Bony Loss Research Articles

Treatment of compound tibial fracture with free osteomuscular latissimus dorsi scapula flap.

Compound tibial fractures with extensive comminution and soft tissue defects are limb-threatening reconstructive challenges. The purpose of this study was to assess the long-term outcomes and the reliability of the latissimus dorsi scapula flap for this indication. The hospital records of 26 compound tibial fracture patients treated with the latissimus dorsi scapula flap were reviewed. An overall assessment was performed in several steps based on a preinformation and two function-related questionnaires together with radiographs, clinical overviews, and functional tests. In 85% of the cases, the fractures had resulted from high-energy trauma and had extensive zone of injury. The mean follow-up time was 6.2 years. Nine patients required reconstruction because of prolonged sequelae after infection, nonunion, or tissue deficiency. One flap loss occurred leading to amputation. Six patients required an additional operation to enhance bony union. Full weight-bearing was allowed in 3 months and the mean time to bony union was 10 months. Overall, 90% returned to their pretrauma occupation. Overall 11 patients were lost to follow-up. A total of 14 patients answered the questionnaires whereas 12 outpatients attended the clinical assessment. The main finding after evaluating the results of the functional tests and reviewing the questionnaires was the limitation in ankle movement while the donor site performed well. This study confirms that osteomuscular latissimus dorsi scapula flap reconstruction is a suitable alternative for compound and comminuted tibia fractures especially in the case of extensive soft tissue injury with bony loss or significant comminution and with high probability of amputation.

Surgical treatment of post-traumatic kyphosis using modified pedicle subtraction osteotomy

Background data Pedicle subtraction osteotomy (PSOS) is a pure closed wedge osteotomy that has been recently introduced for the correction of post-traumatic kyphosis (PTK). Modified PSOS uses the disc as part of the resected wedge together with the upper endplate, thus allowing excision of the degenerated disc material for better fusion and preventing failure. In PTK, the upper endplate is deficient and the upper disc is degenerated. Insertion of a spacer into the intervertebral gap ensures good bony contact and fusion and increases the angle of correction by making the correction in a manner of closed-open wedge rather than a pure closed wedge osteotomy. Purpose The aim of this work was to study the clinical and radiological results of surgical treatment of PTK using modified PSOS with insertion of a cage as a spacer into the intervertebral defect. Study design This was a prospective study conducted on 24 patients with symptomatic PTK. Patients and methods All patients were treated using the modified PSOS technique, with insertion of a cage into the intervertebral gap. Patients were assessed clinically and radiologically. Functional results were assessed using the Oswestry disability index (ODI) score and the Denis pain and work scale. Radiological assessment included local kyphosis angle and sagittal index immediately postoperatively and at the final follow-up, and the state of bony fusion and loss of correction at the last follow-up. Results The average follow-up period was 34.21 ± 4.47 (range 24-50 months). Local kyphosis angle improved from 39.08 ± 3.86° preoperatively to -0.25 ± 4.74° postoperatively, with insignificant change at the last follow-up. The sagittal index significantly improved from 41.33 ± 4.89° preoperatively to 1.81 ± 1.26° postoperatively, without significant change at the last follow-up. All patients showed solid bony fusion at the last follow-up. There were no major complications. All patients improved clinically as evidenced by improvement in pain and neurological status. Functional outcome significantly improved as evidenced by improvement in ODI score and return of most of the patients to their previous level of activity. Conclusion Modified PSOS is more anatomical, less technically demanding, and safe procedure that achieves good radiological and clinical outcomes with lower operative morbidity.

The mandibular symphysis as a starting point for the occlusal-level reconstruction of panfacial fractures with bicondylar fractures and interruption of the maxillary and mandibular arches: Report of two cases

Panfacial fractures represent a challenge, even for experienced maxillofacial surgeons, because all references for reconstructing the facial skeleton are missing. Logical reconstructive sequencing based on a clear understanding of the correlation between projection and the widths and lengths of facial subunits should enable the surgeon to achieve correct realignment of the bony framework of the face and to prevent late deformity and functional impairment. Reconstruction is particularly challenging in patients presenting with concomitant fractures at the Le Fort I level and affecting the palate, condyles, and mandibular symphysis. In cases without bony loss and sufficient dentition, we believe that accurate fixation of the mandibular symphysis can represent the starting point of a reconstructive sequence that allows successful reconstruction at the Le Fort I level. Two patients were treated in our department by reconstruction starting in the occlusal area through repair of the mandibular symphysis. Both patients considered the postoperative facial shape and profile to be satisfactory and comparable to the pre-injury situation.

Remplissage: An Arthroscopic Technique for Management of The Engaging Hill-Sachs Lesion

Following a traumatic anterior shoulder dislocation, the treating physician is challenged not only with management of this injury extremely but also with the goal of preventing recurrent instability episodes. Although arthroscopic Bankart repair has been shown to significantly decrease the prevalence of recurrent instability, some patients remain significantly at risk for failed operative management owing to the presence of anterior glenoid and posterior humeral head bony loss that may remain unrecognized or unaddressed at the time of surgical intervention. In patients with these posterior-lateral humeral head defects (Hill-Sachs lesions), arthroscopic posterior capsulotenodesis, or remplissage, is an arthroscopic procedure that can be used to supplement arthroscopic Bankart repair. The remplissage procedure offers an effective and valuable technique for some patients with Hill-Sachs lesions and has been demonstrated to reduce the risk of recurrent instability.

Clinical results of shoulder arthroscopy combined with an open modified Latarjet procedure for chronic anterior shoulder instability with glenoid bony loss

The purpose of this study was to follow up the clinical results of the modified Latarjet procedure combined with shoulder arthroscopy for chronic anterior shoulder dislocation with glenoid bony defect. From 1999 to 2004, we evaluated 28 patients with 28 shoulders receiving shoulder arthroscopy combined with an open modified Latarjet procedure. The average age of the patients was 28.5 years. The average length of follow-up in this series was 108.2 months (range 86–126 months). At the final follow-up, the Rowe score was excellent in 21 patients (75%), and good in seven patients (25%). No patient reported subluxation or recurrent instability. The average American Shoulder and Elbow Surgeons score was 93.4, and the average total Western Ontario Shoulder Instability score was 72.74%. Shoulder arthroscopy before the Latarjet procedure is recommended because of the higher incidence of intra-articular lesions affecting satisfactory functional outcomes.

Arthroscopic Bristow-Latarjet Procedure (SS-05)

Anterior shoulder instability is well known as a common pathology and many surgeons have chosen the arthroscopic Bankart procedure or other soft tissue procedures for its treatment. However using these techniques may result in unsatisfactory outcomes when an anterior glenoid fracture or bone loss is associated. These patients may achieve better and safer results by using a bony block procedures as the Bristow-Latarjet procedure. The intention of the study is to present the full arthroscopic Bristow-Latarjet procedure of the author and its implications in 21 patients. We performed 21 arthroscopic bristow-latarjet procedures in patients presenting HAGL, soft tissue procedures failures, gross shoulder instability and anterior glenoid bone loss following the senior author's technique. Patients were evaluated by UCLA score and comparative difference of external rotation, before and 6-month after surgeries. Twenty one arthroscopic Bristow-Latarjet procedures have been performed, one lost the surgery because the breakage of the graft, 4 have less than 6 months post surgery. The remaining 16 were evaluated. In the 6-month postoperative evaluation, the UCLA score changed from 24,37 (before surgery) to 33,1. The average loss of external rotation was 12,5 degrees, compared with the normal shoulder. The only real failure was the breaking of the coracoid in 1 patient. In this case the author used successfully the arthroscopic conjoined tendon tenodesis (using anchors) in the anterior glenoid rim. The coracoid and conjoined tendon transfer procedure is one of the most useful treatments for shoulder instability. Using this procedure many other shoulder surgeons have derived good and safe results. This procedure is strongly recommended for anterior glenoid bony loss, in contact athletes, gross anterior shoulder instability and failure of previous soft tissue procedures; however special attention is necessary to avoid limitation in external rotation. To improve surgical access and to make it easier to scope, the surgeon may use different portals to have a wide view and be able to work better. Compared with the open procedure, it is shown to be superior because of limited exposure, especially in young athletes with significant musculature. The arthroscopic technique is also advantageous in those cases in which the preoperative assessment fails to reveal a Humeral Avulsion of the Glenohumeral Ligament lesion or a large bony avulsion from the anterior glenoid rim. It also allows the surgeon to modify his plan intraoperatively. As to the graft placement and fixation, the arthroscopic technique provides better visualization for positioning the coracoid. This should minimize the risk of anterior overhang of the bone block and then, reduce the risk of osteoarthritis of the humeral head, a well-recognized complication of open procedures. There is also the advantage of the graft-shaving possibility. The absence of special devices was our challenge in creating this technique. The coracoid is horizontally positioned exposing the bone marrow and leading to a biological healing. Even with the advantages mentioned in the above, at this time, it does not seem evident that in long term the arthroscopic technique produces better results than the open surgery.

Implant Choices, Technique, and Results in Revision Acetabular Surgery: A Review

Acetabular reconstruction in revision total hip arthroplasty can successfully be achieved with hemispherical components featuring a porous or roughened ingrowth surface and options for placement of multiple screws. Most defects can be reconstructed with large hemispherical or "jumbo" cups. Achieving component stability and sufficient contact area on adequate host bone is mandatory. Defects with greater bony loss or compromised columns require either the use of modular augments combined with a hemispherical shell, reconstruction cages, structural allografts, or custom triflange acetabular components. This paper will detail the necessary pre-operative evaluation, the intra-operative details, and the reported results of these acetabular revisions.

Transposition of a maxillary canine and a lateral incisor and use of cone-beam computed tomography for treatment planning

This report describes the orthodontic treatment of a 12-year-old girl with transposition of the maxillary left canine and the lateral incisor. Cone-beam computed tomography was used during treatment planning. The transposed tooth positions were corrected with an unconventional orthodontic approach. Treatment alternatives and their clinical concerns are presented.

Virtual Assessment of the Endocranial Morphology of the Early Modern European Fossil Calvaria From Cioclovina, Romania

Endocasts provide evidence on size and shape characteristics, blood supply trajectories, and neurological features of the brain, allowing comparative analyses of fossil hominins crucial to our understanding of human brain evolution. Here, we assess the morphological features of the virtual endocast of the Cioclovina Upper Paleolithic calvarium, one of the earliest reliably dated European modern human fossils. Our study was conducted on a computed tomography (CT) scan of the original specimen. The endocranial profile was approximated via a semiautomatic segmentation of the CT data. Virtual reconstructions of the endocast were used for assessing the morphological features of the endocranium and for the estimation of the endocranial volume. Cioclovina exhibits a clockwise torque with a small anterior extension of the left frontal lobe over the right one and a protrusion of the right occipital lobe over the left, most likely due to the superior sagittal sinus coursing over the occipital pole. There is an obvious right predominance of the posterior drainage system. Interestingly, the area of the frontal sinus is occupied by dense bony tissue with small air cells corresponding probably to a natural bony loss in the diploë and to vascular spaces. An estimated endocranial volume of 1498.53 cc was calculated. The convolutional details of the third inferior frontal gyrus (Broca's caps) are indistinguishable from those found in modern Homo sapiens, and the left occipital lobe appears wider than the right, a possible correlate of right-handedness. Our metric analysis of endocranial measurements also aligns Cioclovina with modern humans.

Use of a compression tumor implant with total elbow arthroplasty for traumatic distal humeral bone loss in a young woman

Traumatic open fractures associated with loss of significant portions of osteochondral and diaphyseal bone present a difficult clinical and surgical problem. This injury pattern occurring around the elbow is also known as a “side-swipe” injury.11 For younger patients, open reduction and internal fixation with bone grafting or structural allograft reconstruction is currently the accepted standard of care for manageable defects.12 Management of high-energy distal humeral fractures with significant bony loss using endoprostheses has been previously described.

Bone Loss in Lymphoma Patients Prior to Receiving Front-line Therapy

Abstract Introduction Patients diagnosed with lymphoma are at high risk of developing osteoporosis. When treated with alkylating agents or corticosteroids, especially if the patient develops hypogonadism, the risk is further increased. Osteoporotic bone cannot easily be restored to normal levels of strength; thus, prevention of bony loss is crucial. The percentage of healthy patients with osteoporosis dramatically increases with advanced age, suggesting that progressive bone loss is common, even without the above-mentioned cancer-related factors. Pamidronate can reduce the risk of bone loss and vertebral fractures in patients with lymphoma receiving chemotherapy. Zoledronic acid, a bisphosphonate approximately 100-fold more potent than pamidronate, has not been evaluated in patients with lymphoma. Urinary N -telopeptide cross-linked collagen type I (NTx), a marker of bone resorption, has early predictive value for long-term bony outcomes in patients treated with bisphosphonates. Bone-specific alkaline phosphatase (AP), a marker of bone formation, also correlates with response to bisphosphonate therapy. We have conducted a phase III trial to evaluate the effect of zoledronic acid on the change in bone mineral density (BMD) in patients with untreated lymphoma undergoing chemotherapy. We report the striking number of untreated lymphoma patients who present with osteopenia and thus would be at significant risk for future bone-related sequelae. Patients and Methods All patients with newly diagnosed lymphoma seen at our institution from 2005 to 2009 were evaluated for protocol eligibility. Exclusion criteria included bone fractures, BMD T-scores worse than −2.0, creatinine clearance Results To date, 46 patients have completed the study and have evaluable data. Patient characteristics include 27 male, 4 premenopausal female, 15 postmenopausal female, median age of 62 years (range, 33-80 years). Twenty-one patients had indolent lymphoma (18 follicular, 1 follicular center, 2 small lymphocytic), 19 had large B-cell lymphoma (17 diffuse large B-cell, 2 primary mediastinal B-cell lymphoma), 3 patients had Hodgkin lymphoma, 2 patients had mantle cell lymphoma, and 1 patient had Waldenstrom macroglobulinemia. Twenty-two patients (48% of all patients) had osteopenia at baseline enrollment in the trial, including 15 men (56% of men) and 7 women (37% of women). We have previously reported our significant findings of stable T scores in the zoledronic treatment group at all locations during the 12-month observation, and the T-scores of the control group decreased at every location evaluated (location: L1-4, P = .004; L neck, P = .001; L hip, P = .118; R neck, P = .009; R hip, P = .04). We have also reported our significant findings of the bone markers urine NTx and BSAP decreasing in the zoledronic acid treatment group and increasing in the control group. The bone makers were similar at baseline in both groups, and demonstrated early response at 3 months for BSAP and 6 months for urine NTx. Conclusions Treatment with zoledronic acid in newly-diagnosed lymphoma patients prevents the bone mineral density loss commonly seen in this population. Bone mass lost is difficult to restore, thus necessitating effective prevention strategies. Urine NTx and bone-specific AP levels demonstrate early response to bisphosphonate therapy, which may allow for early intervention and potentially prevention of further bone loss. With improving long-term survival for lymphoma patients, the need to address survivorship issues will prove more relevant to avoid preventable morbidity. We found a much-larger-than-expected portion of men with osteopenia at baseline. The etiology of the baseline low bone mass is unknown, but further evaluation of this finding in future trials is warranted to determine the significance. The portion of all lymphoma patients with baseline osteopenia in our trial, prior to any therapy, is striking and argues for baseline screening of all patients.

Bone Loss in Lymphoma Patients Receiving Frontline Therapy: Urine NTx and Bone Specific Alkaline Phosphatase Provide Early Evidence of Zoledronic Acid Response.

Abstract 3922Poster Board III-858Abstract:Patients diagnosed with lymphoma are at high risk of developing osteoporosis. We have shown previously that the majority of newly diagnosed patients are osteopenic or osteoporotic prior to receiving chemotherapy. When treated with alkylating agents or corticosteroids, especially if the patient develops hypogonadism, the risk is further increased. Osteoporotic bone cannot easily be restored to normal levels of strength, thus prevention of bony loss is crucial. Pamidronate can reduce the risk of bone loss and vertebral fractures in lymphoma patients receiving chemotherapy. Zoledronic acid, a bisphosphonate approximately 100-fold more potent than pamidronate, has not been evaluated in lymphoma patients. We have conducted a phase III trial to evaluate the effect of zoledronic acid on the change in bone mineral density (BMD) in patients with untreated lymphoma undergoing chemotherapy.Urinary N-telopeptide cross-linked collagen type I (NTx), a marker of bone resorption, has early predictive value for long term bony outcomes in patients treated with bisphosphonates. Bone specific alkaline phosphatase (AP), a marker of bone formation, also correlates with response to bisphosphonate therapy. We report the change in urine NTx and bone specific AP levels in lymphoma patients treated with zoledronic acid. MethodsAll newly diagnosed lymphoma patients seen at our institution from 2005 – 2009 were evaluated for protocol eligibility. Exclusion criteria included bone fractures, BMD T-scores worse than –2.0, creatinine clearance less than 60 mL/min, dental problems, and recent steroid or bisphosphonate use. Patients on study were stratified as male, pre-menopausal female, or post-menopausal female. Accrued patients were randomized to receive either: 1) oral calcium and vitamin D (Ca+D) or 2) Ca+D and 4 mg zoledronic acid IV at baseline and at 6 months. Urine NTx and bone specific AP levels were measured at baseline, 3, 6, 9, and 12 months. ResultsTo date, 33 patients have completed the study and have evaluable data. Patient characteristics include: 17 male, 4 pre-menopausal female, 12 post-menopausal female, median age 62 (range 33 – 80). Seventeen patients had osteopenia upon enrollment. Patients that received zoledronic acid had stable median T-scores at all locations during the 12 month observation, whereas the T-scores of the control group decreased at every location evaluated (Location: L1-4, p=0.004; L Neck, p= 0.001; L Hip, p=0.118; R Neck, p=0.009; R Hip, p=0.040). Each group had a similar baseline level of urine NTx and bone specific AP. At 6 months, the urine NTx decreased significantly in the zoledronic acid-treated group compared to urine NTx levels in the control group which increased (p<0.001). The separation between groups remained constant throughout the evaluation period (12 months, p<0.001). The bone specific AP level decreased in the zoledronic acid group by 3 months, and remained below baseline levels at 12 months. The control group had increases in bone specific AP levels throughout the 12 month period (6 months, p=0.001; 12 months, p<0.001). ConclusionsTreatment with zoledronic acid in newly-diagnosed lymphoma patients prevents the bone mineral density loss commonly seen in this population. Bone mass lost is difficult to restore, thus necessitating effective prevention strategies. Urine NTx and bone specific AP levels demonstrate early response to bisphosphonate therapy. The ability to predict response to bisphosphonates at 6 months may allow for early intervention, potentially preventing further bone loss. Our study demonstrates the bone markers urine NTx and bone specific AP are significantly associated with bone health in lymphoma patients receiving chemotherapy. Disclosures:Thompson:Novartis: Research Funding. Toth:Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Hagemeister:Novartis: Research Funding.

Recurrent pneumothoraces, rash, and polyuria

In October, 2008, a 23-year-old woman presented with sudden onset of left-sided chest pain and shortness of breath. She had a history of chronic cough with exertional dyspnoea for 2 years. She had been admitted twice to diff erent hospitals in the previous year for spontaneous pneumothoraces. She had refused further investigation and defaulted follow-up. She had been a smoker for 11 years. Over the previous year, she also noted itchy, nodular rashes aff ecting her armpits and vulva, as well as nocturia and polydipsia. Her primary care physician had managed her cough and rash symptomatically and reassured her that she did not have diabetes mellitus. On presentation, chest radiograph showed a left pneumothorax, so a chest tube was inserted urgently. Severe respiratory distress followed, and she was intubated. Examination showed ulcerative, nodular lesions aff ecting her armpits and vulva. She had notable polyuria with hypernatraemia (157 mmol/L). Desmo pressin was given, resulting in lower serum sodium (140 mmol/L); a diagnosis of cranial diabetes insipidus was made. MRI of the pituitary fossa showed thickening of the infundibulum. CT showed diff use cystic lesions in the lungs (fi gure A) and multiple small bony focal defects (fi gure B). Histological examination of skin lesion biopsy samples showed heavy infi ltrates of histiocytes with strong immunohistochemical staining to CD1a, confi rming the diagnosis of systemic Langerhans’ cell histiocytosis. She was successfully extubated on day 3 of admission and underwent a left thoracotomy for her pneumothorax, after which long-term corticosteroid treatment was started. When seen in February, 2009, she was no longer smoking, and her condition had improved. Her rash had subsided and the lesions seen on CT of the chest and bones remained stable. The aetiology of Langerhans’ cell histiocytosis is unknown, although smoking is the main risk factor for isolated pulmonary disease. Whether Langerhans’ cell histio cytosis is a neoplastic or reactive disorder is controversial. In contrast to paediatric Langerhans’ cell histiocytosis, which is monoclonal in nature, adult lung disease is polyclonal. The Histiocyte Society has developed a simplifi ed classifi cation system for adult Langerhans’ cell histiocytosis, consisting of single organ and multisystem involvement. The incidence in adults is around 1–2 cases per million with a mean age at diagnosis of 35 years. Up to a quarter of cases are asymptomatic. Presenting symptoms depend on the pattern of organ involvement, with bony pain, weight loss, and fever being the most common. Diabetes insipidus from pituitary involvement is a characteristic manifestation of the disease–as in our patient. Patients with lung involvement typically have non-productive cough and dyspnoea. The chest radiograph is usually abnormal, with bilateral reticulomicronodular infi ltrates being the most common pattern. High-resolution CT is mandatory in suspected cases of pulmonary Langerhans’ cell histiocytosis. Defi nitive diagnosis relies on demonstration of CD1a antigen on immunohistochemical studies or identifi cation of Birbeck’s granules on electron micrograph. Smoking cessation is essential in pulmonary Langerhans’ cell histiocytosis. Single organ disease can be managed with watchful waiting; multisystem disease may respond to corticosteroids and systemic chemotherapy. Most patients experience a favourable outcome, although isolated pulmonary Langerhans’ cell histiocytosis has the worst outcome. Lung transplant can be considered in advanced disease, but there may be recurrence in the allograft. Diagnosis of Langerhans’ cell histiocytosis is often delayed with a median time of 4 months. There was substantial delay in diagnosis in our patient, confi rming suboptimal awareness for this uncommon condition.

Fresh cortical autograft versus fresh cortical allograft effects on experimental bone healing in rabbits: radiological, Histopathological and Biomechanical evaluation

Bone grafting is used to enhance healing in osteotomies, arthrodesis, and multifragmentary fractures and to replace bony loss resulting from neoplasia or cysts. They are source of osteoprogenitor cells and induce bone formation and provide mechanical support for vascular and bone ingrowth. Autografts are used commonly but quantity of harvested bone is limit. This study was designed to evaluate fresh cortical autograft and allograft effects on bone healing process. Twenty male White New Zealand rabbits were used in this study. In autograft group the defect was filled by fresh autogenous cortical graft, in allograft group the defect was filled by a segment of fresh allogenous cortical bone which was harvested at the time of surgery during the creation of radius bone defect. Then all surface soft tissue, such as muscle attachments, were removed from the harvested bone and changed between rabbits as a fresh allogenous cortical bone graft and was fixed by cercelage wire. Radiological, histopathological and biomechanical evaluations were performed blindly and results scored and analyzed statistically. Statistical tests did not support significant differences between two groups at the 14th and 56th postoperative day radiographically (P > 0.05). There was a significant difference radiologically for the 28th and the 42nd postoperative (P < 0.05). Autograft was superior to allograft at the 28th and 42nd postoperative day in radiological evaluation (P < 0.03). Histopathological and biomechanical evaluation revealed no significant differences between two groups.

Xenogenic demineralized bone matrix and fresh autogenous cortical bone effects on experimental bone healing: radiological, histopathological and biomechanical evaluation.

BackgroundBone grafting is used to enhance healing in osteotomies, arthrodesis, and multifragmentary fractures and to replace bony loss resulting from neoplasia or cysts. They are source of osteoprogenitor cells and induce bone formation and provide mechanical support for vascular and bone ingrowth. Autografts are used commonly but quantity of harvested bone is limited. The aim of this study is to evaluate autograft and new xenogenic bovine demineralized bone matrix (DBM) effects on bone healing process.Materials and methodsTwenty male White New Zealand rabbits were used in this study. In group I (n = 10) the defect was filled by xenogenic DBM and in autograft group the defect was filled by fresh autogenous cortical graft and fixed by cercelage wire. Radiological, histopathological and biomechanical evaluations were performed blindly and results scored and analyzed statistically.ResultsStatistical tests did not reveal any significant differences between two groups on the 14th postoperative day radiographically (P > 0.05). There was a significant difference for union on 28th and 42nd postoperative days and for remodeling at on the 56th postoperative day radiologically (P < 0.05). Statistical tests did not support any significant differences between two groups for radiological bone formation (P > 0.05). Histopathological and biomechanical evaluation revealed no significant differences between two groups.ConclusionsThe results of this study indicate that satisfactory healing occurred in rabbit radius defect filled with xenogenic bovine DBM. Complications were not identified and healing was faster, same as in cortical autogenous grafting.

Effect of bovine fetal growth plate as a new xenograft in experimental bone defect healing: radiological, histopathological and biomechanical evaluation

Bone grafting is used to enhance healing in osteotomies, arthrodesis, and multifragmentary fractures and to replace bony loss resulting from neoplasia or cysts. They are source of osteoprogenitor cells and induce bone formation and provide mechanical support for vascular and bone ingrowth. Autografts are used commonly but quantity of retrieved bone is limit. This study was designed to evaluate autograft and new xenograft (Bovine fetal growth plate) effects on bone healing process. Twenty male White New Zealand rabbits were used in this study. In autograft group the defect was filled by fresh autogenous cortical graft, in xenograft group the defect was filled by a segment of bovine fetal growth plate and was fixed by cercelage wire. Radiological, histopathological and biomechanical evaluations were performed blindly and results scored and analyzed statistically. Statistical tests did not support significant differences between two groups at the 14th and 28th postoperative day radiographically (P > 0.05). There was a significant difference for remodeling at the 42nd postoperative radiologically (P < 0.05). Xenograft was superior to autograft at the 56th postoperative day for radiological bone formation (P < 0.03). Histopathological and biomechanical evaluation revealed no significant differences between two groups. The results of this study indicate that satisfactory healing occurred in rabbit radius defect filled with calf fetal growth plate. Complications were not identified and healing was faster than cortical autogenous grafting. It was concluded that the use of calf fetal growth plate as a new xenograft is an acceptable alternative to cortical autogenous graft and could reduce the morbidity associated with harvesting autogenous graft during surgery.

Reconstruction of Traumatic Transposition of the Penis and Scrotum and Associated Complex Open Abdominoperineal Pelvic Deformity With Free Innervated Tensor Fascia Latae Osteomyocutaneous Flap

Guidelines for the repair of full-thickness defects of the lower abdominal wall have been established. However, lower abdominal defects associated with traumatic bladder herniation and pubic symphyseal diastasis or bony loss have not been addressed. Poor abdominal wall contour, protuberance, and recurrent hernias are likely when there is discontinuity of the midline pelvis in association with full-thickness lower abdominal defects and visceral herniation. We devised an operation that would not only restore bony continuity by providing a vascularized bone flap but also simultaneously maintain the integrity of the attachment of the tensor fascia latae muscle to the iliac crest and reestablish musculofascial continuity.

Holographic interferometry of cerebral pulsations

Background Holographic interferometry is a noninvasive method used to analyze the mechanical displacement affecting an object undergoing deformation. This technique has been primarily applied to inanimate entities owing to the difficulty in producing stress forces in living subjects. In this report, the possibility of harnessing cerebral pulsations as a displacement force to produce interferograms in neurosurgical patients was studied. Methods This work evaluates the application of this technology to patients with areas of calvarial defects. Using a pulse ruby laser, holographic interferograms were created in neurosurgical patients with areas of calvarial loss. The cardiac cycle was used to trigger the firing of the laser. Results The holographic interferograms were accurate up to within 0.5 mm in outlining the region of bony deficiency. Conclusion Holographic interferometry imaging was successfully accomplished using cerebral pulsations as a cyclic displacement-producing force. This method accurately outlined the area of bony loss. A discussion of this technology is included.

An open forearm fracture with intermedullary foreign body plug—a complication of airbag deployment

We present the case of an open forearm fracture with the previously unreported phenomenon of high-energy foreign body impaction into the exposed medulla, as a result of airbag deployment in a low velocity collision. A 34-year-old male driver was involved in a road traffic accident (RTA). He was the restrained driver in a car travelling at 10–15 miles h−1 which was struck on the passenger side by another car travelling at 15–20 miles h−1. The driver reported that he was driving with his left arm positioned across the steering wheel while making a turn at the time of impact. He sustained a grade III b open fracture of the left radius and ulna (Figs. 1 and 2). The radial fracture was a simple transverse fracture. The wound measured 7 cm × 5 cm. The ulnar fracture was comminuted with the proximal and distal ends of the ulna protruding through the wound. There was significant bony loss and fragments of synthetic foreign matter were identified at the fracture site (Fig. 3).

Prevention of the parrot beak deformity in fingertip injuries.

The nail is supported by the dorsal tuft of the terminal phalanx. Following distal fingertip trauma, varying amounts of nail support may be lost resulting in the nail curving palmarwards. This curvature is dependent upon the degree of bony loss, the amount of remaining nail bed and the degree of scar contracture at the hyponychial-pulp interface. The parrot beak or hooked nail deformity is most commonly caused by tight closure of a fingertip amputation and excessive palmar tension at the hyponychial-pulp suture line. A simple technique using a hypodermic needle, that eliminates tension from the suture line at the fingertip pulp-hyponychial interface and prevents hooked nail deformity is described. This allows healing to take place without any palmarwards pull of the scar and a subsequent parrot beak deformity.