Bone Wax Research Articles

A simple technique to prevent screws dropping during open reduction internal fixation of distal radius fractures

Screws can drop during internal fixation of distal radius fractures, leading to an unnecessary increase in operative time and expense. This is particularly a problem with the Stardrive® screwdriver (Synthes Ltd, 20 Tewin Road, Welwyn Garden City, Hertfordshire AL7 1LG). This can be overcome by applying a small amount of bone wax to the tip of the screwdriver before picking up the screw. This will cause the screw to stick to the screwdriver and prevent it from falling. This technique overcomes the effects of gravity and is simple, effective and low cost. It can be applied in other operations when using shallow screwdriver ends to prevent the screw from falling out.

Granulome à corps étrangers sur cire d’Horsley ®

Horsley wax® is an efficient bone haemostatic agent commonly used in bone surgery. But it is non resorbable and surgeons should be aware of possible complications, which can appear many years later.We report three cases of foreign body granulomas due to bone wax. A 14-years-old female patient with an Apert syndrome underwent Le Fort III osteotomy and distraction osteogenesis; 3 years later, an inflammatory granuloma appeared in the temporal area. A 23-years-old female patient, traffic accident casualty, complained about pain in the hip 1 year after undergoing cervical spine surgery with iliac bone graft. A 35-years-old female patient underwent rhinoplasty with anterior nasal aperture surgery. She presented with an inflammatory reaction requiring several subsequent surgeries.Using Horsley wax® must be performed according to recommendations so as to prevent inflammatory or infectious complications, and to allow good bone healing. Surgeons must mention its use in the surgical report to avoid a delayed diagnosis in case of complications. There are alternatives to bone wax but they are less effective.

C2 laminar screw and C1-2 transarticular screw combined with C1 laminar hooks for atlantoaxial instability with unilateral vertebral artery injury

Transarticular screw fixation (TASF) is technically demanding, with high risk of vertebral artery (VA) injury. How to manage intraoperative VA injury and choose optimal alternative fixation becomes a concern of spinal surgeons. In this study, the management strategy for a patient with suspected intraoperative VA injury was analyzed. A 53-year-old woman developed type II odontoid fracture and brain stem injury due to a motor vehicle accident 3 months earlier. After conservative treatments, the brain stem injury improved, but with residual ocular motility defect in the right eye. The odontoid fracture did not achieve fusion with displacement and absorption of fracture fragments. After admission, atlantoaxial fixation using bilateral C1-2 transarticular screws (TASs) combined with C1 laminar hooks was planed. The first TAS was inserted successfully. Unfortunately, suspected VA injury developed during tapping the tract for the second TAS. Considering the previous brain stem injury and that directly inserting the screw to tamponade the hemorrhage might cause VA stenosis or occlusion, we blocked the screw trajectory with bone wax. C2 laminar screw was implanted instead of intended TAS on the injured side. The management strategy for suspected VA injury should depend on intraoperative circumstances and be tailored to patients. Blocking screw trajectory with bone wax is a useful method to stop bleeding. Atlantoaxial fixation using C2 laminar screw and C1-2 TAS combined with C1 laminar hooks is an ideal alternative procedure.

Controlling Difficult Pelvic Bleeding With Argon Beam Coagulator During Laparoscopic Ultra Low Anterior Resection

In recent years, the standard of care for lower rectal tumors has developed to include a total mesorectal excision, which provides optimal long-term results. There has been debate with regard to the best approach for lower rectal tumors, conventional open versus less invasive procedures. As the trend toward less invasive surgical procedures progresses, similar complications, which are seen in open cases, are being encountered, such as the notorious presacral fascia bleed. These are small vessels, which are difficult to locate and control. Surgical literature suggests different methods during laparoscopic procedures. These include: placing lap pads and holding pressure, placing saline bag, placing tacks, using bone wax, and electrocautry at different settings. We present a case of a 57-year-old male, positive for lymph node disease, who underwent laparoscopic ultra low anterior resection with total mesorectal excision and protective loop ileostomy.

Curative Treatment of Pelvic Arteriovenous Malformation – An Alternative Strategy: Transvenous Intra-operative Embolisation

Objectives Pelvic arteriovenous malformations (AVMs) are difficult to treat. Arterial embolisation is the most common strategy but often has poor results. We report an alternative surgical approach of controlled intra-operative transvenous embolisation with long-term results in seven cases. Materials and methods Between 1980 and 2008, we treated seven patients (four men, three women, mean age 50 years). Indications were rectal bleeding (one case), urinary tract problems (four cases), oedema of lower limb (one case) and high-output cardiac failure (one case). Four of them had previous operations and three had previous attempts for embolisation. Embolisation of the malformation was performed through the internal iliac vein. This was done after clamping of all the feeding and draining vessels. The agent used was cyanocrylate (one case), Ethibloc (one case) and bone wax (five cases). Results Mortality was 0%. Complications occurred in two patients (28,5%), one pulmonary embolism and one regressive femoral paresis. Three patients were re-operated for various reasons. The mean follow-up period was 6 years (1–12 years). Symptoms resolved in all patients, while control by computed tomography (CT) angioscan revealed one residual shunt. Conclusion Complete surgical excision of pelvic AVMs is not always possible. Embolisation does not offer a permanent cure. Intra-operative transvenous embolisation of persisting complex AVMs appears to be an alternative approach with good immediate and long-term results. Ethylene glycol appears to be the most suitable agent.

The use of bone wax for protection from sharp ends of interdental wires

Sir, Mechanical irritation interdental loop wiring and intermaxillary fixation causes inflammation of oral mucosa, marginal gingiva and lips is virtually unavoidable in maxillofacial surgery.[1] Filippi et al. compared different types of splints (composite wire splinting, button bracket splinting, resine splinting and titanium trauma splinting) by means of irritation on gingival mucosa and lips. In their experimental study, they found that more irritation was caused by buton bracket splints on lips and by resine splint on gingival mucosa.[2]

The use of bone wax for protection from sharp ends of interdental wires

The use of bone wax for protection from sharp ends of interdental wires

A New Practical Alternative for the Control of Sternal Bleeding during Cardiac Surgery: Ankaferd Blood Stopper

The control of sternal bleeding during cardiac surgery can sometimes be a challenging and time-consuming problem for surgeons. Several alternatives for the control of sternal bleeding are on the market. Bone wax is a well-known alternative used by many cardiac surgeons for the control of bleeding. It is effective and cheap; however, it inhibits ossification of the sternum and can cause infections and sternal wound healing problems after cardiac surgery. Consequently, control of sternal bleeding without the use of bone wax requires meticulous preparation. Ankaferd Blood Stopper (ABS) (Ankaferd Sağlik Ürünleri, Istanbul, Turkey) is a unique folkloric medicinal plant extract that has been used in Turkish traditional medicine as a hemostatic agent. We present a practical alternative technique for the control of sternal bleeding during cardiac surgery with the use of ABS.

Topical use of colchicine to prevent spinal epidural fibrosis in rats

Objectives: Epidural fibrosis after spinal surgery may be the cause in most cases of recurrent pain. Numerous pharmacological agents and anti-adhesive barriers have been used to prevent epidural fibrosis, but the success rates are variable. Colchicine is an historical drug extracted from the flowers of Colchium autumnale widely used in arthritic conditions in the past. Currently, it is used in acute gout attacks, familial mediterranean fever for its anti-inflammatory and antifibrotic effects. Also, colchicine is used locally in the cutaneous diseases (e.g. actinic keratoses, psoriasis) for its similar effets. In present study, we investigated the effect of topical colchicine on spinal epidural fibrosis in the rats.Methods: The rats were randomly divided to three groups of six animals each. Total L4-5 laminectomy was performed, and ligamentum flavum and epidural fat were removed gently. Meticulous hemostasis was achieved by using cotton pad when necessary, and no bone wax and cauterization were used. Dura was left clean with no hemorhages. In treatment group cotton pads (5 × 5 mm) soaked with 0.005 mg/ml colchicine and applied on laminectomy sites for 10 minutes and remowed, in sham group only saline irrigation was done. In control group no medication or irrigation was applied. The wound was closed in layers using the same material in each group. Four weeks later, the rats were killed, and the spinal column, including surrounding muscle tissue, was removed en bloc, decalcified, and fixed in formaldehyde. Epidural fibrosis was evaluated histologically.Results: In colchicine-treated group, epidural fibrosis was significantly reduced compared with control and sham groups.Conclusions: Epidural fibrosis is a well-known complication following lumbar disc surgery. Topical application of colchicine is very effective in preventing epidural fibrosis.

Cardiopulmonary bypass line sternal wrapping: technical tips

Cardiopulmonary bypass line sternal wrapping (SW) is a new approach to sternal care which avoids bone wax and offers mechanical protection and a shield from bacterial contamination, with beneficial effects on sternal healing. Since its introduction in February 2008, the technique has undergone some developments: it is possible to harvest internal thoracic arteries with SW in place and its haemostatic properties have improved.

Bone healing after median sternotomy: A comparison of two hemostatic devices

BackgroundBone wax is traditionally used as part of surgical procedures to prevent bleeding from exposed spongy bone. It is an effective hemostatic device which creates a physical barrier. Unfortunately it interferes with subsequent bone healing and increases the risk of infection in experimental studies. Recently, a water-soluble, synthetic, hemostatic compound (Ostene®) was introduced to serve the same purpose as bone wax without hampering bone healing. This study aims to compare sternal healing after application of either bone wax or Ostene®.MethodsTwenty-four pigs were randomized into one of three treatment groups: Ostene®, bone wax or no hemostatic treatment (control). Each animal was subjected to midline sternotomy. Either Ostene® or bone wax was applied to the spongy bone surfaces until local hemostasis was ensured. The control group received no hemostatic treatment. The wound was left open for 60 min before closing to simulate conditions alike those of cardiac surgery. All sterni were harvested 6 weeks after intervention.Bone density and the area of the bone defect were determined with peripheral quantitative CT-scanning; bone healing was displayed with plain X-ray and chronic inflammation was histologically assessed.ResultsBoth CT-scanning and plain X-ray disclosed that bone healing was significantly impaired in the bone wax group (p < 0.01) compared with the other two groups, and the former group had significantly more chronic inflammation (p < 0.01) than the two latter.ConclusionBone wax inhibits bone healing and induces chronic inflammation in a porcine model. Ostene® treated animals displayed bone healing characteristics and inflammatory reactions similar to those of the control group without application of a hemostatic agent.

How good patient blood management leads to excellent outcomes in Jehovah's witness patients undergoing cardiac surgery

The refusal of blood products makes open-heart surgery in Jehovah's witnesses (JW) an ethical challenge. We demonstrate how patient blood management strategies lead to excellent surgical outcomes. From 2003 to 2008, 16 JW underwent cardiac surgery at our institution. Only senior surgeons performed coronary revascularization (n=6), valve (n=6), combined (n=1) and aortic surgery (n=3) of which two patients presented with acute type-A dissection. Off-pump surgery remained the method of choice for patients requiring a bypass procedure (n=5). Preoperative hematocrit (Hk) and hemoglobin (Hb) were 42.8±4.7% and 14.5±2 g/dl. In three patients with an Hb<12 g/dl, preoperative hematological stimulating treatment was implemented. All patients survived, no major complications occurred and no blood transfusion was administered. The Cell Saver® system (transfused volume: 474±101 ml) and synthetic plasma substitutes [Ringer's Lactate: 873±367 ml and hydroxyethyl starch (HES) 6%: 700±388 ml] were used routinely as well as hemostaticas, such as bone wax, and fibrin glue. The decrease of Hk and Hb appeared to be the lowest after off-pump surgery when compared to all other procedures requiring cardiopulmonary bypass (CPB) (25±9% vs. 33±6%; P=0.01 and 22±9% vs. 31±6%; P=0.04). Similarly, the decrease of platelets was significantly lower (20±12% vs. 43±14%; P=0.01). In the follow-up period (52±34 months), one patient died due to a non-cardiac reason, whereas all others were alive, in good clinical condition and did not have major adverse cardiac events (MACE) or recurrent symptoms requiring re-intervention. Patient blood management leads to excellent short- and long-term outcomes in JW. Combined efforts in regard to preoperative hematological parameter optimization, effective volume management and meticulous surgical techniques make this possible but raise the cautionary note why this is only possible in JW patients.

Gelatine Based “Bone Wax”

Gelatine Based “Bone Wax”

Gelatine Based “Bone Wax”

Gelatine Based “Bone Wax”

Efficacy of quantitative CT in assessment of fracture healing

Objective To investigate the efficacy and accuracy of quantitative computed tomography (QCT) in assessment of fracture healing. Methods Twenty-four healthy New Zealand rabbits were enrolled in the study and randomly divided into two groups, ie, Croup A (union model group, transverse fracture open created on mid-shaft of tibia and inter-fixed by kirschner wire) and Group B (non-union model group, transverse fracture with 5 mm defect on mid-shaft of tibia open created, then sealed with bone wax on fracture gap and medulla cavity, inter-fixed by kirschner wire). At 2, 4, 8 and 12 weeks, Kirschner wire was withdrawn and plain X-ray and QCT scanning were performed on the bilateral tibia. Then, rabbits were scarified and its bilateral tibia were desected and histologically examined. The result of X-ray and histological analysis was used as the golden standard for evaluation of fracture healing. Receiver operating characteristic curve (ROC) was used to analyze the evaluation performance of QCT. The corresponding segments of the contralateral healthy tibia were used as control to investigate the change of QCT parameters. Results In Group A, X-ray and histological analysis verified clear fracture line filled with irregular callus at 2 and 4 weeks but proved vague or vanishing fracture line and continuous and intact cortex of irregular callus at 8 and 16 weeks. In Group B, X-ray and histology analysis found clear fracture line with inactive ossification at 2 and 4 weeks but vague fracture line with scarce osteocyte and bone trabecula at 8 and 16 weeks. ROC analysis of QCT results showed the following results; (1) the areas under curve (accuracy) of material parameters including bone mineral density (BMD) and bone mineral content (BMC) were 0.781 and 0.750 respectively; (2) structure parameter-cross-sectional area (CSA) and the area under curve of cross-sectional moment of inertia (CSMI) were 0.781 and 0.469 respectively (P <0.05); (3) the areas under curve of the extending parameters bone strength indices (BSICSA) and CSMI bone strength indices ( BSICSMI) were 0. 913 and 0. 813 respectively (P < 0.05); (4) the area under curve (accuracy) of BSICSA, CSA and BMD were 0.905, 0.921 and 0.905 respectively (P<0.05). Conclusions QCT has potential in distinguishing fracture union and nonunion models in measurement of local fracture pattern. The screening parameters with more accuracy are BSICSA, CSA, BMD, which have advantages of accuracy and specialty in assessing fracture healing. Key words: Fracture healing; Radiographic image interpretation, computer-assisted; Animal model

Intra-operative protection from exposed K-wires

Double-ended Kirschner wires have a variety of uses in orthopaedic surgery. The sharp ends are a potential hazard in theatre if left uncovered. Temporarily covering the exposed wire with a needle sheath containing a small amount of bone wax provides secure protection without blunting the wire. We have found this to be a cheap and effective way of protecting against inadvertent drape perforation and needlestick injury. Figure 1 Needle sheath containing bone wax: exposed K-wire and protected K-wire.

Vascularized Tissue Engineering Mouse Chamber Model Supports Thymopoiesis of Ectopic Thymus Tissue Grafts

We have previously established a chamber model of tissue engineering that promotes de novo angiogenesis and vascularization of engrafted cells and tissues when combined with an extracellular matrix. Here we demonstrate that the mouse chamber (MC) model can sustain ectopic grafts of murine fetal thymus lobes and, to a limited degree, human pediatric thymus tissue, resulting in de novo T-cell production. Silicone chambers containing Matrigel((R)) and thymus tissues were placed around exposed epigastric vessels and the ends sealed with bone wax, before implantation into the inguinal fat pad of athymic Balb/c(nu/nu) (nude) mice. Murine, embryonic day 15 (E15) thymus grafts were found to be well vascularized and viable within the MC upon harvest at week 11. In contrast, engraftment of both adult murine and pediatric human thymus tissue was limited, with only one out of the seven human thymus grafts sustaining mature, murine-derived T-cell development. Increased CD4(+) and CD8(+) T-cell numbers were observed in the peripheral blood of nude mice within 2 weeks after E15 thymus-MC grafts (n = 8), compared with nude control mice. Peripheral blood T-cell percentage and subset distribution were comparable to mice receiving conventional thymus kidney capsule grafts. T-cell function of both kidney capsule- and MC-E15 thymus grafts was established via successful rejection of major histocompatibility complex (MHC)-mismatched skin grafts. Sustained growth of fetal thymus tissue in the MC provides an alternative model for the study of thymopoiesis and related applications of T-cell-mediated immunity.

Management of High-Flow Arteriovenous Malformation in the Maxillofacial Region

Management of high-flow arteriovenous malformation (AVM) in the oral and maxillofacial region, one of the greatest challenges facing oral and maxillofacial surgeons, is patient-specific in almost all cases. The aim of this study was to review our experience with superselective intra-arterial embolization followed by surgical resection and bone wax packing (BWP) of the bone cavity and curettage to manage AVM. Sixteen patients with AVM of the oral and maxillofacial region were included in this study. All patients were evaluated with preoperative angiography, and superselective intra-arterial embolization of the lesions was done in the same session by the same interventional radiologists. Forty-eight to 72 hours later, surgical resection of the soft-tissue vascular lesions and BWP of the bone cavity and curettage were performed. There were no complications related to either the preoperative angiography or the embolization procedure. The pulsation and noise were absent, and the hemorrhage disappeared. Followed up after the surgical treatment for a mean of 38 months (range, 7-63 months), 14 cases were controlled and 2 were improved, and no case was persistent or recurred. Superselective intra-arterial embolization followed by surgical resection and BWP of the bone cavity and curettage was an effective therapy in the oral and maxillofacial region.

Inferior alveolar nerve damage caused by bone wax in third molar surgery

The authors present a case of inferior alveolar nerve morbidity attributable to use of bone wax to control haemorrhage during third molar surgery. The patient presented after 11 symptom-free years with parasthesia and, eventually pain in the cutaneous distribution of the right inferior alveolar nerve. Radiographs revealed a 1cm radiolucency consistent with a neuroma. Pathological examination of the surgically resected lesion revealed a foreign body reaction to bone wax. The case illustrates the poor resorption qualities of bone wax and the need for other haemostatic agents to achieve haemostasis in dentoalveolar surgery.

Effect of C(1-2) venous sinus upon operative safety of atlantoaxial screw insertion

To introduce a new C(1) screw insertion technique to avoid injury to C(1-2) venous sinus in posterior atlantoaxial fixation. 48 cases (96 sides of C(1) screws) undergoing posterior atlantoaxial fixation were retrospectively analyzed, including 28 cases of C(1) or C(2) fresh fracture and 20 cases of congenital malformation or old fracture & dislocation, among which 12 cases (24 sides) were operated by Goel lateral mass screws, 14 cases (28 sides) by TAN Mingsheng C(1) transpedicular screws and 44 sides of C(1) screws in 22 cases were inserted via notch on underside of C(1) posterior arch combined with bone wax column protecting C(1-2) venous sinus. Bleeding was encountered in five sides of C(1) screws among 26 cases (52 sides) whose venous sinuses were not protected by bone wax column, involving 3 cases of Goel lateral screw implant fixation. There was statistical difference in the incidence rate of bleeding between Goel technique and ours (P < 0.05) while there was no statistical difference between C(1) transpedicular technique and ours (P > 0.05) or between Goel sides of Goel lateral mass screws (12.5%) and 2 sides of C(1) transpedicular screws (7.1%). It occurred in none of 22 cases (44 sides) with our presented technique. There was a significant difference between Goel lateral screw implant fixation and C(1) transpedicular technique (P > 0.05). All the screws were implanted successfully. All cases were followed up and there was not any sign of implant failure. Our presented C(1) screw insertion technique can provide a better bony landmark and vascular protection, stronger bony holding power and more extensive applicability to reduce injury to C(1-2) venous sinus and increase the surgical safety.