Bone Chips Research Articles

Thermoresponsive Inverted Colloidal Crystal Hydrogel Scaffolds for Lymphoid Tissue Engineering.

Inverted colloidal crystal (ICC) hydrogel scaffolds represent unique opportunities in modeling lymphoid tissues and expanding hematopoietic-lymphoid cells. Fully interconnected spherical pore arrays direct the formation of stromal networks and facilitate interactions between stroma and hematopoietic-lymphoid cells. However, due to the intricate architecture of these materials, release of expanded cells is restricted and requires mechanical disruption or chemical dissolution of the hydrogel scaffold. One potent biomaterials strategy to release pore-entrapped hematopoietic-lymphoid cells without breaking the scaffolds apart is to transiently increase the dimensions of these materials using stimuli-responsive polymers. Having this mindset, thermoresponsive ICC scaffolds that undergo rapid (<1 min) and substantial (>300%) diameter change over a physiological temperature range (4-37 °C) by using poly(N-isopropylacrylamide) (PNIPAM) with nanogel crosslinkers is developed. For a proof-of-concept study, the stromal niche by creating osteospheroids, aggregates of osteoblasts, and bone chips is first replicated, and subsequently Nalm-6 model hematopoietic-lymphoid cells are introduced. A sixfold increase in cell count is harvested when ICC hydrogel scaffolds are expanded without termination of the established 3D stromal cell culture. It is envisioned that thermoresponsive ICC hydrogel scaffolds will enable for scalable and sustainable ex vivo expansion of hematopoietic-lymphoid cells.

The efficacy of porous hydroxyapatite chips as gap filling in open-wedge high tibial osteotomy in terms of clinical, radiological, and histological criteria

PurposeHydroxyapatite (HA) does not fully degrade, which raises concerns about poor remodeling and incorporation into the bone after open-wedge high tibial osteotomy (HTO). The purpose of this study was to compare the results between gap filling with allogenous chip bone and HA chip after open-wedge HTO using propensity score matching and to analyze the radiological unabsorbed area of opening gaps histologically in HA using patients. MethodsThe matched variables were age, body mass index, sex, correction angle, and smoking status. After matching, the allogenous group and HA group included 33 patients each with two years of follow-up. The range of motion (ROM), International Knee Documentation Committee (IKDC) subjective score, Knee Injury and Osteoarthritis Outcome Score (KOOS), mechanical axis (MA), tibial slope, osteoconductivity, and absorbability were evaluated and compared between both groups. Among the HA group, 20 patients underwent bone biopsy and histologically analyzed of the radiological unabsorbed area. ResultsThe postoperative ROM, IKDC subjective score, and KOOS were similar in both groups. The osteoconductivities did not differ significantly. The absorbability in the HA group was significantly lower than allogenous group (59.6% vs. 22.6%, P < .001). The histological sections of the radiological unabsorbed area showed mature lamelliform bone tissues were significantly greater than structurally degraded remnant HA (30.4% and 4.2%, P < .001). ConclusionThe HA chips showed an inferior absorbability, however, a mature lamelliform bone was observed in significantly larger amounts than remnant HA in the radiological unabsorbed area. The allogenous bone chips and HA chips showed similar clinical and radiological results after open-wedge HTO.

Split crest technique for implant treatment of agenesis of the upper lateral incisors: results of a randomized pilot histological and clinical study at 24-month follow-up.

Agenesis of lateral incisors, besides the functional issues, represents a great esthetic drawback. The selection of an appropriate treatment is a complex decision, which should consider the stability of the clinical outcomes over time. The aim of the present study was a histological and clinical comparison of two-stage split crest technique (SCT), with bone chips alone or mixed with porcine bone in patients affected by unilateral and bilateral agenesis of the upper lateral incisors. Eleven patients were enrolled, and randomly assigned to receive a treatment with autologous bone chips (group 1) or autologous bone chips mixed 1:1 to porcine-derived xenogenic bone (group 2). After a 2-month healing period, implants were placed and biopsies harvested for histomorphometrical evaluation. Clinical assessment, according to ICOI PISA health scale, and radiographic marginal bone loss evaluation at 12- and 24-month follow-ups were conducted. The histomorphometry showed significantly greater new bone formation (p > 0.0229) in group 2. At 12- and 24-month follow-ups, all the evaluated implants, regardless of the group they were allocated, could be categorized as "success" in the ICOI Pisa Health Scale for Dental Implants, and did not show significant difference in crestal bone loss. To the best of our knowledge, these are the first histological and clinical outcomes indicating that the use of bone chips mixed 1:1 to porcine bone in SCT could be a promising technique for the rehabilitation of patients with agenesis of the upper lateral incisors, although studies with a larger number of patients and implants, and a longer follow up are needed.

A New Surgical Protocol For Horizontal Ridge Augmentation: Simplified Apposition Technique. Human Histologic and Radiographic Analysis After 2.5 Years of Follow-Up, A Case Report

Following tooth extraction, alveolar ridge undergoes a physiological and inevitable remodeling process that could influence the prosthodontic rehabilitation. Therefore, augmentation of an insufficient bone volume is often indicated, although it remains a significant challenge in clinical practice. The aim of this case report was to scientifically validate a new minimally invasive surgery technique called “Simplified Apposition Technique” (S.A.T), which consists in the use of deproteinized bovine bone, human fibrin glue and collagen membrane in association with a post-extraction socket, in order to obtain an increase of the horizontal ridge dimension in the nearby atrophic bone crest. A 69-years-old man patient was enrolled in this study. The hopeless tooth 4.7 was extracted and the ridge reconstruction and the socket preservation were carried out following S.A.T. After 11 months, the formation of newly bone was evaluated through radiographic analysis (Cone Beam Computed Tomography, CBCT) comparing the status before and after surgery and at 2.5 years of follow-up. Simultaneously, an implant was placed in the regenerated site and the bone chips remaining in the drills were used for the histological evaluation. The CBCT revealed an increase of the bone crest width from 3.7 to 6.5 mm and, after 2.5 years of follow-up, the bone width has remained stable. The histological evaluation showed various stages of bone formation and maturation with a good integration of the regenerated area. According to these results, S.A.T can be considered a good surgical technique for horizontal ridge augmentation in the atrophic bone, near the extraction site.

Instrumented posterior lumbar interbody fusion using a single cage and corticocancellous laminectomy bone chips for L4-L5 massive lumbar disc herniation with instability

Introduction: Lumbar disc herniation is one of the most common spinal degenerative disorders which leads to low back pain and radicular leg pain. The aim of this study is to evaluate the clinical and radiological outcome of Instrumented Posterior Lumbar Interbody Fusion in L4-L5 massive lumbar disc herniation with instability. Materials and Methods: It is a prospective clinical study of 10 consecutive patients. The duration of study is from July 2015 to July 2016. The duration of follow up range from 12 to 18 months. Clinical outcome is assessed using Oswestry Disability Index (ODI), Visual Analog score (VAS), The Japanese Orthopaedic Association (JOA) score. Radiological outcome on fusion by using Modified criteria of Lee et al. Results: Of the 10 patients (8 male and 2 female) with the mean age of 60.9 years. Average follow up duration is 14 months. Mean BMI of the patients is 26.14 + 1.95 kg/m2. The difference in pre-operative and post-operative patient’s ODI, VAS and JOA scores are significant (p value < 0.05). Surgery restores the disc height and at a mean follow up of 14 months, 8 patients shows possible fusion and 2 patients shows possible pseudoarthrosis. Conclusions: Corticocancellous Laminectomy bone chips with single cage provide adequate fusion and stability in L4- L5 Instrumented Posterior Lumbar Interbody fusion.

Health Related Quality of Life after the Bony Obliteration Tympanoplasty for COM with Cholesteatoma using the COMQ12 - A Disease Specific PROM.

This study aimed to investigate the effect of canal wall up with bony obliteration tympanoplasty (CWU-BOT) on the health-related quality of life (HRQOL) in patients with chronic otitis media with cholesteatoma by using the chronic otitis media questionnaire 12 (COMQ-12). This study is a retrospective analysis of the COMQ-12 of 26 patients who completed the COMQ-12 before and after a CWU-BOT with eradication of cholesteatoma followed by obliteration of the mastoid and paratympanic space with bone chips and bone pâté and reconstruction of the tympanic membrane and ossicular chain. All patients were operated upon in our institute between 2014 and 2017. The median score of the 12 questions was preoperatively and postoperatively calculated, and then compared. A large effect was observed in the total score and the questions about running ear, discharge, and visits to the general practitioner. A medium positive size effect was observed in the questions about hearing in noisy surroundings, discomfort, dizziness, tinnitus, medication use, and the mental aspect of the patient. In the questions about the hearing at home and quality of life and impact on work, we noted a small positive size effect. In 50% of patients, the HRQOL became normal; the remaining 50% improved to a level very close to normal. Canal wall up with bony obliteration tympanoplasty (CWU-BOT) showed a clear decrease in the severity of the symptoms, life and work impact, and health care after surgery.

Direct Reprogramming of Mouse Fibroblasts into Functional Osteoblasts.

Although induced pluripotent stem cells hold promise as a potential source of osteoblasts for skeletal regeneration, the induction of pluripotency followed by directed differentiation into osteoblasts is time consuming and low yield. In contrast, direct lineage reprogramming without an intervening stem/progenitor cell stage would be a more efficient approach to generate osteoblasts. We screened combinations of osteogenic transcription factors and identified four factors, Runx2, Osx, Dlx5, and ATF4, that rapidly and efficiently reprogram mouse fibroblasts derived from 2.3 kb type I collagen promoter-driven green fluorescent protein (Col2.3GFP) transgenic mice into induced osteoblast cells (iOBs). iOBs exhibit osteoblast morphology, form mineralized nodules, and express Col2.3GFP and gene markers of osteoblast differentiation. The global transcriptome profiles validated that iOBs resemble primary osteoblasts. Genomewide DNA methylation analysis demonstrates that within differentially methylated loci, the methylation status of iOBs more closely resembles primary osteoblasts than mouse fibroblasts. We further demonstrate that Col2.3GFP+ iOBs have transcriptome profiles similar to GFP+ cells harvested from Col2.3GFP mouse bone chips. Functionally, Col2.3GFP+ iOBs form mineralized bone structures after subcutaneous implantation in immunodeficient mice and contribute to bone healing in a tibia bone fracture model. These findings provide an approach to derive and study osteoblasts for skeletal regeneration. © 2019 American Society for Bone and Mineral Research.

Multiple Myeloma Pathogenesis: The Role of Junb in Bone Marrow Angiogenesis

A significant increase in bone marrow (BM) angiogenesis represents a key event in early, microenvironment-dependent, multiple myeloma (MM). Angiogenic growth factor- and cytokine- production and secretion is a complex process regulated by a plethora of transcription factors (TFs). Over the past years, members of the AP-1 family of TFs have emerged as potential new therapeutic targets. Our recent work demonstrated for the first time a pivotal role for the AP-1 family member JunB in MM pathogenesis (Fan et al., 2017). Whether JunB also contributes to MM BM angiogenesis is currently unknown. In silico and immunohistochemical analyses revealed a correlative increase of JunB and angiogenic growth factors in samples isolated from healthy donors to MGUS and MM patients; and a decrease in samples isolated from patients with plasma cell leukemia. These data were supported by the utilization of an innovative in vivo MM model of clonal evolution. Specifically, JunB as well as selected angiogenic factors were significantly increased in tumor cell clones at primary sites (bone chips) versus tumor cell clones at metastatic (distant BM) sites, as evidenced by whole exome and RNA sequencing. Functionally, doxycyclin- induced inhibition of stroma cell: MM cell co-culture- as well as of IL-6- mediated JunB upregulation in TetR-shJunB/ MM.1S cells significantly reduced production and secretion of angiogenic factors; and consequently inhibited in vitro angiogenesis. Conversely, 4-hydroxytamoxifen (4-OHT)-mediated upregulation of JUNB activity in JUNB-ER/MM cells strongly increased the expression and secretion of angiogenic factors and in vitro angiogenesis. The interaction of JunB with angiogenic factor- encoding DNA in MM cells was further confirmed utilizing chromatin immunoprecipitation (ChIP)- sequencing. Finally, treatment with doxycycline effectively inhibited JunB levels and consistently reduced microvessel density in immunodeficient NSG mice inoculated with TetR-shJUNB/ MM.1S, but not TetR-SCR/ MM.1S. In conclusion, our findings demonstrate a pivotal role of JUNB in MM BM angiogenesis; they thereby provide further evidence that JUNB is a promising therapeutic target particularly in early MM. Disclosures Vallet: Pfizer: Honoraria; Roche Pharmaceuticals: Consultancy; MSD: Honoraria. Roccaro:Associazione Italiana per al Ricerca sul Cancro (AIRC): Research Funding; Associazione Italiana per al Ricerca sul Cancro (AIRC): Research Funding; AstraZeneca: Research Funding; Transcan2-ERANET: Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Transcan2-ERANET: Research Funding; AstraZeneca: Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees; European Hematology Association: Research Funding; European Hematology Association: Research Funding. Goldschmidt:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; John-Hopkins University: Research Funding; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; MSD: Research Funding; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Mundipharma: Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Adaptive Biotechnology: Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Research Funding; Dietmar-Hopp-Stiftung: Research Funding; John-Hopkins University: Research Funding; Chugai: Honoraria, Research Funding; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Research Funding; Molecular Partners: Research Funding. Podar:Takeda: Consultancy; Celgene: Consultancy, Honoraria; Amgen Inc.: Honoraria; Janssen Pharmaceuticals: Consultancy, Honoraria; Roche Pharmaceuticals: Research Funding.

The Influence of Thrust Force on the Vitality of Bone Chips Harvested for Autologous Augmentation during Dental Implantation.

Bone drill chips that are collected during implant site preparation can be reused as autologous bone-grafting material for alveolar ridge augmentation. This study characterized five market-leading implant drill sets regarding their geometric properties and ability to produce vital bone chips. The drill geometry of each tool of five commercial implant drill sets was characterized while using optical profile projector devices and SEM. Bone chips were collected during the in vitro preparation of porcine jaw bone with the various drill sets. Produced bone chip masses were measured. The bone chips were cultured in vitro and the number of outgrown cells was determined and measurand for vitality. Furthermore, the thrust force and cutting torque were recorded to examine the mechanical loads of the manual drilling process. The tool geometry and set configuration of one out of five implant drill sets appears to be superior regarding chip mass, vitality, and thrust force. It could be proven that there is a correlation between vitality and thrust force. The thrust force is influenced by the cutting behavior of the tool, which in turn depends on the geometry of the tool. The tool geometry has an influence on the vitality of the augmentation material due to this relationship.

Bovine-derived xenograft in combination with autogenous bone chips versus xenograft alone for the augmentation of bony dehiscences around oral implants: A randomized, controlled, split-mouth clinical trial.

The aim of the study was to evaluate whether the use of a xenograft is not inferior to the use of xenograft and autogenous bone chips in treating dehiscences at implant placement. After implant placement, leaving a dehiscence, control sites were treated using a composite graft (autogenous bone chips and xenograft) and at the test sites 100% xenograft was used. Both sites were covered with a resorbable collagen membrane. Dehiscences were measured clinically at implant placement and at re-entry. CBCT was taken immediately after implant placement and after 4months. In total, 28 GBR procedures were performed in 14 patients. On average, the change in vertical defect height was 2.07mm (46.7%-test group) and 2.28mm (50.9%-control group) (p>.05). The horizontal defect width at the implant shoulder change on average 1.85mm (40.5%-test group) and 1.75mm (40.9%-control group) (p>.05). On average, a loss in augmentation thickness of 0.45mm (68.9%-test group) and 0.64mm (55.5% control group) between implant placement and augmentation and abutment surgery was obtained at the implant shoulder. Both treatment modalities seem to work to a certain extent. At implant shoulder level, the augmentation thickness seems to be disappeared after the healing phase. (NCT03946020).

Calcium Phosphate Bone Graft Substitutes with High Mechanical Load Capacity and High Degree of Interconnecting Porosity.

Bone graft substitutes in orthopedic applications have to fulfill various demanding requirements. Most calcium phosphate (CaP) bone graft substitutes are highly porous to achieve bone regeneration, but typically lack mechanical stability. This study presents a novel approach, in which a scaffold structure with appropriate properties for bone regeneration emerges from the space between specifically shaped granules. The granule types were tetrapods (TEPO) and pyramids (PYRA), which were compared to porous CaP granules (CALC) and morselized bone chips (BC). Bulk materials of the granules were mechanically loaded with a peak pressure of 4 MP; i.e., comparable to the load occurring behind an acetabular cup. Mechanical loading reduced the volume of CALC and BC considerably (89% and 85%, respectively), indicating a collapse of the macroporous structure. Volumes of TEPO and PYRA remained almost constant (94% and 98%, respectively). After loading, the porosity was highest for BC (46%), lowest for CALC (25%) and comparable for TEPO and PYRA (37%). The pore spaces of TEPO and PYRA were highly interconnected in a way that a virtual object with a diameter of 150 µm could access 34% of the TEPO volume and 36% of the PYRA volume. This study shows that a bulk of dense CaP granules in form of tetrapods and pyramids can create a scaffold structure with load capacities suitable for the regeneration of an acetabular bone defect.

Macrofluidic recirculating model of skeletal metastasis

While microfluidic systems model aspects of metastasis, they are limited to artificially created tissues of limited complexity. We set out to develop an in vitro model of tumor cell migration from a primary tumor to a distant site that allows use of tissue. Accordingly, we created a macrofluidic model using culture plate wells connected with type I collagen-coated large bore tubing and has recirculating media. Green fluorescent protein-positive prostate carcinoma cells in a hydrogel or excised tumor xenografts from mice were placed into primary tumor sites and either human bone stromal cells (HS-5) in a hydrogel or human-derived bone chips were seeded into metastatic sites. Cells from the primary sites migrated to and grew in metastatic sites. Bone enhanced growth at metastatic sites and established a CXCL12 gradient that was higher in metastatic versus primary sites. AMD3100-mediated inhibition of CXCL12 function reduced the number of cells targeting the bone at the metastatic sites. In summary, we have developed a macrofluidic metastasis model that allows incorporation of tumor and metastatic microenvironment tissues and models chemotaxis. This system allows for incorporation of tumor heterogeneity and inclusion of an intact microenvironment. These features will facilitate identification of mechanisms and therapeutics for bone metastasis.

The Adipo-Fascial ALT Flap in Lower Extremities Reconstruction Gustillo IIIC-B Fractures. An Osteogenic Inducer?

Background: Purpose of this report is to analyze possible effects and clinical outcomes of anterolateral thigh (ALT)-free fascial flaps on bone healing in Gustilo type IIIB-C open tibial fractures. Methods: We present a technique, wherein the fascia is wrapped around bone stumps, bone chips or not vascularized bone graft were used to fill the defects. Five patients with a mean follow-up of 36 months were treated. Results Mean time from injury to flap coverage was 72 hours. The mean size of bone defects was 4-7,6 cm. All flaps were Antero Lateral Tight flaps, and the fracture sites did not have any evidence of infection. None of the patients was a smoker. A solid bone union was reached, and full wearing was in a mean of 11 (4–20) weeks after the injury. The lower limb was saved in 100% of the cases. Conclusion Despite the goods results, further studies applied on a large number of patients are needed to confirm authors theory, however, we can consider the fascial ALT flap as a valid help for bone healing in 3B-C open tibial fractures.

A Powder-free DNA Extraction Workflow for Skeletal Samples.

The processing of skeletal material poses several challenges for forensic laboratories. Current methods can be laborious, time-consuming, require dedicated equipment, and are vulnerable to contamination. In this study, various sample mass (1×50mg, 3×50mg, and 1×150mg chip(s)) and incubation times (2, 4, and 16h) were tested using the PrepFiler® BTA™ Forensic DNA Extraction Kit to digest whole bone chips in lieu of powdering. The most effective method was then applied to bones and tooth fragments collected from contemporary human cadavers exposed to various environmental conditions using an automated platform. Over a third of the samples tested generated full DNA profiles without having to powder the bone/tooth fragment or further alter the manufacturer's protocol. However, for most samples resulting in incomplete STR profiles due to low amounts of DNA, slightly better results were achieved with powdered tissue. Overall, this workdemonstrates the potential use of a faster, nonpowdering DNA extraction method for processing skeletal samples as an effective first-pass screening tool.

Bovine derived xenograft in combination with autogenous bone chips versus xenograft alone for the augmentation of bony dehiscences around oral implants: A randomized, controlled, split‐mouth clinical trial

Bovine derived xenograft in combination with autogenous bone chips versus xenograft alone for the augmentation of bony dehiscences around oral implants: A randomized, controlled, split‐mouth clinical trial

Rat Palatine Fissure: A Suitable Experimental Model for Evaluating Bone Regeneration.

The rat palatine fissure is anatomically similar to human alveolar cleft. In this study, we examined potential bone repair by an autologous bone implant and beta-tricalcium phosphate (β-TCP) using rat palatine fissure as a model. Autologous bone chips or β-TCP granules were implanted into the rat palatine fissure. Our model demonstrated that higher bone volume and bone mineral density were achieved with autologous bone graft than with β-TCP. We have provided the first demonstration of the suitability of the rat palatine fissure as the implant site to simulate the transplantation of bone graft materials into human alveolar cleft.

The management of vertical bone defects in the posterior area – The challenge

Background The rehabilitation in the posterior area in the absence of adequate quantity and quality of bone represents one of the most complicated challenges in the implantology. The management of the atrophy can be performed with different methods and materials. The autogenous bone is still considered the best material for the regeneration of the bone defects particularly when we have to recovery atrophy in the 3 D dimension. Aim/Hypothesis The present study evaluated the reliability and predictability of the treatment of severe bone loss in the posterior maxilla and mandible. The inclusion criteria were the advanced bone defects due to previously lost teeth and complications of cases already treated with other materials and technique Material and Methods Of 32 consecutive patients were treated in the posterior area (premolar and molar) after failures of previous treatment or in the cases of severe 3D bone atrophy and followed from 4 years to 8 years post-operative. In all the cases was performed only a 2 stage approach due to the severe bone loss. All the augmentation were carried out according to Khoury's biological concept. The harvested bone block from the mandibular retromolar area with the Microsaw, was splitted in 2 thin blocks and they were screwed to reconstruct at least two bone walls with the micro screws allowing a 3D reconstruction of the alveolar crest. The space between the two blocks were filled with particulate bone chips collected with a bone scraper. 22 reconstructions were carried out in the maxilla and 18 in the posterior mandible. No membranes were used. Implants were placed 4 months after the augmentation. The soft tissue management and augmentations were performed during the implant exposure 3 months post-operative Results A primary good healing occurred in all the 32 patients. No exposure of the grafts was registered after the augmentation or at the moment of implant insertion. The grafted bone after 4 months showed a good revascularization and stable bone volume showing the same consistence and bleeding like the native bone. Therefore, we proceeded to insert 93 implants with regular diameter (3.4–4.5 mm) and length (9.5–13 mm) in the augmented posterior area in the mandible and in the maxillary as we planned. In only two patients a secondary bone augmentation with local harvested bone was necessary due to incomplete bone regeneration (both cases were complication of previous reconstruction techniques). All the patients presented after a follow-up between 4 and 8 years a good function and aesthetical result with the correct hight of the crowns. The radiographic control, repeated every year, documented the stability of the grafted and regenerated bone. Conclusion and Clinical Implications The management of bone defects in 3D dimension represents a big challenge particularly when the demand of the patient is really important. With the biological concept we were able to ensure a long-term stability with very good outcomes for aesthetics and function. The use of autogenous bone offered more safety and reduced considerably the time of the treatment in comparison to other augmentation materials remaining nowadays more reliable and predictable.

Grafting and fixation after aseptic non-union of the humeral shaft: A case series

PurposeNon-unions after humeral shaft fractures are seen frequently in clinical practice at about 2–10% after conservative management and 30% after surgical treatment. Non-union, displacement of structures and fixation failure can be hazardous complications. The purpose of our study was to evaluate the outcomes of an on-lay bone graft strut construction with bone chips as grafting augmentation in the management of aseptic non-unions of the humeral shaft. MethodsFrom 124 eligible patients with a humeral shaft non-union, we included 48 patients. In all cases an anterolateral humeral approach was used, with an on-lay bone graft using an allograft strut construction and with bone substitute augmentation in the non-union gap. To assess the bone healing on radiographs, we used the non-union scoring system according to Whelan. Patients were followed with objective and subjective scores. ResultsIn all 48 patients we achieved full bone healing without major complications. The average period of union was 124 days. In 40 cases after healing the alignment was neutral, valgus deformation occurred in 6 cases a varus deformation in 2 cases. At twelve months after surgery, all patients recovered with satisfactory range of motion of shoulder and elbow and a good quality of life, without any radial nerve palsies or other major complications. ConclusionGiven the satisfactory results of full bone healing, recovery of the range of motion and the lack of major complications as seen in this study, we find that plating with supporting allograft as a good choice of treatment in the cases of aseptic non-union of the humeral shaft.

Autologous bone reconstruction as sandwich technique in pediatric posterior fossa surgery: finding a noble eightfold path for developing countries

Background: Sub-occipital craniotomy in pediatric population is difficult owing to uneven surface of growing calvaria and thin dura. Our novel technique using autologous bone chips and gelfoam bridges the two standard techniques. In this study, we intend to compare the surgical outcome in pediatric posterior fossa tumours.Methods: We included patients, operated via midline sub-occipital approach, from January 2013 to October 2018 and grouped them, on basis of whether or not sandwich reconstruction was done. We compared pseudomeningocele, post-operative headache, CSF leakage and postoperative hydrocephalus requiring CSF diversion. The aesthetic outcome was assessed using Stony Brook scar evaluation scale (SBSES).Results: 124 patients, divided into group A (n=53), group B (n=58) and group C (n=13) based on technique of surgical closure. The sandwich closure is significantly better in terms of both aesthesis and post-operative pain (p&lt;0.05). There was a trend showing that sandwich closure decreases risk for pseudomeningocoele, wound infection, CSF leak and post-operative hydrocephalus. Median SBSES Score in group B was 4 compared to 2 in group A and patients were significantly more satisfied.Conclusions: The uniform bone coverage with sandwich closure provides nearly similar reconstruction to craniotomy. All risks of using drill over pediatric calvaria are eliminated and advantages are carried. The bony barrier prevents adhesion and decreases both immediate and delayed headache. The technique is not only technically easier and aesthetically better, but also has better long term satisfactory results with possibility of neo-bone formation.

Effectiveness of Sodium Bicarbonate (NaHCO3) on Physicochemical and Sensory Characteristic of Notopterus notopterus Bone Chips

This study was aimed to determine the physicochemical and sensory characteristics of chips made from bones of Notopterus notopterus previously soaked in sodium bicarbonate. Different concentrations of sodium bicarbonate (0; 0.5; 1; 1.5; 2; and 2.5%) were used to soak the bones. The parameters observed were chemical analysis, physical analysis, and sensory analysis. The soaking of the fish bones in sodium bicarbonate had significant effects (p&lt;0.05) on the chemical characteristics including water content, ash content, protein content, NaHCO3 residue as well as physical characteristic of the chips. However, on the soaking did not affect phosphorus, calcium and sensory characteristics of the chips.