Autologous Iliac Bone Research Articles

Analyzing the clinical effect of one-stage anterior transplantation with iliac crest allograft or autograft in the treatment of thoracolumbar tuberculosis

Objective To evaluate the safety, feasibility and clinical efficacy of one-stage anterior transplantation with iliac crest allograft or autologous in the treatment of thoracolumbar tuberculosis. Methods From January 2012 to June 2015, 235 cases of thoracolumbar tuberculosis were treated with allogeneic or autologous iliac crest graft combined with internal fixation during one-stage after radical debridement, which were reviewed retrospectively. These cases were divided into two groups: allograft group (162 cases) and autograft group (73 cases). In allograft group, there were 87 males and 75 females, with a mean age of 42.5(range 2-80) years. In autograft group, there were 41 males and 32 females, with a mean age of 40.3 (range 14-68) years. The operation time, bleeding volume, hospital stay, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, visual analogue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, the changes of American Spinal Injury Association(ASIA) scale for neurological classification of spinal and graft fusion satisfaction rate in each groups were evaluated respectively before and after surgery. Results The operation time was (122.41±30.55) min in allograft group and (141.56±25.69) min in autograft group, the difference was statistically significant. The average hospital stay and bleeding volume were no significant difference between the two groups. In each group, VAS scores, JOA scores, ESR and CRP level and the changes of ASIA scale were significant difference between pre- and post-operation, but these index showed that there were no significant differences between the two groups. The mean ESR level was (16.46±7.39) mm/h in allograft group, and (13.61±6.85) mm/h in autograft group 3 months after the operation. The fusion time (8.13 ± 1.97) months in allograft group was significantly longer than that in autograft group (5.37±1.72) months, the difference was statistically significant. At final follow-up, the graft fusion satisfaction rate and the changes of ASIA showed no significant difference. Perioperative complications including gastrointestinal dysfunction in 5 cases (allograft group in 3cases; autograft group in 2cases), and pulmonary infection in 6 cases (allograft group in 4cases; autograft group in 2cases). Postoperative complications including kyphosis in 4 cases (allograft group in 3cases; autograft group in 1case), tuberculosis recurrence in 5 cases (allograft group in 3cases; autograft group in 2cases), sinus formation in 5 cases (allograft group in 3cases; autograft group in 2cases), chronic pain of the donor site in 6 cases (group autograft). Conclusion There was no significant difference between allogeneic iliac graft and autologous iliac graft in the treatment of thoracolumbar tuberculosis. Allogeneic iliac bone may be the ideal substitute of autologous iliac bone for the clinical treatment of thoracolumbar tuberculosis. Key words: Tuberculosis; Spinal fusion; Treatment outcome; Transplantation, homologous

Effectiveness analysis of induced membrane technique in the treatment of infectious bone defect

To evaluate the effectiveness of induced membrane technique in the treatment of infectious bone defect. Thirty-six patients (37 bone lesions) with infectious bone defects were treated with induced membrane technique between January 2011 and June 2014. There were 28 males and 8 females with an average age of 36 years (range, 20-68 years). All bone defects were post-traumatic infectious bone defect. The bone defect was located at the tibia and fibula in 24 cases (25 bone lesions), at femurs in 6 cases (6 bone lesions), at ulnas and radii in 2 cases (2 bone lesions), at calcanei in 3 cases (3 bone lesions), and at clavicle in 1 case (1 bone lesion). The average time between onset and the treatment of induced membrane technique was 6.2 months (range, 0.5-36.0 months); 15 patients were acute infections (disease duration was less than 3 months). At the first stage, after the removal of internal fixator (applicable for the patients who had internal fixation), complete debridement of infection necrotic bone tissue and surrounding soft tissue was performed and the bone defects were filled with antibiotic-impregnated cement spacers. If the bone was unstable after debridement, external fixator or plaster could be used for stabilization. Patients received sensitive antibiotics postoperatively. At the second stage (usually 6-8 weeks later), the cement spacer were removed, with preservation of the induced membrane formed by the spacer, and filled the bone defect with autologous iliac bone graft within the membrane. The hospitalization time after debridement was 17-30 days (mean, 22.2 days), and the hospitalization time after the second stage was 7-14 days (mean, 10 days). All the flaps healed uneventfully in 16 cases treated with local flap transposition or free flap grafting after debridement. One patient of femur fracture received Ilizarov treatment after recurrence of infection at 11 months after operation; 1 patient of distal femoral fracture received amputation after recurrence of infection at 1 month after operation; 1 patient of distal end of tibia and fibula fractures received ankle arthrodesis after repeated debridements due to the recurrence of infection; 1 patient of tibia and fibula fractures lost to follow-up. The other 32 patients (33 bone lesions) were followed up 1-5 years (mean, 2 years) without infection recurrence, and the infection control rate was 91.7% (33/36). All the patients had bony union, and the healing time was 4-12 months (mean, 7.5 months); no refracture occurred. One patient of femur bone defect had a lateral angulation of 15° and leg discrepancy of 1.5 cm. Superficial pin infection was observed in 7 cases and healed after intensive wound care and oral antibiotics. Adjacent joint function restriction were observed in 6 cases at last follow-up. Induced membrane technique is a simple and reliable technique for the treatment of infectious bone defect. The technique is not limited to the size of the bone defect and the effectiveness is satisfactory.

Comparison of Puddu osteotomy with or without autologous bone grafting: a prospective clinical trial

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.

Femoral supracondylar osteotomy for the treatment of valgus knee osteoarthritis in young and middle-aged patients

To evaluate the clinical efficacy of open supracondylar osteotomy of the femoral condyle for the treatment of valgus knee osteoarthritis. From April 2008 to June 2015, 21 patients with valgus knee osteoarthritis underwent an open wedge femoral supracondylar osteotomy using the distal femur dissection plates combined with autologous iliac bone graft for the bone defect. There were 8 males (8 knees) and 13 females (15 knees), ranging in age from 30 to 54 years old, with a mean age of 41.2 years old. All the patients had valgus deformity and knee joint pain in the lateral compartment. The average tibiofemoral angle was (162.0±2.6)° which was measured on the image of preoperative lower extremity weight-bearing X-ray. Clinical outcomes were comprehensively assessed according to the bone healing time, postoperative complications, progress of knee osteoarthritis after operation, the Hospital for Special Surgery rating system (HSS), and tibiofemoral angle before and after operation. All 21 patients were followed up, the valgus deformity of knee joint was corrected in all patients after operation. No obvious delayed union or nonunion were found, and no serious complications were found. The HSS knee score was improved from the preoperative 57.3±3.1 to the final follow-up time 88.6±2.7. Tibiofemoral angle was improved to the postoperative(176.0±1.4)°. Open wedge femoral supracondylar osteotomy has a clear surgical approach, and it is easy to control the bone mass of osteotomy and can effectively correct the valgus deformity and improve the function of knee joint using this method. It is an effective method for the treatment of valgus knee osteoarthritis in young and middle-aged patients.

Anterior cervical discectomy and fusion in patients with cervical disc disease- a clinical outcome study

Materials and methods: This study was conducted over a period of five years from 2008 to 2013. The study group included eight male patients and four female patients. Maximum age of the patient was sixty years and minimum age was twenty six years. Maximum period of follow up was four years and minimum was six months. All patients underwent anterior cervical discectomy and fusion with autologous iliac bone graft with instrumentation (2 patients) or without instrumentation (10 patients). For all patients postoperative period was uneventful. Conclusion: ACDF is an effective treatment for cervical disc disease in patients who failed adequate period of conservative treatment.

Autologous structural iliac bone grafts in reconstructions of short bone defects in the hand and foot after primary bone tumor resections: a single-institution retrospective study.

The use of structural autografts from the iliac crest for reconstruction of bony defects in the hand and foot was described by Wilson and Lance in 1965. However, very few series of this technique are published and long-term results are unknown. We present a single-institution series of 23 patients with a mean follow-up of 92months. We also describe a novel modification of this technique using the anterior superior iliac spine for reconstruction of the adjacent joint. Failure rate was 13% at mean of 17.3months. All patients had a firm grip in the hand and walked without support. Bony fusion was achieved in all cases regardless of the type of fixation used. The use of ASIS for joint reconstruction was successful, particularly in low-demand joints. We encountered 1 case of instability and progressive stiffness in weight-bearing joints. This is a reliable method of reconstructing bony defects in the hand or foot following tumor resections.

Difference in Spinal Fusion Process in Osteopenic and Nonosteopenic Living Rat Models Using Serial Microcomputed Tomography.

ObjectiveTo identify and investigate differences in spinal fusion between the normal and osteopenic spine in a rat model.MethodsFemale Sprague Dawley rats underwent either an ovariectomy (OVX) or sham operation and were randomized into two groups: non-OVX group and OVX group. Eight weeks after OVX, unilateral lumbar spinal fusion was performed using autologous iliac bone. Bone density (BD) was measured 2 days and 8 weeks after fusion surgery. Microcomputed tomography was used to evaluate the process of bone fusion every two weeks for 8 weeks after fusion surgery. The fusion rate, fusion process, and bone volume parameters of fusion bed were compared between the two groups.ResultsBD was significantly higher in the non-OVX group than in the OVX group 2 days and 8 weeks after fusion surgery. The fusion rate in the non-OVX group was higher than that in the OVX group 8 weeks after surgery (p=0.044). The bony connection of bone fragments with transverse processes and bone formation between transverse processes in non-OVX group were significantly superior to those of OVX group from 6 weeks after fusion surgery. The compactness and bone maturation of fusion bed in non-OVX were prominent compared with the non-OVX group.ConclusionThe fusion rate in OVX group was inferior to non-OVX group at late stage after fusion surgery. Bone maturation of fusion bed in the OVX group was inferior compared with the non-OVX group. Fusion enhancement strategies at early stage may be needed to patients with osteoporosis who need spine fusion surgery.

Polyetheretherketone Cage with Demineralized Bone Matrix Can Replace Iliac Crest Autografts for Anterior Cervical Discectomy and Fusion in Subaxial Cervical Spine Injuries.

ObjectiveThis study aimed to compare the clinical and radiologic outcomes of patients with subaxial cervical injury who underwent anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft or polyetheretherketone (PEEK) cages using demineralized bone matrix (DBM).MethodsFrom January 2005 to December 2010, 70 patients who underwent one-level ACDF with plate fixation for post-traumatic subaxial cervical spinal injury in a single institution were retrospectively investigated. Autologous iliac crest grafts were used in 33 patients (Group I), whereas 37 patients underwent ACDF using a PEEK cage filled with DBM (Group II). Plain radiographs were used to assess bone fusion, interbody height (IBH), segmental angle (SA), overall cervical sagittal alignment (CSA, C2–7 angle), and development of adjacent segmental degeneration (ASD). Clinical outcome was assessed using a visual analog scale (VAS) for pain and Frankel grade.ResultsThe mean follow-up duration for patients in Group I and Group II was 28.9 and 25.4 months, respectively. All patients from both groups achieved solid fusion during the follow-up period. The IBH and SA of the fused segment and CSA in Group II were better maintained during the follow-up period. Nine patients in Group I and two patients in Group II developed radiologic ASD. There were no statistically significant differences in the VAS score and Frankel grade between the groups.ConclusionThis study showed that PEEK cage filled with DBM, and plate fixation is at least as safe and effective as ACDF using autograft, with good maintenance of cervical alignment. With advantages such as no donor site morbidity and no graft-related complications, PEEK cage filled with DBM, and plate fixation provide a promising surgical option for treating traumatic subaxial cervical spine injuries.

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.

The causes and surgical strategy of spinal tuberculosis retreatment

Objective To investigate the causes of spinal tuberculosis retreatment and its surgical treatment strategy. Methods Between May 2010 and May 2014, 96 patients with spinal tuberculosis who had been operated before were retreated. The dates of them were reviewed. There were 51 males and 45 females with mean age of 39.7 years. Deciding upon the revision surgical procedure should be determined by last operation approach, the direction of compression of spinal cord, the position of sinus and extent of foci. The retreated patients were compared with 481 unretreated patients in the following index including sex, age, duration of disease, focus range, nutrition, drug resistant tuberculosis, debridement, stability of instrumentation, postoperative regular chemotherapy, associated tuberculosis. Results The surgery duration time was 160-280 min, average 210 min, and the blood loss was 400-1500 ml, average 600 ml. The VAS score before the operation was 6-9 (average 7.5) and 1-3 (average 1.5) at the last follow-up, the difference was statistically significant. Neurological deficits in 21 patients clinically improved at least one grade according to the ASIA grading system at last follow-up. Kyphosis and scoliosis degrees were corrected significantly postoperatively and the correction was 9.5°±3.6° at the final follow-up. The average angle loss was 3.5°±1.1°. There was significant difference between the kyphosis angles preoperatively, postoperatively and final follow-up. Kirkaldy-Willis function score showed that the total fine rate was 88%. There were 35 patients whose tuberculosis bacterial culture and drug sensitive experiments suggested drug resistance. Wound healing delayed in 7 patients. 24 cases had sinus formation, 13 cases in which were healed after wound dressing, and 11 cases undertook operation again. Conclusion The causes of spinal tuberculosis retreatment include uncompleted debridement, drug resistant strains of tuberculosis, irregular postoperative anti-tubercular treatment, poor preoperative nutritional status and failure of spinal stability reconstruction. The key of successful revision surgery includes radical debridement, strut grafting with autologous iliac bone block, proper reconstruction of spinal stability, individualized chemotherapy according to the drug-resistance, and the appropriate use of irrigation and drainage postoperatively. Key words: Tuberculosis; Spinal diseases; Risk factors; Clinical protocols

Autologous Iliac Crest Bone Marrow Mononuclear Cells in Bone Fusion

Introduction: Autologous iliac bone harvesting is associated with significant drawbacks and low fusion rates are noted in conditions such as osteoporosis. Bone Marrow Aspirate (BMA) is relatively inexpensive and contains mononuclear cells which can be utilised. Aim: To document the efficacy of concentrated Bone Marrow Mononuclear Cells (BM-MNC) in bone fusion and compare fusion rates with autologous Iliac Crest Bone Graft (ICBG) alone versus combined ICBG and BM-MNC. Materials and Methods: This prospective, non randomised study included study group and age matched control group (of previously operated craniovertebral junction anomalies) with 15 patients in each group. Combined autologous ICBG+BM-MNC (study group) was compared with autologous ICBG alone (control group). The BMA was processed in stem-cell laboratory to procure mononuclear cells. Morcelised graft pieces mixed with BM-MNC were applied over fusion site after instrumentation. Patients were assessed for fusion and neurological outcome. Qualitative data analysis was done using Fisher exact test. Results: Mean age, surgical procedures and complications were similar in both groups. Average duration for procurement of cells was 98 minutes. Average of 40.6 million cells were utilised. Higher fusion rates were noted in the study group both at three and six months which, however, was not statistically significant (p-value 0.06 and 0.26 respectively). Conclusion: To the best of our knowledge, this is the first study of its kind to utilise concentrated mononuclear cells combined with iliac graft which lead to higher proportion of fusion and was effective in all surgical procedures. It seems economical and might be suitable for patients who cannot afford expensive graft substitutes and with conditions like osteoporosis. Further prospective studies in larger numbers are needed to confirm these findings.

Anterior Cervical Corpectomy and Fusion Using a Synthetic Hydroxyapatite Graft for Ossification of the Posterior Longitudinal Ligament.

The significant complication rate associated with harvesting autologous iliac bone or fibula has encouraged development of alternative graft substitutes. In this study, the authors investigated the efficacy and safety of synthetic porous hydroxyapatite (HA) combined with local vertebral bone graft for use in anterior cervical corpectomy and fusion (ACCF) for the treatment of patients with ossification of the posterior longitudinal ligament (OPLL). Since 2006, twenty-five OPLL patients underwent ACCF using HA blocks (HA group). Hydroxyapatite blocks with 40% porosity were used for the 1-level ACCFs, and HA blocks with 15% porosity were used for the 2-level ACCFs. Clinical and radiological evaluation was performed with a minimum of 2-year follow-up. Outcomes were compared with those of 25 OPLL patients who underwent ACCFs using auto-fibula grafts at the authors' institution before 2006 (FBG group). Patients' demographic data were similar in the HA and FBG groups. Both groups demonstrated significant neurological improvements postoperatively. No difference was observed in operating time, whereas the intraoperative blood loss was significantly less in the HA group. The fusion rates in the HA group were comparable to those in the FBG group. The incidences of general complications were similar in the 2 groups; however, prolonged donor-site pain was observed in 9 (36.0%) cases in the FBG group. Based on the results of this study, ACCF using HA is a safe and efficacious method for the treatment of patients with OPLL as an alternative to conventional ACCF using autologous fibula bone grafting. [Orthopedics. 2017; 40(2):e334-e339.].

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.