Autologous Iliac Bone Graft Research Articles

A comparison of local bone graft with PEEK cage versus iliac bone graft used in anterior cervical discectomy and fusion

ObjectiveAnterior cervical discectomy and fusion (ACDF) is a popular procedure for patients with cervical spondylotic myelopathy, but few studies reported the clinical outcomes of cervical local bone graft with a PEEK cage used in it. This retrospective study was performed to compare the clinical and radiological outcomes of using local bone graft with a PEEK cage versus iliac bone graft in ACDF. Patients and methodsA total of 60 consecutive patients who underwent ACDF were evaluated from January 2010 to January 2013. Twenty-nine patients received ACDF with a PEEK cage combined with cervical local bone graft (local bone group) and 31 patients received ACDF with autologous tricortical iliac bone graft (iliac bone group). The intraoperative and perioperative complications of both groups were recorded. Preoperative and postoperative radiographs were taken to calculate the ratio of interbody height to the disc height and the interbody bony fusion rate. The Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) were used to estimate postoperative clinical outcomes. ResultsThe mean follow-up duration was 25.0±3.8months in the local bone group and 24.4±3.4months in the iliac bone group (P=0.56). Although there was no significant difference between the two groups in terms of blood loss (P=0.17), the length of surgery was significantly less in the local bone group comparing with that of iliac bone group (P=0.01). Postoperatively, VAS scores were significantly decreased, and JOA scores were improved in both groups. However, no statistically significant differences were found between the two groups at final follow up (P=0.45 and P=0.93). The disc space height and segmental interbody angle at the surgical segment were greater in local bone group than those in the iliac bone group (P<0.001 and P<0.001). The fusion rates were 93.1% in local bone group and 90.3% in the iliac bone group at last follow up (P=0.70). Perioperative complication rates in local bone group and iliac bone groups were 6.8% and 29%, respectively (P=0.04). ConclusionsBased on this study, patients receiving ACDF with local bone graft combined with a PEEK cage had significant shorter operation time, lower perioperative complications rate, and better radiological results comparing with those with an iliac bone graft alone. It seems that the local bone graft with a PEEK cage appears to be a safe alternative to the iliac bone graft for ACDF.

Comparação de osteotomias de Puddu com ou sem enxerto ósseo autólogo: estudo clínico prospectivo

ObjectivesTo test the hypothesis that autologous iliac bone grafts do not enhance clinical results and do not decrease complication rates in patients undergoing medial opening‐wedge high tibial osteotomy. MethodsForty patients allocated in a randomized, two‐armed, double‐blinded clinical trial were evaluated between 2007 and 2010. One group received bone graft, and the other group was left without filling the osteotomy defect. The primary outcome was the Knee Society Score. Radiographic measurement of the frontal anatomical femoral‐tibial angle and the progression of osteoarthritis according to the modified Ahlback classification were used as secondary outcomes. ResultsThere was no difference in KSS scale between the graft group (64.4±21.8) and the graftless group (61.6±17.3; p=0.309). There was no difference of angle between the femur and tibia in the frontal plane between the groups (graft=184±4.6 degrees, graftless=183.4±5.1 degrees; p=1.0), indicating that there is no loss of correction due to the lack of the graft. There was significant aggravation of osteoarthritis in a greater number of patients in a graft group (p=0.005). ConclusionAutologous iliac bone graft does not improve clinical outcomes in medium and long‐term follow‐up of medial opening‐wedge high tibial osteotomy fixed with a first generation Puddu plate in the conditions of this study.

Intervention en deux temps pour tuberculose destructrice du médio-pied : à propos de 14 cas

IntroductionTuberculosis (TB) in midfoot is often secondary to tuberculosis elsewhere in the body. The experience and literatures to treat midfoot tuberculosis are rare. Up until now, no successful method is reported to treat midfoot tuberculosis. HypothesisStage surgery is a effective method to treat midfoot bone TB. Material and methodsBetween January 2008 to January 2011, 14 patients who were diagnosed with midfoot tuberculosis and suffered stage operation were enrolled. All the patients had been diagnosed definitely relying on imaging examination and laboratory tests preoperatively. Two-stage operation was performed to all patients. At the first stage, TB tissue and infective tissue were completely removed and replaced by antibiotic bone cement. Normal foot length and arch would be restored and maintained by k-wires and external fixators. At the second stage, autologous iliac and allogeneic bone graft were used to replace bone cement and by fixed by locking plates. American Orthopaedic Foot and Ankle Society (AOFAS), SF-36 and visual analogue scale (VAS) pain score were recorded at the last follow-up. ResultsThe average bone union time was 3.8 (range 3–6) months. There is no case of local recurrence or skin sinus. Neither implant broken nor screw loosen was present in this study. The AOFAS score was increased from 51.7±6.8 (range 43–61) preoperatively to 82.9±3.9 (range 76–90) postoperatively (P<0.001). The SF-36 score increased from 46.1±6.1 preoperatively to 83.1±5.4 postoperatively (P<0.001). The VAS score decreased from 6.1±1.1 preoperatively to 1.4±0.9 points postoperatively (P<0.001). DiscussionStage operation is an effective treatment to stage III, IV midfoot tuberculosis. Levels of evidenceLevel 4, retrospective.

Analysis of the factors affecting outcome after combat-related cranial defect reconstruction

IntroductionReports on the outcomes of cranioplasty after combat-related injuries are relatively rare in the current literature. We present our results on the reconstruction of cranial defects resulting from injuries sustained in combat, comparing outcomes using autologous (iliac bone) grafts or (acrylate) allografts, and analysis of other factors that may influence the final outcome. Material and methodsThe study comprised 207 patients with cranial defects resulting from combat-related injuries, repaired with autografts or allografts. The final outcome was defined at least 5 years postoperatively on the basis of cosmetic restoration and the existence of complications as successful (acceptable cosmetic restoration + absence of complications) or unsuccessful (poor cosmetic restoration or acceptable cosmetic restoration + complications). ResultsSuccessful outcomes were achieved in 83.6% of patients; there was no operative mortality. There were 25 instances of complications: postoperative infection (n = 15, allograft (7/53), autograft (8/154)), autograft resorption (n = 8), and in two cases, graft luxation. Poor cosmetic restoration was noted in 9 (4.3%) patients who had received an autograft. ConclusionsThin and poorly vascularized skin, a surface area of the defect larger than 88 cm2, previous local infection and communication with paranasal cavities significantly influenced outcomes after combat-related cranioplasty, the final three being independent predictors of an unsuccessful outcome.

Recontruction of coronoid process using autologous tricortical iliac bone graft after persistent traumatic elbow dislocation- case report

Coronoid fractures are challenging to manage and rarely isolated. It’s always associated with three instability patterns of the elbow, which is the terrible triads, varus posteromedial rotatory instability and transolecranon fracture- dislocation. We have performed an open reduction and reconstruction of the coronoid process using autologous tricortical iliac bone graft for one patient after persistent elbow dislocation in malunited type III coronoid fracture. The main goal of management of coronoid fracture with elbow dislocation is to maintain the joint stability and acceptable elbow functions. Through understanding the pattern of injuries, proper investigation and approach could improve the outcome of surgery. We believe that reconstructing coronoid process using tricortical iliac bone graft provides acceptable stable elbow joint and good functional flexion arc of motion.

The patient-reported outcome of chronic pain after the harvest of anterior iliac bone for anterior cervical arthrodesis

BackgroundAnterior cervical fusion (ACF) with autologous iliac bone graft is a traditional surgical method, but high rate of chronic pain (30%) at the anterior iliac crest presents a considerable hindrance to harvesting iliac bone. The memory of acute pain may become fainter as time progresses, and the incidence of chronic pain may not be as high as previously reported. The primary objective was to show the patient-reported outcome of chronic pain in the anterior iliac crest. MethodsTelephone surveys were conducted for patients with single-level ACF (group-S; n=72; M:F=52:20; median age, 53years), multiple-level ACF (group-M; n=61; M:F=40:21; 56years) using autologous iliac bone, and single-level ACF with a stand-alone cage (group-C; n=53; M:F=38:15; 51years). Logistic regression analysis was performed to determine the risk factors, and the variables included group, age, gender, postoperative period and satisfaction with the surgical outcome. ResultsThere was no chronic pain in 87% of the patients, with no difference among the groups (p=0.52). During the acute postoperative period, patients remembered no pain in 38/72 (53%) patients of group-S, 25/61 (41%) of group-M and 42/53 (79%) of group-C (p<0.001). Female gender (p=0.027; OR, 2.68; 95% CI, 1.12–6.41) was the risk factor for chronic pain. ConclusionsIliac bone harvest may not cause chronic pain in 87% of patients, and the memory of acute pain was faded in 40–50% of patients. Female gender was a risk factor for chronic pain. This information should be considered before harvesting iliac bone.

Two-stage operation to treat destructive midfoot tuberculosis: 14 cases experience

IntroductionTuberculosis (TB) in midfoot is often secondary to tuberculosis elsewhere in the body. The experience and literatures to treat midfoot tuberculosis are rare. Up until now, no successful method is reported to treat midfoot tuberculosis. HypothesisStage surgery is an effective method to treat midfoot bone TB. Material and methodsBetween January 2008 to January 2011, 14 patients who were diagnosed midfoot tuberculosis and suffered stage operation were enrolled. All the patients had been diagnosed definitely relying on imaging examination and laboratory tests preoperatively. Two-stage operation was performed to all patients. At the first stage, TB tissue and infective tissue were completely removed and replaced by antibiotic bone cement. Normal foot length and arch would be restored and maintained by K-wires and external fixators. At the second stage, autologous iliac and allogeneic bone graft were used to replace bone cement and by fixed by locking plates. American Orthopaedic Foot and Ankle Society (AOFAS), SF-36 and visual analogue scale (VAS) pain score were recorded at the last follow-up. ResultsThe average bone union time was 3.8 (range 3–6) months. There is no case of local recurrence or skin sinus. Neither implant broken nor screw loosen was present in this study. The AOFAS score was increased from 51.7±6.8 (range 43–61) preoperatively to 82.9±3.9 (range 76–90) postoperatively (P<0.001). The SF-36 score increased from 46.1±6.1 preoperatively to 83.1±5.4 postoperatively (P<0.001). The VAS score decreased from 6.1±1.1 preoperatively to 1.4±0.9 points postoperatively (P<0.001). DiscussionStage operation is an effective treatment to stage III, IV midfoot tuberculosis. Levels of evidenceLevel IV, retrospective.

Morphology analysis of nano hydroxyapatite/biphasic calcium phosphate for posterlateral lumbar fusion after combined magnetic field-an experimental study in rabbit

Objective To analyze morphology of nano hydroxyapatite (nano-HA) coating and combined magnetic field (CMF) treatment on rabbits posterlateral lumbar fusion (PLF). Methods 48 adult rabbits undergone bilateral intertransverse processes fusion at the level of L5-6 were randomly divided into six groups G1, G2, G3, G4, G5 and G6 according to grafts used and CMF treatment. Group G1 received autologous iliac bone graft (AIBG) and CMF treatment; Group G2, nano-HA/biphasic calcium phosphate (BCP)+ CMF; Group G3, BCP+ CMF; Group G4, AIBG + placebo; Group G5, nano-HA/BCP + placebo; Group G6, BCP+ placebo. CMF treatments began at postoperative 1 week for 8 weeks, 30 minutes a day. The animals were euthanized at postoperative 9 weeks. Analyses included Field Emission Transmission Electron Microscope (FESEM), bone morphogenetic protein-2 (BMP-2) and transforming growth factor-β1 (TGF-β1) expression by immunohistochemistry and histological analysis. Results The biological scaffold were covered with new bone callus and bone ingrowth. Continuous bone bridge formed between the L5 and L6 transverse process in some specimens.The histological fusion score in G1-G6 group was 7.25±1.16, 5.00±0.76, 5.88±1.64, 5.87±1.25, 6.50±1.60 and 5.25±1.91. CMF and nano-HA coating significantly improved the spinal fusion rate, fusion score (P 0.05). Conclusion Both CMF and nano-HA coating can promote new bone formation and osseointegration, improve the spinal fusion rate in this rabbit PLF model. CMF combined with nano-HA/BCP for PLF can be used as a new spinal fusion method. Key words: Nano hydroxyapatite coating; Combined magnetic field; Biphasic calcium phosphate; Posterlateral lumbar fusion

Posterior Open Reduction and Interlaminae Compression Fusion for Os Odontoideum with Atlantoaxial Dislocation

To evaluate the outcome of posterior open reduction and interlaminae compression fusion using a screw-rod system combined with a structural iliac bone graft in the treatment of atlantoaxial dislocation (AAD) secondary to os odontoideum. A retrospective study was performed on 24 patients with AAD secondary to os odontoideum. All cases were with partial reduction after skeletal traction. Intraoperative open reduction and fixation were performed with a posterior screw-rod system, followed by interlaminae compression of an autologous iliac bone graft for fusion. The modified atlanto-dental interval (MADI) was measured to assess the degree of dislocation before traction, after traction, and postoperatively. Japanese Orthopaedic Association (JOA) score, Nurick scale score, visual analog scale score for neck pain (VASSNP), Neck Disability Index (NDI) score, and neck stiffness were used to evaluate functional outcomes. The mean duration of follow-up was 43.0±24.0 months. All patients achieved relief of symptoms and solid bone fusion. There were no complications associated with instrumentation and operation. At the final follow-up, the average MADI was reduced to 2.0 ± 0.8 mm (pretraction: 9.2 ± 1.1 mm; post-traction: 6.6 ± 0.7 mm; P<0.001). The neck stiffness was significantly relieved (P< 0.001), and function of the spinal cord manifested by the JOA score and Nurick scale score significantly improved (all P < 0.001). The NDI score and VASSNP markedly decreased (all P < 0.001). Intraoperative open reduction and interlaminae compression fusion using a posterior screw-rod system combined with a structural iliac bone graft is a safe and effective procedure for AAD secondary to os odontoideum.

Anterior Coloumn Reconstruction with Stand Alone Titanium Cage, without Anterior Plating in Tuberculosis Cervical Spine. An Experience of 47 Patients

Introduction Tuberculosis is a common problem specially in under developed countries. Tuberculosis of the vertebral column constitutes nearly 50% of all lesions of osteoarticular tuberculosis. The commonest site for the disease is in the peridiscal region. Treatment option usually is anti tuberculous chemotherapy but in some patients usually with severe pain and involving neurology, instability, large abcess, surgery is recommended. To our knowledge there is not a single publication in literature in which standalone titanium cage and bone graft without anterior plating is used in the treatment of TBS. The aim of this study is to evaluate the efficacy of standalone titanium mesh cages in TB cervical spine. Material and Methods A retrospective study of 47 patients with cervical tuberculous spondylitis (TBS) was performed at Ghurki trust teaching hospital. This study approved by the Institutional Review board and the ethics committee, included 47 patients with TBS of cervical spine who gave their informed consent to be included in the research. All patients had radical debridement, decompression, anterior coloumn reconstruction and instrumentation with standalone titanium cage without anterior plating filled with autologous iliac bone graft. The diagnosis of TBS was based on clinical correlation including night fever, loss of weight, fatigue and neck pain, laboratory investigations including ESR, CRP and tuberculin test were done in all patients. Visual analogue score (VAS) and frankel scoring system was used to score pain severity and grade neurological status. ATT was started preoperatively. The radiographic assessment included preoperative standard anteroposterior and lateral views. Cobbs methos was used to measure the sagittal profile. Results 61.6% patients fell in age group 3–35 years and 28.4% fell in group 36–70 years of age. 26 were men and 21 were women. Out of all patients 26 had pre op frankel grade E and 4pts had grade D and 10 pts had grade C and 2 pts had grade B and five pts had grade A preoperatively. Post operatively one patient of grade A remained same while other four improved to grade C in follow up and rest of all pts. improved to grade E in two year follow up. Pre-op cob's angle was 39.06 ± 10.92 (Mean±SD) which improved to -5.51 ± 4.77 (Mean±SD). P value is &lt; 0.05. In comparison of visual analogue score there is also statistically significant difference in pain improvement. All patients had single stage radical debridement, decompression and instrumentation. Anterior coloumn reconstruction was done in all patients using standalone titanium cage. Conclusion The use of titanium cages effectively restores the sagittal deformity in TB spine with no donor site morbidity.

Clavicle Nonunion: Matchstick Bone-grafting and Osteosynthesis

Background: This study was conducted to evaluate the surgical outcomes of plate fixation using autologous iliac bone graft shaped in the form of a matchstick in clavicle nonunion resulting from prior surgical or non-surgical management. Methods: From May 2005 to February 2013, 17 patients underwent surgery for clavicle nonunion. The mean age at the time of surgery was 48.8 years. The iliac bone was harvested and shaped into slivers approximately 3 cm long, which resembled matchsticks. After opening of the medullary canal, the plate and screws were applied and cancellous bone was placed at the nonunion site. Matchstick bone grafts which were longitudinally placed and encircled on the nonunion site were tied with periosteum using 3–4 stitches. Union was determined via postoperative plane X-ray. Clinical status was evaluated using the visual analogue scale score for pain, and Constant and American Shoulder Elbow Surgeon score. Results: All patients had a stable radiological union at the follow-up. The mean duration from index operation to nonunion operation was 13.2 months (7–32 months). The mean follow-up period was 20.1 months (8–56 months), and the mean duration until union was 11.2 weeks (8–16 weeks). All clinical scores were improved at the final follow-up (p Conclusions: Matchstick shaped autologous iliac bone grafting technique in clavicle nonunion is acceptable with a high union rate.

The fusion rate of demineralized bone matrix compared with autogenous iliac bone graft for long multi-segment posterolateral spinal fusion

BackgroundAlthough autogenous iliac bone graft (AIBG) remains the gold standard for spine fusion, harvesting morbidity has prompted the search for alternatives especially for multi-segment fusion. This study aimed to evaluate the efficacy of using demineralized bone matrix (DBM) as a substitute of AIBG for long instrumented posterolateral fusion (≧ three-level fusion).MethodsA total of 47 consecutive patients underwent laminectomy decompression, and multi-level instrumented posterolateral fusions were reviewed. Group 1 comprised 26 patients having DBM with autologous laminectomy bone (ALB). Group 2 consisted of 21 patients having AIBG with ALB. The fusion success evaluation was based on findings using the 12-month anteroposterior and dynamic plain radiographs.ResultsGender, age, and the number of fusion levels were similar for both groups. 21 of 26 (80.8 %) patients in group 1 and 18 of 21 (85.7 %) patients in group 2 were observed to achieve solid bony fusion. There was no statistical difference in the fusion success (p = 0.72). Blood loss was significantly more in group 2 (p = 0.02). The duration of the hospital stays and operative times being longer for group 2, but the difference was not significant.ConclusionsDBM combined with ALB and osteoconductive materials is as effective as an autologous iliac bone graft with respect to long multi-segment posterolateral fusion success. DBM can be used as an effective bone graft substitute and may decrease morbidities associated with iliac bone graft harvest.

Percutaneous Transpedicular Interbody Fusion Technique in Percutaneous Pedicle Screw Stabilization for Pseudoarthrosis Following Pyogenic Spondylitis.

This report introduces a percutaneous transpedicular interbody fusion (PTPIF) technique in posterior stabilization using percutaneous pedicle screws (PPSs). An 81-year-old man presented with pseudoarthrosis following pyogenic spondylitis 15 months before. Although no relapse of infection was found, he complained of obstinate low back pain and mild neurological symptoms. Radiological evaluations showed a pseudoarthrosis following pyogenic spondylitis at T11–12. Posterior stabilization using PPSs from Th9 to L2 and concomitant PTPIF using autologous iliac bone graft at T11–12 were performed. Low back pain and neurological symptoms were immediately improved after surgery. A solid interbody fusion at T11–12 was completed 9 months after surgery. The patient had no restriction of daily activity and could play golf at one year after surgery. PTPIF might be a useful option for perform segmental fusion in posterior stabilization using PPSs.

Surgical Outcomes of Anterior Cervical Fusion Using Deminaralized Bone Matrix as Stand-Alone Graft Material: Single Arm, Pilot Study.

ObjectiveTo investigate the safety and efficacy of demineralized bone matrix (DBM) as a bone graft substitute for anterior cervical discectomy and fusion (ACDF) surgery.MethodsTwenty consecutive patients treated with ACDF using stand-alone polyestheretherketone (PEEK) cages (Zero-P) with DBM(CGDBM100) were prospectively evaluated with a minimum of 6 months of follow-up. Radiologic efficacy was evaluated with a 6-point scoring method for osseous fusion using plain radiograph and computed tomogrpahy scans. Clinical efficacy was evaluated using the visual analogue scale (VAS), Owestry disability index (ODI), and short-form health questionnaire-36. The safety of the bone graft substitute was assessed with vital sign monitoring and a survey measuring complications at each follow-up visit.ResultsThere were significant improvements in VAS and ODI scores at a mean 6-month follow-up. Six months after surgery, solid fusion was achieved in all patients. Mean score on the 6-point scoring system was 5.1, and bony formation was found to score at least 4 points in all patients. There was no case with implant-related complications such as cage failure or migration, and no complications associated with the use of CGDBM100.ConclusionACDF using CGDBM100 demonstrated good clinical and radiologic outcomes. The fusion rate was comparable with the published results of traditional ACDF. Therefore, the results of this study suggest that the use of a PEEK cage packed with DBM for ACDF is a safe and effective alternative to the gold standard of autologous iliac bone graft.

Anterior surgical treatment of 4-level cervical spondylotic myelopathy

Objective To investigate the clinical results, neurological scores, radiographic changes and complications for patients with 4-level cervical spondylotic myelopathy(4-level CSM) who underwent anterior decompression and fusion surgery. Methods All the medical records of anterior cervical surgery in our hospital between September 2006 and March 2014 were collected. Among them, thirty-two consecutive patients with 4-level CSM underwent the anterior decompression and fusion procedures were retrospectively investigated. Neurological function was measured at different times using Japanese Orthopedic Association(JOA) scores. The visual analogue score(VAS) was recorded for neck-shoulder pain evaluation. X-rays were conducted before and after surgery for cervical lordosis and fusion rate. Complications such as iliac pain, dysphonia, C5 palsy, cerebral fluid leakage, axial neck pain and temporary dysphagia were recorded and analyzed as well. Results All the operations were performed uneventfully. The mean operative time was 136±18min and mean blood loss was 67±16ml. The overall follow-up period of the patients ranged from 1-8 years(average 3.6±1.7years). The VAS score significantly decreased from 7.3±1.2 preoperatively to 3.6±0.8 at 12 months postoperatively. The JOA score was 9.2±1.6 preoperatively, and 9.6±2.2, 12.5±3.3, 13.2±3.2, 13.7±3.4 at 1 week, 3 months, 6 months and 12 months postoperatively. Autologous iliac bone grafts were used in 4 patients, whose fusion rate was 100% at 6 months postoperatively. Titanium meshes were used in 28 patients, whose fusion rate was 85.7% at 6 months postoperatively and 100% at 12 months postoperatively. No hardware-related complications such as screw pull-out or plate bending occurred during the short-or long-term follow-up. Complications included iliac pain(3 cases), dysphonia(1 case), C5 palsy(1 case), cerebral fluid leakage(2 cases), axial neck pain(5 cases) and temporary dysphagia(1 case). Conclusion Anterior approach for 4-level CSM is a challenging surgical technique. The choice of corpectomy levels should depend on the characteristics of cord compression. C4 and C6 discontinuous corpectomy with titanium mesh graft fusion and plate fixation is recommended procedure. This technique will be safe and effective if proper decompression and steady fixation are guaranteed. Key words: Cervical vertebrae; Spinal cord compression; Spinal fusion; Postoperative complications

Up-and-Coming Mandibular Reconstruction Technique With Autologous Human Bone Marrow Stem Cells and Iliac Bone Graft in Patients With Large Bony Defect

Large bony defects followed by resection of the mandible need to be reconstructed by various surgical techniques such as the fibular flap. In this article, we report the case of mandibular reconstruction with autologous human bone marrow mesenchymal stem cells and autogenous bone graft, followed by placement of dental implants and prosthodontic treatment in a patient who has been failed to reconstruct mandibular bone defect after resection of mandible.

Anterior Retropharyngeal Reduction and Sequential Posterior Fusion for Atlantoaxial Rotatory Fixation With Locked C1-C2 Lateral Facet.

Retrospective case series. To introduce a new type of atlantoaxial rotatory fixation (AARF) with a locked C1-C2 lateral facet and evaluate its therapeutic strategy. AARF presenting with torticollis and limited neck motion is commonly seen in teenagers. Fielding and Hawkins' classification is generally applied to AARF. Although conservative treatment is effective for acute AARF, it is often unsuccessful for chronic AARF, which ultimately requires surgery. We introduce a new type of chronic AARF with a locked C1-C2 lateral facet that does not fit into Fielding and Hawkins' classification and describe the appropriate treatment. Eight patients who had chronic AARF with a unilaterally locked C1-C2 lateral facet were referred to our clinic. Reduction had failed after traction for 3 to 4 weeks. After open release and reduction using the anterior retropharyngeal approach, we applied posterior C1-C2 transpedicular screw fixation with an autologous iliac bone graft for stage I or II. The anterior retropharyngeal approach provided direct access to the C1-C2 locked lateral facet. The patient in an overall poor condition (stage II) underwent delayed posterior C1-C2 arthrodesis. The others (stage I) underwent immediate posterior C1-C2 arthrodesis. All patients were followed up for an average of 14.8 months (5-37 mo). Three-dimensional computed tomography revealed C1-C-2 arthrodesis bone graft fusion after an average of 3.1 months (2-4 mo). There was no recurrence of symptoms and no dislocations or internal fixation device loosening or breakage. AARF with a locked C1-C2 lateral facet is a new type of AARF that cannot be classified using Fielding and Hawkins' classification. The anterior retropharyngeal approach for the release and reduction of AARF, followed by posterior C1-C2 arthrodesis is an effective therapeutic strategy for AARF with a locked C1-C2 lateral facet. 4.

A Retrospective Study of 39 Patients Treated With Anterior Approach of Thoracic and Lumbar Spondylodiscitis: Clinical Manifestations, Anterior Surgical Treatment, and Outcome.

The aim of this study is to report our 39 patients treated with anterior debridement and autologous iliac bone grafting with or without anterior instrumentation, which is the presumed treatment of choice for thoracic or lumbar spondylodiscitis.Our patients underwent surgical treatment of spondylodiscitis using anterior debridement and autologous iliac bone grafting with or without anterior instrumentation and were analyzed with a mean follow-up of 8 years (range, 2–11 years). Kaneda 2-rod system instrumentation was used in 12 patients, in total. Clinical outcomes were assessed by the Frankel grade. Radiographic fusion was characterized based on 3-dimensional computed tomography.Of the whole group, 20 patients suffered from tuberculous spondylodiscitis and 19 suffered from hematogenous spondylodiscitis. Pathogens responsible for pyogenic infection included Staphylococcus aureus (4 patients), Pseudomonas aeruginosa (3 patients), and Brucella melitensis (1 patient). Fifteen patients had thoracic involvement, 20 had lumbar involvement, and 4 had thoracolumbar junction involvement. Preoperative neurological deficits were noted in 13 of the 39 patients. In terms of Frankel grade, 8 patients have improved, 4 have remained the same, and 1 patient has worsened during the follow-up period. Imaging-documented fusion was achieved in 23 of 27 patients in the graft group (85% fusion rate) and 11 of 12 patients in the graft + Kaneda instrumentation group (91% fusion rate).There was no instrumentation failure, loosening, or graft-related complication such as slippage or fracture of the graft. This approach demonstrated a good recovery rate of neurological functions and a high fusion rate.

Comparison between normal anatomic plate with bone graft and locking plate in treatment of calcaneal fractures of Sanders types II & III

Objective To compare the clinical efficacy between calcaneal anatomic plate + autologous bone graft and calcaneal locking plate in treatment of calcaneal fractures of Sanders types Ⅱ & Ⅲ. Methods The current study recruited 68 cases of calcaneal fractures of Sanders types Ⅱ & Ⅲ who had been treated in our hospital from August 2010 to December 2013. The patients were treated either by ordinary calcaneal anatomic plate plus autologous iliac bone graft (36 cases) or by calcaneal locking plate (32 cases). The general clinical data were compatible between the 2 groups (P< 0.05). The 2 groups were compared in terms of operation time, postoperative drainage, hospital stay, non-bearing ambulant time, full bearing time, postoperative complications, Bohler angle, Gissane angle, the length, width and height of the calcaneus, and the Maryland scores of the foot function. Results All the patients achieved fine fracture union without postoperative infection, skin necrosis or wound dehiscence. There was no significant difference between the 2 groups in incidences of postoperative calcaneal pain or calcaneofibular impingement syndrome (P>0.05). The bone graft group needed significantly longer operation time, non-bearing ambulant time and hospital stay than the locking plate group (P 0.05). There were significant differences between pre-operation and one year post-operation in Bohler angle, Gissane angle, and the length, width and height of the calcaneus (P 0.05). The 2 groups showed insignificant differences in the Maryland scores of the foot function either (P>0.05). Conclusion In treatment of calcaneal fractures of Sanders type Ⅱ and Ⅲ, compared with ordinary plate + autologous bone graft, locking plate without bone graft may reduce the incidences of post-operative pain caused by iliac bone graft, infection, hematoma, and other complications but shows no obvious advantages in calcaneal reduction or foot function. Key words: Calcaneal fractures; Fracture fixation, internal; Bone plates

Surgical fixation methods for tibial plateau fractures.

Surgical fixation methods for tibial plateau fractures.