment process included nonunion area exposure, previous implant removal, sclerotic bone debridement, LCP fixation, bone-forming channel creation, and iliac bone grafting, and a second LCP fixation when required. At follow-up, X-ray images were obtained to assess bone healing and implant failure. Visual analog scale (VAS), fracture site stability, limb function, activity, muscle strength, limb length, and complications were recorded.ResultsA total of 34 patients (24 males and 10 females) were finally enrolled, with a mean age of 49.8 ± 12.3 years. At a mean follow-up of 35.6 ± 22.0 months, 32 patients displayed bone union, with a healing rate of 94.1% and mean union time of 6.8 ± 2.4 months. The VAS score was 0.7 ± 1 at the final follow-up. The functional results showed that 19 patients were excellent, 11 patients were good, 2 patients were poor, and 2 patients did not heal.ConclusionBone-forming channel technique combined with LCP vertical fixation is an excellent option to treat recalcitrant long bone nonunion.Level of evidenceTherapeutic Level IV.

Assessing donor site pain after Iliac Crest Bone Graft

Objective: The aim of the present study was to evaluate the intensity of donor site pain after autogenous iliac crest bone graft harvest for arthrodesis of joints and non-union of fractures.
 Methodology: This prospective cross-sectional study was conducted at the Orthopedics Department of Khalifa Gul Nawaz Teaching Hospital in Bannu. A total of 156 patients who underwent iliac crest bone graft harvest were included in the study. The frequency and intensity of donor site pain were assessed using the visual analogue scale (VAS) after one month of postoperatively.
 Results: Out of 156 patients, the majority were males (61.5%). The mean age and pain score observed in the enrolled patients was 34.7 ± 9.5 years and 2.24 ± 2.01, respectively. Mild pain was present at one-month follow-up postoperatively in 50.6% of the patients. The pain intensity was assessed in relation to gender and age; there was no significant difference in the mean VAS scores between males and females (p=0.45). Furthermore, stratification with respect to age also displayed no significant variation in the pain scores with respect to age (p=0.99).
 Conclusion: Donor site pain remains significant morbidity associated with iliac crest bone graft, mild pain was observed in half of the enrolled cases, and only 23% were pain-free after one month of the surgery.

Iliac Crest Bone Graft Harvesting: Modified Technique for Reduction of Complications.

bone grafting; complications; iliac crest; pain.

Regional anesthesia for nonunion surgery with iliac crest bone grafting results in an increase in same day discharge.

The purpose of this study was to evaluate the outcomes of fracture nonunion repair with autogenous iliac crest bone graft (ICBG) under regional anesthesia alone or in combination with other techniques compared to other anesthesia techniques. Overall, 137 patients were identified who underwent ICBG as part of a repair of a long bone fracture nonunion between January 1, 2013 and October 1, 2020. Surgical and anesthetic records were reviewed to classify patients by anesthesia type. General, spinal, and regional anesthetics were used as either the primary anesthetic or as a combination of regional nerve block with general or spinal anesthesia. Administration of regional anesthesia alone or in combination with general or spinal anesthesia (RA) and general or spinal anesthesia only (GS) groups differed in nonunion site distribution (p < 0.001). RA patients were discharged the same day more often than GS patients (30.9% vs 10.0%, p = 0.009) and experienced fewer postoperative complications (p = 0.021). The RA group achieved union sooner than the GS group (by 5.3 ± 3.2months vs. by 6.8 ± 3.2months, p = 0.006). Mean morphine equivalent dose was similar between groups (p = 0.23). Regional anesthesia use increased from 2013 to 2020, and same day discharge surgeries simultaneously increased over the same time period. Regional anesthesia use increased in nonunion repair surgery with ICBG from 2013 to 2020. This was associated with an increase in same day discharge, sooner time to union, and decreased postoperative complications. There was not a need for increased opioid prescription in patients that underwent regional anesthesia.

Observing the Eruption of Canine After Secondary Alveolar Bone Grafting

Alveolar bone grafting is undertaken to provide stability to the dental arch and facilitate the eruption of permanent canine as teeth in the line of cleft usually have an altered pattern of eruption. The purpose of this study was to assess the eruption status and the change in the position and pattern of canine eruption after secondary alveolar bone grafting. An ambispective cohort study was conducted in patients operated for alveolar bone grafting with unilateral/bilateral alveolar cleft between the age of 9 to 13 years using autogenous iliac crest bone graft. The predictor variables of interest include the preoperative eruption status of canine (completely erupted/partially erupted/unerupted), stage of root development (one-third/two-third/more than two-third/complete) and position (vertical/lateral/buccopalatal) of the canine. The primary outcome variable is the eruption status of the canine (completely erupted/partially erupted/unerupted) at 6 months postoperatively. Secondary outcome variables include the stage of root development, change in the vertical, lateral and buccopalatal position of the canine observed in the first 6 months postoperatively with follow-up at 1 and 3 months. Another secondary outcome variable was the status of bone graft at 6 months postoperatively. Statistical analysis was done using Spearman's rank correlation and ANOVA chi-square test. The study sample consisted of 30 non-syndromic alveolar cleft patients with a mean age of 11.9 years, out of which partial and complete eruption of canine was seen in 43.33 and 36.67%, respectively. The canine was unerupted in 20% of the cases (P=.001). There was evidence of continued root development through the grafted bone. No significant change in the angulation of canine was observed in the postoperative period. Significant change in the eruption status and root development of canine with no statistically significant change in the vertical and lateral angulation during eruption was observed. Identifying these risk factors by continuous postoperative monitoring will help in identifying the malposition at an early stage.

Structural Iliac Crest Autograft for Segmental Reconstruction After Metastatic Renal Cell Tumor Resection of the Radial Shaft

Introduction: Metastatic bone lesions are sometimes managed with en bloc resection that creates defects often requiring reconstruction. Reconstructive options for intercalary segmental bone defects are dependent on defect site and size. The radius is a rare site of metastatic disease and even rarer to require resection. While vascularized or nonvascularized fibular autografts have been used in this setting, there is no prior report detailing the use of a large autogenous iliac crest bone graft. We report structural iliac crest autograft reconstruction in a surgically resected radial diaphyseal solitary renal cell carcinoma metastasis. Case Report: A 62-year-old man presented with a solitary osseous metastatic bone lesion to the radial shaft. After nephrectomy, resection of the bone lesion followed by reconstruction with autogenous iliac crest bone graft was accomplished. Postoperative plain radiographs a year later showed integration at both graft-host junctions without hardware failure. The Musculoskeletal Tumor Society (MSTS)/Enneking score at 1 year was 22/30 points. Discussion: This article presents a case illustrating unique use of structural iliac crest autograft in segmental diaphyseal reconstruction of the radial shaft following metastatic renal cell carcinoma bone resection. This technique has the advantage of potentially increasing rate and decreasing time of healing when compared with allograft techniques and avoids increased operative time and potential donor site morbidity of vascularized fibular grafts.

Is autogenous iliac crest bone graft a good alternative for rehabilitation in cases of large Odontogenic myxoma? Case Report with a 5‐year follow‐up

AbstractOdontogenic myxoma is a mesenchymal odontogenic tumor that is aggressive and locally invasive. Recurrence rates in jaws are high, mainly by the absence of epithelial coating that allows infiltration in surrounding bone, which makes it difficult for total removal. Consequently, the treatment is rather challenging and rehabilitation options are controversial, requiring a multidisciplinary approach. In most cases, autogenous bone grafts or vascularized flaps are performed as adequate tissue reconstruction and to allow implant placement. Here, we report a case of satisfactory post‐resection of extensive odontogenic myxoma using autogenous iliac crest bone and synthetic grafts, implant placement, and fabrication of implant‐supported prosthesis.

Autogenous iliac crest bone grafting for tibial nonunions revisited: does approach matter?

Tibial nonunion remains a considerable burden for patients and the surgeons who treat them. In recent years, alternatives to autogenous grafts for the treatment of tibial nonunions have been sought. The purpose of this study was to evaluate the efficacy of autogenous iliac crest bone graft (ICBG) in the treatment of tibial shaft nonunions. Sixty-nine patients were identified who underwent ICBG for repair of atrophic or oligotrophic tibial nonunion and had complete data with at least one year of follow-up (mean 27.9months). Surgical treatments consisted of revision/supplemental fixation ± ICBG. Surgical approaches for graft placement were either posterolateral (PL), anterolateral (AL), or direct medial (DM). Healing status, time to union, postoperative pain, and functional outcomes were assessed. Bony union was achieved by 97.1% (67/69) of patients at a mean time of 7.8 ± 3.2months postoperatively. There was no significant difference in mean time to union between the three surgical approach groups: (PL (44.9%) = 7.3months, AL (20.3%) = 9.2months, DM (34.8%) = 7.6months; p = 0.22). Intraoperative cultures obtained at the time of nonunion surgery were positive in 27.5% of patients (19/69). Positive cultures were associated with need for secondary surgery as 8/19 patients (42.1%) with positive cultures required re-operation. Two out of four patients that developed iliac donor site hematomas/infections requiring washout had positive intraoperative cultures as well. There was no difference in final SMFA among the three surgical approach groups. Autogenous ICBG remains the gold standard in the management of persistent tibial nonunions regardless of surgical approach. There is a small risk for complication at the iliac crest donor site. Given the high union rate, autogenous iliac crest bone grafting for tibial nonunion remains the gold standard for this difficult condition. Level III.

Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion

BackgroundAlthough most cases of humeral shaft nonunion respond well to surgical intervention, surgeons still encounter patients with humeral shaft nonunion who have already undergone repeated surgeries for nonunion. This study retrospectively analyzed the efficacy of double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting for recalcitrant humeral shaft nonunion.MethodsA consecutive series of patients with aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in our institution. Standardized treatment included thorough debridement, double LCP and screw fixation, and autogenous iliac bone grafting. The injury type and the duration of nonunion were recorded for all patients. The main outcome measurements were the Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function, and visual analog scale (VAS) for pain. In addition, all complications were documented.ResultsThe study cohort comprised six females and nine males with a mean age of 45.3 ± 13.1 years. Each patient had already undergone at least one failed surgery for humeral shaft nonunion. The average duration of nonunion before the index intervention was 126.8 ± 124.2 months. All patients achieved bone union without implant failure. At final follow-up, the mean Constant and Murley score and mean MEPI were significantly improved, and the mean VAS score was significantly decreased. Each patient was very satisfied with the treatment. Four patients had complications, including one with a superficial wound infection, one with radial nerve palsy, one with ulnar nerve palsy, and one with discomfort at the iliac crest.ConclusionDouble plate fixation combined with autogenous iliac crest bone grafting results in successful salvage of humeral shaft nonunion after prior failed surgical interventions.

Effect of Platelet Rich Plasma (PRP) on Bone Graft in Alveolar Cleft Repair

Background: Ultimate repair of alveolar defects is a greatchallenge in practical field, many bone graft materials havebeen evolved in the literatures for alveolar defect reconstructionas autogenous, allogenic, xenogenic, and alloplastic grafts[1], autogenous iliac crest bone graft is the gold standardamong other graft materials evaluated. However, the procedureassociated with a potential risk of early complications suchas graft resorption, graft leakage, infection, or graft failure,failure rate is about 30% [2].Objectives: To assess the efficacy of using Platelet RichPlasma (PRP) in alveolar cleft reconstruction; in combinationwith Iliac Crest Bone Graft (ICBG) in comparison to theconventional Iliac Crest Bone Grafting (ICBG).Patients and Methods: 20 patients underwent alveolarcleft reconstruction at the age of mixed dentition over a 3-year's period; their mean age was 8.8±2.3 years years andtheir mean post-operative follow-up was 13.4 months. Ofthese, 10 patients treated with ICBG combined with PRP(Group I), and 10 patients repaired by ICBG alone Group II(control group) results were assessed by rating the radiographsobtained 3, 6, and 12 months post-operatively according tocone beam CT (CBCT) volume and density assessment.Results: Alveolar cleft repairs using PRP combined cancellousbone (Group I) were 90 percent successful, alveolarcleft repairs using cancellous bone (Group I) were 70 percentsuccessful as regard; bone resorption reduction, bone volumegaining and improved bone density in CBCT at 3, 6, and 12months post-operative with decreased post-operative complicationrates.Conclusion: Application of PRP enhances bone formationin alveolar clefts when admixed with autologous bone graftharvested from the iliac crest as it leads to early bone formation,increased bone density, decreases bone resorption, low infectionrate and least post-operative complications.

241. Preclinical safety and performance assessment of a novel 3D-printed HA-DBM composite scaffold using a rodent posterolateral fusion model

BACKGROUND CONTEXT Historically, autogenous iliac crest bone graft (ICBG) has been considered the gold standard material for spinal fusion. However, the high burden of donor-site morbidity associated with graft harvesting has led clinicians to favor other materials. Notably, INFUSETM – recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered via an absorbable collagen sponge (ACS) – has been shown to yield excellent fusion rates as individual therapy, although its use is associated with significant postoperative inflammation and adverse events. In contrast, most other bone graft substitutes provide insufficient bone regeneration when utilized alone for spinal fusion. Hence, there is a need for novel bone graft substitutes capable of providing adequate osteogenesis with a favorable safety profile. PURPOSE To compare the efficacy and safety profile of previously described 3D-printed HA-DBM composite scaffolds relative to INFUSETM in a rodent L4-L5 posterolateral fusion (PLF) model. STUDY DESIGN/SETTING Preclinical animal model (rat L4-L5 posterolateral spinal fusion model) PATIENT SAMPLE Female Sprague-Dawley rats (age 12-16 weeks) OUTCOME MEASURES Radiographs, fusion scoring, biomechanical testing, MRI quantification of local edema METHODS Fifty Sprague-Dawley rats underwent bilateral L4-L5 posterolateral fusion (PLF), receiving either INFUSETM (10 µg rhBMP-2 on ACS) or HA-DBM composite scaffold. Spines were harvested at 8 weeks postoperation. Fusion was assessed via manual palpation of the samples by three blinded observers. For each sample, a fusion score was determined, wherein 0 = no bridging bone, 1 = unilateral bridging bone, and 2 = bilateral bridging bone. Samples with an average fusion score ≥1 were considered successfully fused. A subpopulation of twenty specimens, 10 INFUSETM and 10 HA-DBM, underwent biomechanical testing to quantify segmental range-of-motion and overall stiffness relative to 8 nonoperated control specimens. An additional 60 animals underwent L4-L5 PLF receiving either ACS only, INFUSETM, or HA-DBM, and were harvested at increasing postoperative time points to undergo lumbar MRI for quantification of soft tissue edema. An additional 90 animals underwent L4-L5 PLF, and various gene and protein expression analyses were used to investigate the pro-osteogenic mechanism of action of the different implant materials. RESULTS Fusion rates were similar between the INFUSETM (100%) and HA-DBM (93%) scaffold groups, although the average fusion score was greater for INFUSETM (2.0± 0.0) relative to HA-DBM (1.5±0.5). Both INFUSETM and HA-DBM treatment resulted in significantly greater stiffness and reduced segmental range-of-motion relative to the nonoperative controls, although these effects were significantly more profound in INFUSETM relative to HA-DBM groups. Both INFUSETM and HA-DBM groups demonstrated significant increases in expression of various pro-osteogenic markers (eg, Alp, Osx, and Runx2). Notably, the INFUSETM group yielded significant edema at both 2- and 5-days postoperation, which was not seen with HA-DBM treatment. CONCLUSIONS The HA-DBM scaffold yielded comparable fusion rates with slightly lower fusion scores and reduced osteoinductivity relative to INFUSETM. However, the exaggerated host inflammatory response seen with INFUSETM was absent in HA-DBM-treated animals. Therefore, the HA-DBM scaffold shows promise as a bone graft substitute with a favorable safety profile. FDA DEVICE/DRUG STATUS rhBMP-2 (INFUSE) [non-human use] (Investigational/Not approved)

Are Some Randomized Clinical Trials Impossible?

Congenital tibial pseudarthrosis is a rare condition seen in neurofibromatosis type 1 (NF1), and treatment is complex. A randomized, placebo-controlled trial of bone morphogenetic protein (rhBMP-2; INFUSE bone graft) at time of tibial surgery was developed by the Neurofibromatosis Clinical Trials Consortium. Patients were randomized to receive rhBMP-2 that would, or would not, be added to the standard surgical procedure consisting of resection of pseudarthrosis tissue, insertion of a rigid intramedullary rod, and placement of autogenous iliac crest bone graft. Despite involvement of 16 centers with wide experience with NF1 orthopaedic management, only 5 patients (of 54 required) were able to be enrolled in the study during a 3-year time period. Because of the inability to recruit sufficient patients, this study was closed in June 2019, with plans to terminate. The obstacles that were encountered during the study are summarized. The authors question whether a randomized, placebo-controlled trial of a rare pediatric orthopaedic condition is possible to accomplish. Recommendations are provided to guide future studies of orthopaedic manifestations of NF1.Level of Evidence: Level V.

Randomized clinical trial: expanded autologous bone marrow mesenchymal cells combined with allogeneic bone tissue, compared with autologous iliac crest graft in lumbar fusion surgery

BACKGROUND CONTEXTAlthough autogenous iliac crest bone graft (AICBG) is considered the gold-standard graft material for spinal fusion, new bone substitutes are being developed to avoid associated complications and disadvantages. By combining autologous bone marrow mesenchymal stromal cells (MSCs) expanded ex vivo and allogenic cancellous bone graft, we obtain a tissue-engineered product that is osteoconductive and potentially more osteogenic and osteoinductive than AICBG, owing to the higher concentration of MSCs. PURPOSEThis study aimed to evaluate the feasibility and safety of implanting a tissue-engineered product consisting of expanded bone marrow MSCs loaded onto allograft bone (MSC+allograft) for spinal fusion in degenerative spine disease, as well as to assess its clinical and radiological efficacy. STUDY DESIGN/SETTINGA prospective, multicenter, open-label, blinded-reader, randomized, parallel, single-dose phase I-II clinical trial. PATIENT SAMPLEA total of 73 adult patients from 5 hospitals, with Meyerding grade I-II L4–L5 degenerative spondylolisthesis and/or with L4–L5 degenerative disc disease who underwent spinal fusion through transforaminal lumbar interbody fusion (TLIF). OUTCOME MEASURESSpinal fusion was assessed by plain X-ray at 3, 6, and 12 months and by computed tomography (CT) at 6 and 12 months post-treatment. An independent radiologist performed blinded assessments of all images. Clinical outcomes were measured as change from baseline value: visual analog scale for lumbar and sciatic pain at 12 days, 3, 6, and 12 months posttreatment, and Oswestry Disability Index and Short Form-36 at 3, 6, and 12 months posttreatment. METHODSPatients who underwent L4–L5 TLIF were randomized for posterior graft type only, and received either MSC+allograft (the tissue-engineered product, group A) or AICBG (standard graft material, group B). Standard graft material was used for anterior fusion in all patients. Feasibility was measured primarily as the percentage of randomized patients who underwent surgery in each treatment group. Safety was assessed by analyzing treatment-emergent adverse events (AEs) for the full experimental phase and appraising their relationship to the experimental treatment. Outcome measures, both radiological and clinical, were compared between the groups. RESULTSSeventy-three patients were randomized in this study, 36 from the MSC+allograft group and 37 from the AICBG group, and 65 were surgically treated (31 group A, 34 group B). Demographic and comorbidity data showed no difference between groups. Most patients were diagnosed with grade I or II degenerative spondylolisthesis. MSC+allograft was successfully implanted in 86.1% of randomized group A patients. Most patients suffered treatment-emergent AEs during the study (88.2% in group A and 97.1% in group B), none related to the experimental treatment. X-ray-based rates of posterior spinal fusion were significantly higher for the experimental group at 6 months (p=.012) and 12 months (p=.0003). CT-based posterior fusion rates were significantly higher for MSC+allograft at 6 months (92.3% vs 45.7%; p=.0001) and higher, but not significantly, at 12 months (76.5% vs 65.7%; p=.073). CT-based complete response (defined as the presence of both posterior intertransverse fusion and anterior interbody fusion) was significantly higher at 6 months for MSC+allograft than for AICBG (70.6% vs 40%; p=.0038), and remained so at 12 months (70.6% vs 51.4%; p=.023). Clinical results including patient-reported outcomes improved postsurgery, although there were no differences between groups. CONCLUSIONSCompared with the current gold standard, our experimental treatment achieved a higher rate of posterior spinal fusion and radiographic complete response to treatment at 6 and 12 months after surgery. The treatment clearly improved patient quality of life and decreased pain and disability at rates similar to those for the control arm. The safety profile of the tissue-engineered product was also similar to that for the standard material, and no AEs were linked to the product. Procedural AEs did not increase as a result of BM aspiration. The use of expanded bone marrow MSCs combined with cancellous allograft is a feasible and effective technique for spinal fusion, with no product-related AEs found in our study.

Traumatic Composite Bone and Soft Tissue Loss of the Leg: Region-Specific Classification and Treatment Algorithm

The management of traumatic composite bone and soft tissue loss (TCBSTL) requires a classification system and decision-making algorithm for the purpose of description, prognosis and choice of treatment method. between the year 2000 and 2017 a series of 254 cases of TCBSTL were treated using distraction histogenesis and external fixation techniques. The tissue loss was due to either the initial injury or debridement of infection. Adjunctive procedures included split thickness skin grafting and ICBG when indicated. A classification system was designed by the author. The classification is based on factors that influence management and prognosis; (1) stability of the host bone (intact tibia or a well-fixed fracture), (2) presence or absence of infection in the fracture site, (3) size of bone defect, and (4) contamination (infection) of the medullary cavity. A flowchart and decision-making algorithm was subsequently developed. Ilizarov external fixator was used in all cases. Ten cases (4%) had combined Masquelet - Ilizarov technique. One hundred seventy five cases (68.9%) had gradual distraction-compression (GDC) technique; while 79 cases (31.1%) had acute shortening and re-lengthening (ASRL) technique. Seventy-two cases (28.3%) had autogenous iliac crest bone graft (ICBG). All cases (100%) had complete clinical and radiological fracture union. All patients completed the follow up that ranged from 24 to 118 months (mean 43.3 ± 23). The results were satisfactory in 212 cases (83.5%) and unsatisfactory in 42 (16.5%) cases due to residual leg length discrepancy, joint stiffness, and persistent pain. the proposed classification is simple, applicable, recallable and includes most scenarios of reconstructable TCBSTL. The classification provides a basis for communication, description and evaluation of such cases. The algorithm, based on our classification, provides a guideline for management without over/under treatment.

Comparison of Union Rates Between Autogenous Iliac Crest Bone Graft and Local Bone Graft as Fusion Materials in Lumbar Fusion Surgery: An Evaluation of Up to 3-Level Fusion

To compare the radiologic union rates between autogenous iliac crest bone graft (ICBG) and local bone graft in 1- to 3-level lumbar fusion. We reviewed 178 consecutive patients who underwent 1- to 3-level lumbar fusion surgery because of lumbar spinal stenosis. Fusion status of the anterior or posterior column was evaluated by plain radiographs obtained at 24 months postoperatively. If at least either the anterior or posterior column was fused, that segment was regarded as having achieved fusion and was termed segment union. The definition of overall union was achieving union of all segments in a single patient. For each ICBG group and local bone graft group, fusion rate of the anterior and posterior column, and rate of the segments and overall union at postoperative 2years were not different between the groups, regardless of surgery level. In the overall union rate according to the fusion level, the ICBG group showed constant overall fusion rate according to the fusion level (i.e., 96.9%, 96.9%, and 93.1% for 1-, 2-, and 3-level fusion), but tended to decrease with increasing level in the local bone graft group (100%, 95.8%, and 85.7% for 1-, 2-, and 3-level fusion, respectively) without statistically significant differences. The union rate of 3-level fusion was not inferior to those of 1- or 2-level fusion in both ICBG and local bone graft patients. Local bone graft could be regarded as an adequate option for not only 1- or 2-level lumbar fusion but also 3-level lumbar fusion surgery.

Quadriceps-splitting midline approach in the treatment of distal femur infected nonuinon with stiff knee and severely scarred soft tissues

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Treatment of infected distal femur non-union with a stiff knee and severely scarred soft tissues is a challenging problem. We describe a method of addressing the non-union using quadriceps splitting approach to the distal femur.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We retrospectively reviewed 5 patients with distal femur infected nonunion and knee stiffness, who, after infection control, required distal femur bone grafting. All patients had autogenous iliac crest bone grafting of the distal femur using the quadriceps splitting approach. The parameters assessed were the time to surgical wound healing, wound infection, time to bony union, and if any additional procedures were needed.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 5 patients were referred with distal femur infected non-union in addition to knee stiffness, with or without an implant &lt;em&gt;in situ&lt;/em&gt;. All patients underwent debridement, implant exit, and external fixation of the femur spanning the knee as the primary surgery here, followed later on by iliac crest bone grafting of the distal femur using the above approach. All patients united well within 12 to 16 weeks, without the need for additional procedures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In the presence of pre-existing knee stiffness with severely scarred and contracted soft tissues the quadriceps-splitting approach is a useful method to address bony problems in the distal femur, without the need for a separate procedure for soft tissue or flap cover.&lt;/p&gt;

Chondroblastoma of the patella with pathological fracture in an adolescent: a case report

BackgroundChondroblastoma is a rare primary bone tumor of young people that generally occurs in the epiphyseal plate of long bones. To date, only 13 cases of patella with pathological fracture in chondroblastoma have been previously published.Case presentationA 15-year-old male patient presented with acute pain in the left knee after an injury occurred while playing basketball. Plain radiographs and computed tomography showed a pathological fracture of the left patella with an osteolytic lesion (1.5 × 2 × 3 cm). Magnetic resonance imaging revealed an expansile lesion within the patella with a slightly high signal on the T1-weighted image, a high signal on the T2-weighted image and soft tissue swelling in front of the patella. A m99Tc bone scintigraphy revealed moderate uptake. The preoperative diagnosis was chondroblastoma. This patient underwent intralesional meticulous extended curettage, adjuvant high-speed burr, 95% alcohol and electrotome treatment, autogenous iliac crest bone grafting, and internal fixation. A postoperative pathological diagnosis was chondroblastoma. The patient’s function was satisfactory, and there was no sign of tumor recurrence. The internal fixator was good, with no loosening or migration observed at the last follow-up at 20 months after surgery.ConclusionsRarely, chondroblastoma of the patella can present with acute pain due to pathological fracture. We present the 14th such case in the literature to associate patellar chondroblastoma with pathological fracture. The patient was treated with curettage, inactivation, autogenous bone grafting, and internal fixation. A satisfactory therapeutic effect was obtained. This case may be beneficial to the diagnosis and treatment of chondroblastoma patella.