Bone Graft Reconstruction Research Articles

Résultats des reprises pour descellement glénoïdien: À propos d’une série multicentrique de 37 prothèses d’épaule

Purpose of the study The purpose of this study was to assess outcome after revision total shoulder arthoplasty as a function of therapeutic options. Material and methods Revision total shoulder arthroplasty procedures were performed in three French centers specialized in shoulder surgery. Mean follow-up was 28.5 months (range 12-69). Constant's score was determined preoperatively and at last follow-up. Nineteen reimplantations of a cemented glenoid, twelve “glenoplasties” without reimplantation and five inverted prosthesis implantations were performed. Arthroplastic resection was performed in one patient with infection. Results The function score improved in all patients. Reimplantation of a cemented glenoid led to significant improvement in function at last follow-up. For patients without reimplantation, bone graft reconstruction of the bone loss led to better results than simple removal of the loosened implant. For patients with cuff tears, use of an inverted prosthesis led to improved clinical scores, particularly for pain. Two patients experienced repeated loosening of cemented glenoids and one patient developed infection requiring a second revision. Discussion Different therapeutic options can be proposed for patients with glenoid loosening. Simply removing the implant is effective in relieving pain but has a modest effect on motion. This type of procedure should be reserved for frail patients requiring an intervention with limited goals. The remaining amount of glenoid bone stock is the key to functional outcome after surgical repair. Glenoid reimplantation can be attempted if only a moderate amount of bone has been lost. Unlike cortical grafts, pure cancellous grafts do not allow reliable reconstruction. After grafting, reimplantation of the glenoid implant can be achieved in a two-stage procedure. Screwed glenoid implants allow fixing the graft in a single operation in better conditions than cemented implants. Inverted prostheses offer a therapeutic solution worth developing for patients with rotator cuff tears and glenoid loosening.

Nasal reconstruction in surgery of the anterior skull base

Objectives We sought to evaluate the effectiveness of a number of surgical maneuvers in nasal reconstruction of a diverse population of patients undergoing skull base surgery. Study design We conducted a retrospective review of a cohort of patients undergoing nasal reconstruction during surgery of the anterior skull base and craniovertebral junction. Methods All patients undergoing skull base surgery and nasal reconstruction by the senior author (Y.D.) with a minimum follow-up of 12 months from 1997 to 2001 were evaluated. Preoperative and postoperative photographs and clinical evaluation were examined in detail with particular attention focused on the nasal complex. Results A total of 47 patients were evaluated for this study, including those who had undergone anterior craniofacial resections (n = 14), Le Fort osteotomies (n = 5), subcranial approaches (n = 10), maxillotomies (n = 8), and midfacial disassemblies (n = 10). Primary calvarial bone graft reconstruction of the anterior craniofacial group was facilitated with the use of positioning plates and resuspension of the upper lateral cartilages when available. In contradistinction to secondary bone grafting, dorsal grafts in this group extended to the native nasal bone length. A small overlay bone graft was thought to be necessary when the nasal root was osteotomized in conjunction with the orbital and/or maxillary segments to maintain dorsal height in the long term. Le Fort osteotomy patients require refixation of the septum to the anterior nasal spine region for stability. Conclusions Use of the techniques outlined in this article appears to be associated with gratifying long-term nasal form in reconstruction of the anterior skull base.

Novel Angiogenic Compounds for Targeted Drug Delivery

ABSTRACTInduction of angiogenesis is necessary for the success of engineered implantable tissues in order to meet oxygen and nutrient requirements of cells during tissue repair. Insufficient vascularization in bone graft reconstruction may impede healing and initiate hypoxic cell death at the interior of the implant. As a result, endogenous growth factors have been studied to enhance angiogenesis during wound repair. However, these peptide-based molecules are highly sensitive to processing that occurs during scaffold biomaterial fabrication and treatment for tissue engineering purposes. We report here the development of new small molecule regulators of angiogenesis that may circumvent the impediments associated with protein-based growth factor delivery. In this study, we report the design and evaluation of SC–3–143 as a regulator of endothelial function. We show that the compound significantly increases the formation of microvascular networks in vitro, and selectively enhances endothelial survivability by reducing endothelial cell death under serum deprived culture conditions.

Pasteurized autogenous bone graft for reconstruction after resection of malignant bone and soft tissue tumors

Pasteurized autogenous bone graft for reconstruction after resection of malignant bone and soft tissue tumors

Cancellous and cortical morselized allograft in revision total hip replacement:: A biomechanical study of implant stability

To restore femoral intramedullary bone stock loss in revision surgery of failed total hip arthroplasties, impacted morselized cancellous allograft is recommended. This study investigated the mechanical properties of both impacted cortical (group A) and cancellous (group B) morselized bone graft for reconstruction of femoral bones. Ten matched pairs of fresh frozen human femora were prepared by over-reaming to create a smooth-walled cortical shell. Each pair had one cortical and one cancellous impacted morselized allograft and cement. Stem subsidence was evaluated by a cyclic axial load, which was applied by a servohydraulic test. The stem subsidence was measured for initial subsidence (subsidence at the first 1000 cycles), the total axial subsidence (subsidence at the end of cycles under load) and the final axial subsidence (subsidence after the unloading phase). Torque test was measured by torsional loads through the prosthetic femoral heads. Total axial subsidence was significantly higher in group B (mean: 1.32±0.32 mm) compared to group A (mean: 0.94±0.26 mm) ( P<0.01). There was no significant difference between the two groups in terms of initial subsidence ( P=0.09) and final axial subsidence. The mean maximum torque before failure was 39.5±22.2 N-m for the cortical morselized allograft and 32.5±18.1 N-m for cancellous. We concluded that impacted morselized cortical bone graft used for reconstruction of contained femoral bone loss in revision hip arthroplasy, may reduce the stem subsidence. Further animal experimentation for mechanical and histological evaluation of in vivo application is warranted.

Giant Cell Tumor of Tendon Sheath with Bony Invasion-A Case Report

Giant cell tumor of tendon sheath (GCTTS) is a common benign hand tumor. It may be locally aggressive and cause bony indentation but intraosseous extension is rare. We reported a case of giant cell tumor of tendon sheath (GCTTS) over right hand in a 37-year-old women. MRI revealed a large lobulated tumor arising from the right 5(superscript th) extensor tendon sheath with tumor extension to the surrounding bony structures including 4(superscript th) and 5(superscript th) metacarpal bases, hamate and triquetrum. We treated this patient with wide excision of tumor and free vascularized iliac bone grafting. The bone graft was fixed with mini-plates and K-wires. Solid bone union and preserved wrist motion were achieved. There is no tumor recurrence in 18-month-period. Wide excision combined with free-vascularized bone graft reconstruction provides a treatment choice when the GCTTS invading bone over hand region.

The efficacy of Gore-Tex vs. hydroxyapatite and bone graft in reconstruction of orbital floor defects

Fractures of the orbital floor often need to be reconstructed with rigid materials that provide a stable orbital floor and reestablish the correct orbital volume. In addition to autologous bone grafts, many alloplastic materials are available such as hydroxyapatite and, recently, expanded polytetrafluoroethylene reinforced with fluorinated ethylene propylene also known as reinforced SAM Gore-Tex. This study compared the efficacy and biocompatibility of reinforced and nonreinforced SAM Gore-Tex to those of hydroxyapatite and autogenous bone graft for reconstructing the orbital floor. A defect measuring 1.5×1.0 cm was created in the left orbital floor in 24 short-hair cats while the right side served as the control. The cats were divided into four groups, the defect being reconstructed with an autogenous iliac crest corticocancellous bone graft (group A), hydroxyapatite (group B), nonreinforced Gore-Tex (group C), or reinforced Gore-Tex (group D). Computed tomography was performed postoperatively at 1 and 8 weeks, and at the conclusion of the study specimens from the left orbit were harvested to evaluate the histological biocompatibility of each material. Reinforced SAM Gore-Tex possessed excellent physical properties. It was malleable yet firm enough and therefore easily contoured during repair of the defect while strong enough to support the orbital contents. It could even be sutured to the orbital rim or a fixating plate to ensure further stabilization, if necessary. Additionally, the material demonstrated exemplary biocompatibility as it initiated a minimal inflammatory response. As healing progressed, a growth of host tissue into the material was noted in all histological specimens, thereby augmenting the stability of the implant and reducing the incidence of extrusion.

Application of locked intramedullary nails in the treatment of complications after distraction osteogenesis

Distraction osteogenesis (callotasis) has been widely used in patients with limb-length inequality or massive bone defects. This procedure, however, may be associated with a high incidence of physical and psychosocial complications. Callotasis telescoping on a locked intramedullary nail has been used to shorten the period of external fixation. Little attention has been given to the use of locked intramedullary nails in the treatment of complications after callotasis. Between 1990 and 1999, we used locked intramedullary nailing in 27 patients for the treatment of complications after distraction osteogenesis. There were 17 men and ten women with a mean age of 33.2 years (16 to 66). The nail was inserted at a mean of 3.4 weeks (0 to 15) after removal of the external fixator. Simultaneous autogenous bone grafting and soft-tissue reconstruction were also undertaken in seven and two patients, respectively. There was consolidation of the callus or docking site in all patients at a mean of 6.4 months (2 to 14) after surgery. The mean shortening of the callus was 0.7 cm (0 to 2.5). Two patients had infection at the site of a distal screw which resolved after removal of the nail. In 17 patients the nail was removed at a mean of 26 months after its insertion. Locked intramedullary nails are useful in treating complications after distraction osteogenesis in skeletally mature patients. The risk of infection should be borne in mind.

Application of locked intramedullary nails in the treatment of complications after distraction osteogenesis.

Distraction osteogenesis (callotasis) has been widely used in patients with limb-length inequality or massive bone defects. This procedure, however, may be associated with a high incidence of physical and psychosocial complications. Callotasis telescoping on a locked intramedullary nail has been used to shorten the period of external fixation. Little attention has been given to the use of locked intramedullary nails in the treatment of complications after callotasis. Between 1990 and 1999, we used locked intramedullary nailing in 27 patients for the treatment of complications after distraction osteogenesis. There were 17 men and ten women with a mean age of 33.2 years (16 to 66). The nail was inserted at a mean of 3.4 weeks (0 to 15) after removal of the external fixator. Simultaneous autogenous bone grafting and soft-tissue reconstruction were also undertaken in seven and two patients, respectively. There was consolidation of the callus or docking site in all patients at a mean of 6.4 months (2 to 14) after surgery. The mean shortening of the callus was 0.7 cm (0 to 2.5). Two patients had infection at the site of a distal screw which resolved after removal of the nail. In 17 patients the nail was removed at a mean of 26 months after its insertion. Locked intramedullary nails are useful in treating complications after distraction osteogenesis in skeletally mature patients. The risk of infection should be borne in mind.

Chondrosarcoma of bone: functional outcome and quality of life.

Outcome studies of chondrosarcoma have so far only reported oncological and functional results. Quality-of-life assessment becomes more important because more long-term survival after treatment of malignant diseases occur. The objective of this study is to analyze functional outcome and quality of life. Functional evaluation of the patients was carried out according to the MSTS functional scoring system. For assessment of quality of life, questionnaires were used. Response of the questionnaires sent to 45 disease-free patients was 84%. The mean functional score of these 38 patients was 74% (20-100%). Best functional results were seen after bone graft reconstruction and curettage and cryosurgery with reconstruction. Quality-of-life analysis revealed a mean global health status of 75 (66-84). Furthermore, 24% of the patients experienced severe fatigue. Patients reported more problems with regard to physical functioning and sleep in comparison with healthy controls. No correlation was found between global health status scores and functional scores. Functional scores depend on the type of treatment with best results after curettage and cryosurgery. Quality-of-life analysis reveals problems on several domains, including fatigue, physical functioning and sleep.

Expanded excision of sternal tumor with iliac bone grafting for reconstruction of the sternum

Expanded excision of sternal tumor with iliac bone grafting for reconstruction of the sternum

尺骨遠位端に発生した骨巨細胞腫の１例

We report a rare case of giant cell tumor (GCT) of the distal ulna. A 35-year-old male suffered from pain and swelling in the left wrist. Range of motion of the wrist was limited, and grasping power had decreased to about one-third of the right hand. There was a destructive, expansile osteolytic lesion of the distal ulna on X-ray. The cortex was thin and a part of the lesion was disrupted. On MR imaging, bone tumor of the distal ulna was identified as a low- and iso-intense lesion on both T1- and T2-weighted images, enhanced homogeneously by Gd-DTPA. Diagnosis of GCT was confirmed by open biopsy. We performed en bloc resection and arthroplasty of the wrist, and used an autogenous iliac bone graft for reconstruction. Wrist pain disappeared at 12 months after surgery, and mobility of the wrist improved enough that he was able to return to work. Both X-ray and MR imaging of his wrist showed no recurrence of the tumor.

Small free vascularized iliac crest bone grafts in reconstruction of the scaphoid bone: a retrospective study in 60 cases.

Carpal instability may result in progressive degenerative arthritis of the wrist. The surgical goal of the reconstruction of scaphoid nonunion is to achieve bone union and to restore the scaphoid. Many procedures are described to treat scaphoid nonunion for different indications. This retrospective study reports on the anatomical fundamentals, the operative procedure, and the results of 60 patients (21 with recalcitrant scaphoid nonunion that lasted longer than 4 years, 26 with an avascular pole fragment, and 13 with scaphoid nonunion after previous surgery) who were treated by a small free vascularized iliac crest bone graft. All 60 patients have routinely been followed up clinically and with magnetic resonance imaging. Union was achieved in 91.7 percent by improvement of stability and the compromised vascularity of the scaphoid. The bone flap loss rate and persisting nonunion was 8.3 percent, leading to progressive arthritis and carpal collapse. Complaints concerning discomforts caused by the scar were heard from 40.1 percent of the patients, and 31.7 percent complained of discomforts caused by the bony deformity. Bone deformations on the donor site were detected radiologically in 63.3 percent of the patients. In 31.7 percent, an impairment of the lateral femoral cutaneous nerve was noted. Reconstruction of the scaphoid by means of implantation of a vascularized iliac bone graft proved efficient to treat avascular recalcitrant scaphoid nonunion and pseudarthrosis with avascular proximal pole fragments.

Free vascularized bone grafts for reconstruction of traumatic bony defects of mandible and maxilla.

Small bone defects of the mandible and maxilla can be surgically treated with conventional bone grafts provided local conditions are optimal for bone healing. However, when the bone defect is large, is associated with soft tissue loss, or when conventional bone grafting fails, a free vascularized bone graft often becomes an important alternative to ensure adequate healing. As free vascularized bone grafting is today considered a more reliable procedure for bone reconstruction, with success rates over 96%, we prefer to treat even smaller segmental bone defects with this technique when local conditions are less than ideal. The technique also allows for simultaneous insertion of osteointegrated dental implants at the time of vascularized bone grafting, thereby facilitating earlier total oral rehabilitation.

The dynamic treatment of intraarticular fractures of the base of the middle phalanx with the Suzuki dynamic fixator

Between 1994 and 1998, we have treated eleven patients with intraarticular fractures of the base of the middle phalanx including impaction, dislocation, and pilon types of injuries. All patients were evaluated after a median follow-up period of 25.8 (8 to 57) months. Treatment was carried out according to Suzuki's technique with a dynamic PIP-joint distraction fixator consisting of Kirschner wires and rubber bands. In five cases, there was additional osteosynthesis (Kirschner wires, resorbable hemicerclage) or cancellous bone-grafting for reconstruction of the joint surface. Early mobilisation commenced with active exercises for the PIP joint on the day of surgery. The dynamic extension fixator was applied for an average duration of 28 (15 to 42) days. By the time of follow-up examinations, we found a range of motion on an average of 64 (0 to 105) degrees including a lack of extension of 11 (0 to 60) degrees and a median flexion capacity of 75 (30 to105) degrees. All fractures healed uneventfully with restored joint stability. Eight patients were completely painfree, three complained of mild occupational pain.

Vascularized fibula bone grafts for reconstruction after resection of pelvic bone tumors

Vascularized fibula bone grafts for reconstruction after resection of pelvic bone tumors

Pasteurized Autogeneous Bone Graft for Reconstruction after Resection of Malignant Bone and Soft Tissue Tumors: Imaging Features

Our experimental study revealed that pasteurization was sufficient for killing all tumor cells in any massive bone and that the osteoinductivity and mechanical strength of pasteurized bone were about same as that of a fresh bone graft and better than boiled or autoclaved bone. We have performed reconstruction surgery using pasteurized autogenous bone graft since 1990. Resected bone was warmed for 30 minutes in a homeothermal heater set at 60 degrees C and then placed back to the original anatomic site. The graft was fixed with a plate or intramedullary nail with or without bone cement. Based on our experience in 31 patients, no local recurrence was seen in the grafts. Among 24 patients who can be adequately evaluated, incorporation of graft was complete in 17 cases and partial in 4 cases. In 18 of 21 patients, uptake of radionuclide in the grafted pasteurized bone was detected on bone scintigraphy approximately 6 months after surgery, and the uptake increased gradually, which suggested revascularization and remodeling of grafted bone.

Reconstruction of posttraumatic long bone defect with free vascularized bone graft: good outcome in 48 patients with 6 years' follow-up.

We analyzed our clinical results in 48 patients (40 men) treated during 1990-1993 with free vascularized bone-graft reconstruction for bone defects, the follow-up being an average 6 (5-8) years. The bone defects were located in the femur (10), tibia (32), humerus (2), and forearm (4). We performed 41 fibula transfers, 4 iliac transfers, and 3 rib transfers in these patients. 3 patients required early revision surgery due to venous thrombosis. The average time needed for radiographic bone union was 4.2 months. Bone transfers to the lower extremity showed significantly more hypertrophy than those in the upper extremity. The functional outcome was good in 43 patients.

Segmental bone and cartilage reconstruction of major nasal dorsal defects.

This article describes the results of segmental bone and cartilage reconstruction of significant nasal dorsal defects. Solid bone graft reconstructions frequently lead to an unnatural hardness of the nasal tip. Rib cartilage reconstructions are pliable and soft but are a problem because they easily undergo warpage. The operation is performed using the open approach. Outer cranial bone graft is used for the bone component and extends at least two-thirds of the length of the dorsum. It is secured in place with a compression screw and a Kirschner wire. The cartilage component consists of an abbreviated L strut constructed of septal or conchal cartilage. It is slotted into the cranial bone in a tongue-in-groove manner and is sutured to it through a drill hole in the bone. The dorsal profile is completed with a single cartilage onlay graft or multiple sagittal cartilage grafts secured to the sides of the L strut. Twelve patients underwent segmental reconstruction of nasal deformities. Within this group, five patients underwent secondary rhinoplasty, five underwent posttraumatic rhinoplasty, and two underwent nose augmentation for Oriental features. There were seven men and five women. In all cases, good nasal tip mobility was maintained, and the nasal tips were soft. The interface between the bone graft and cartilage graftwas well camouflaged. The two did not separate. This procedure follows the principle of replacing lost tissue with like materials.

A comparison of vascularized and nonvascularized bone grafts for reconstruction of mandibular continuity defects.

A comparison of vascularized and nonvascularized bone grafts for reconstruction of mandibular continuity defects.