Iliac Cancellous Bone Graft Research Articles

Calcium Sulphate Delivery System with Tobramycin for the Treatment of Chronic Calcaneal Osteomyelitis

The case of a 24-year-old woman with Pseudomonas aeruginosa and Proteus mirabilis chronic calcaneal osteomyelitis is presented. Extensive debridement of the necrotic bone and application of tobramycin-loaded polymethylmethacrylate beads was performed and ciprofloxacin was given post-operatively. Three months later, laboratory tests, including complete blood cell count, erythrocyte sedimentation rate and C-reactive protein, were normal. At this time, extensive surgical debridement and filling of the osseous defect with autologous iliac cancellous bone graft and tobramycin-impregnated calcium sulphate pellets and paste were performed. Oral ciprofloxacin was administered for 3 months after surgery. At the latest follow-up, 2 years later, the patient had full weight-bearing function; there was no recurrence of the infection, and complete incorporation of the autologous bone and calcium sulphate graft with the host bone was observed. This case demonstrates that two-stage surgical treatment with extensive debridement and tobramycin-impregnated calcium sulphate was effective in treating chronic calcaneal osteomyelitis.

The first case of primary metacarpal V restoration with titanium mesh and cancellous bone graft

Any references of use of the titanium mesh in hand reconstruction could not be found. A case of primary metacarpal reconstruction after severe hand trauma with a help of cage made of titanium mesh and cancellous iliac bone graft is presented.

Clinical experience of iliac cancellous bone grafting in alveolar cleft repair

目的 报告自体髂骨松质骨修复牙槽突裂的临床应用.方法对2003年7月至2005年1月收治的10例牙槽突裂髂骨松质骨修复的回顾性研究.结果植骨成功9例.结论自体髂骨松质骨修复牙槽突裂是一项成熟有效的技术。

Coralline hydroxyapatite and laminectomy-derived bone as adjuvant graft material for lumbar posterolateral fusion

The purpose of this study was to evaluate the effectiveness of coralline hydroxyapatite (CHA) and laminectomy-derived bone as an adjuvant graft material when combined with autogenous iliac bone graft (AIBG) in posterolateral fusion (PLF). This prospective, case-control study involved 58 patients who underwent lumbar instrumentation-augmented PLF for degenerative spinal stenosis-induced segmental instability between July 2000 and June 2001. The patients were divided into three groups. Laminectomy bone and AIBG were placed in the right intertransverse process space in Group 1 (20 patients), CHA and AIBG were placed in Group 2 (19 patients), and laminectomy bone and CHA were placed in Group 3 (19 patients). Pure autogenous iliac cancellous bone graft was placed in the left intertransverse process space in all three groups of patients. Successful fusion was determined by two spine surgeons after examining the plain, anteroposterior, bilateral oblique, and lateral flexion-extension radiographs. If the examiners did not agree on fusion status, fine-cut computerized tomography scans of the fusion mass were used to make the final decision. The chi-square test was used to compare the fusion rate at different time intervals among the three groups. Pure AIBG placed in left intertransverse process space was associated with the best fusion rate. After 6 months, CHA produced a comparable result to laminectomy-derived bone when combined with AIBG. When laminectomy bone was mixed with CHA, the combination failed to yield a satisfactory fusion rate (57.9%) even 1 year after surgery if no AIBG was added.

Long-term results of multiple-stage treatment for posttraumatic osteomyelitis of the tibia.

The treatment of posttraumatic osteomyelitis of the tibia requires meticulous debridement and adequate soft tissue coverage. At our institution, we perform a staged procedure consisting of surgical debridement followed by muscle coverage. If necessary, implantation of a cancellous iliac bone graft was always performed as a three-stage treatment. We performed a retrospective analysis of 47 patients treated for posttraumatic osteomyelitis of the tibia between 1987 and 1998. Twenty-two patients originally had a Gustilo grade III fracture, 21 patients had a Gustilo grade I or II or closed fracture, the Gustilo grade was not known for 2 patients, and 2 patients had no fracture. Using the Cierny-Mader classification, most patients had a localized osteomyelitis. To cover the debrided area, 20 pedicled muscle transfers and 28 microvascular free flaps were used; one patient had two localizations of osteomyelitis (both proximal and distal) and received two muscle flaps. Flap failure was 8% and was successfully treated by additional flap coverage in two cases; one was closed by a split skin graft and one was closed by secundum. Twenty-six patients received a cancellous bone graft. During an average follow-up of 94 months, 9% had a recurrence of osteomyelitis for which additional surgical interventions were necessary. Finally, all the infections were eventually cured. Our staged surgery proved to be an excellent method of treating osteomyelitis after open or closed fractures of the tibia.

Cancellous bone grafting in alveolar cleft repair: new experience.

Bone grafting plays an important role in the dental rehabilitation of patients with alveolar cleft. During the period between 1993 and 2001, 12 patients with alveolar clefts have been treated in our clinic. Cancellous iliac bone grafts were used in all 12 patients. Seven patients had left and five patients had right complete unilateral cleft lip and complete cleft palate operations. All patients had palatal fistulas. The ages were between 4 and 18 years (mean age, 10.5 y). Seven of them were female (58.4%) and 5 were male (41.6%). All the cancellous grafts survived. Enough filling and the closure of the fistulas were achieved except one patient who had wound dehiscence and partial graft loss. The patients experienced a limp for 2 days (mean time) because of the donor site. This surgical procedure achieves successful results if it is used with the proper indication in suitable cases.

Nonunion of the isolated capitate waist fracture

AbstractWe report a patient with nonunion of an isolated fracture of the capitate. A male 17-year-old high school student directly hit the dorsal aspect of the carpal with the wrist in flexion position against another player’s shoulder during a rugby football game. Radiographs did not show a fracture of the capitate on the day after the injury, but nonunion was distinct across the waist at the middle one-third of the capitate 4 months later. The fixation using two cannulated Herbert-Whipple screws with iliac cancellous bone graft led to sound union of the capitate and the patient’s ability to return to sporting activities. Although the initial plain radiographs do not show a fracture of the capitate, we should consider the capitate fracture and check the patient by repeated physical examinations and radiographs if the patient suffers from persistent localized pain and tenderness over the capitate.

Emergency management of type IIIB open tibial fractures

We present our therapeutic strategy for the treatment of type IIIB open tibial fractures. It involves emergency internal stabilisation of the bone by locked intra-medullary nailing when appropriate and skin cover using either a pedicled or free muscle flap. Where there is bone loss, a cancellous iliac graft is performed at the same time. Eighteen cases of type IIIB open tibial fractures treated between 1986 and 1995 were analysed. There were 17 men and 1 woman; the average age was 35 years. Each of the 18 patients underwent wound debridement as a primary emergency procedure with no secondary reoperation. Bone fixation was performed by locked intra-medullary nailing (AO nail, How Medica) 6–10 h after trauma. A primary cancellous iliac bone graft was performed in three cases. Cover was applied immediately after nailing (muscular pedicle flaps in 12 cases, muscular free flaps in 6 cases). Local flap cover led to two failures: both these fractures were followed by postoperative complications. The 6 free muscle flaps were successful. The average time to bone union was 6.5 months (range: 3–18.5 months) according to clinical criteria and 9 months (range: 4–27 months) according to radiological criteria. Out of the 18 fractures, 13 were primarily united (72.2% of cases); 3 involved osteitis and 2 nonunion. Sixteen patients were examined again with a mean follow-up of 4.8 years (range: 1–11 years). Six moderate malunions occurred; none needed surgical reoperation. Ankle motion was normal in 7 cases and reduced to below 50% in 9 cases when compared with the healthy ankle. Thirteen patients resumed their previous professional activities. This surgical strategy reduces bone union time, the number of operations and the time spent in hospital; it improves functional results.

デンタルＸ‐Ｐによる補綴学的診断

The purpose of this study was to investigate the problem of prosthetic diagnosis using periapical dental radiographs for crown and bridge. In general, periapical dental radiographs were on the following.1. The form of pulp cavity.2. The length ratio of crown to root.3. The form of root trunk.4. The resorption of root and bone.5. The dental caries and the root fracture.6. The structure of periodontal tissue (the space of periodontal membrane, the alveolar border, the lamina dura and the spongy substance of alveolar bone).The radiographic findings are useful for periodontic and endodontic diagnosis. More useful and functional information must be obtained for prosthetic diagnosis. Thus, the suggested plans are as follows:1. The crown and bridge made by prosthodontist with a 5-year guarantee.2. The oral radiologist should administer and manage all periapical dental radiographs.3. To investigate viewing radiographs from a functional perspective.4. Practice of prosthetic treatment with team-approach.Two cases were reported. One was a destruction case of periodontal tissue by ITI implant. The other was a reconstruction case of periodontal tissue by the transplantation of mandibular molar following iliac cancellous bone graft.

Management of femoral diaphyseal infected nonunion with antibiotic beads local therapy, external skeletal fixation, and staged bone grafting.

Fifteen patients with femoral shaft fractures complicated by infected nonunions were treated with a two-stage protocol. In the first stage, radical debridement was performed along with antibiotic bead chains local therapy and external skeletal fixation. In the second stage, the debrided nonunion site was repaired with bone grafting and the external skeletal fixator was used until bony union was achieved. The time between the first and second stages of treatment was 2 to 6 weeks. The debrided bone defects ranged from 0.5 to 15 cm. Autogenous iliac cancellous bone grafting was performed in 11 patients, and microvascularized osteoseptocutaneous fibular transfer was performed in 4 patients. Wound healing and bone union were achieved in all 15 cases. The duration of external fixation of these patients ranged from 7 to 15 months, with an average of 9 months. Minor pin-track infection was seen in seven patients. Postoperative infection after the second-stage bone grafting occurred in three patients. These three infections were arrested by limited debridement along with 2 to 4 weeks of parenteral antibiotic therapy. In one case, stress fracture occurred at 11 months after microvascularized fibular transfer; this was managed with another 5 months of external skeletal fixation. With an aggressive physical therapy program, 10 patients achieved nearly full range of knee motion and 5 patients had relevant knee flexion deficits. The follow-up averaged 58 months (range, 40-76 months); no recurrence of osteomyelitis was observed even at 76 months. We have found that our two-stage treatment with antibiotic beads local therapy, definitive external skeletal fixation, and staged bone grafting is an acceptable treatment protocol for the management of femoral diaphyseal infected nonunion. It results in rapid recovery from osteomyelitis and a predictable recovery from nonunion.

Sinusfloor elevation and grafting with autogenous iliac crest bone.

Insufficient bone height in the posterior area of the maxilla, due to expansion of the maxillary sinus and atrophic reduction of the alveolar process of the maxilla, represents a contra-indication for insertion of dental implants. This anatomic problem can, in many cases, be solved by augmentation of the floor of the maxillary sinus. This surgical technique was introduced by Tatum. The so-called top hinge door method creates a new floor of the maxillary sinus at a more cranial level. Underneath this new floor the existing space is filled with a bone graft. Implantation in the alveolar process with increased bone height allows insertion of dental implants. This sinus grafting technique was used in the present study. In total, 62 sinusfloor elevations were performed with cancellous iliac bone grafts in 42 patients. In those 62 augmented sinuses, 161 ITI screw type implants were inserted. The follow-up was 1-6 years after implantation. In 2 cases infections occurred. One implant needed an extended integration time. No implants were lost. The ITI solid screw implant appears to be a suitable implant following sinusfloor elevation operations, due to its rough surface, its shape and the size of the thread. The sinusfloor elevation procedure with autogenous cancellous bone graft appears to be a valuable and reliable pre-implantological procedure, provided a proper pre-operative investigation and careful surgery are performed. This procedure allows dental implant placement with a high success rate.

Use of microcomputed tomography scanning as a new technique for the evaluation of membranous bone.

Previous basic bone studies in cranial bone biology and bone grafting have used calipers, volume displacement, and cephalometric tracings to measure membranous bone and to infer fundamental properties of cranial bone. These tools have limited accuracy and reproducibility. Histomorphometry has also been used in the quantitative analysis of cranial bone; however, two-dimensional histology is unable to capture a precise representation of the three-dimensional structure of bone. For the first time, we have used the advanced technology of three-dimensional microcomputed tomographic (micro-CT) scanning as a highly accurate and automated tool to precisely measure changes in bone stereology, volume and projection, and microarchitecture in the evaluation of membranous bone. The advantages of this technology are numerous and include the rapid and nondestructive three-dimensional analysis of bone microstructure at resolutions between 10 and 75 microns. Measures of "connectivity" in three dimensions and the architectural parameter of "anisotropy" are available through micro-CT imaging but can only be inferred through two-dimensional histological series. We successfully imaged two full-thickness cranial bone specimens and one cancellous iliac bone graft. The images demonstrate a similarity between the two membranous specimens and a marked difference in comparison with the endochondral graft. These differences are borne out by mathematical analysis, and their significance is discussed. The utility of micro-CT in the evaluation of membranous bone was displayed by its ability to rapidly calculate differences in bone stereology and to quantitatively measure morphological changes at an ultrastructural level. We believe the benefits of this system will prove to be extremely useful for investigations into the basic biology of membranous bone, bone grafts, and craniofacial interfaces, and we encourage its use by other scientific investigators in the field of craniofacial surgery as they strive for more scientifically rigorous tools to understand the basic biology of membranous bone.

Minimally Invasive Iliac Cancellous Bone Graft Harvesting

Minimally Invasive Iliac Cancellous Bone Graft Harvesting

下顎骨に発生したｏｄｏｎｔｏｇｅｎｉｃ ｇｈｏｓｔ ｃｅｌｌ ｔｕｍｏｒの１例

Odontogenic ghost cell tumor, considered to be a solid type of calcifying odontogenic cyst, is a rare entity, and only a few cases have been reported in the English and Japanese literature. Here, we report a case of odontogenic ghost cell tumor in a 59-year-old man. The patient presented with a painless swelling in the mandible. The swelling extended from the first right molar region to the ramus. Radiography revealed a relatively well defined radiolucent lesion containing some irregularly-shaped radiopaque masses and an impacted third molar. Segmental resection and reconstruction with an iliac cancellous bone graft and a titanium mesh plate were performed. Histopathologically, there was evidence of tumor invasion of the periphelial cortical bone, areas consisting of large amounts of calcifying flaky keratin close to masses of ghost cells, and dysplastic dentinoid matrix adjacent to epithelial cell nests. Atypical mitosis was not found. A final diagnosis of “central odontogenic ghost cell tumor” was made. Three years after operation, the patient is well with no signs of recurrence.

The Fate of Free, Pedicled and Free Vascularized Cancellous Iliac Bone Grafts and the Effect on the Healing of Femoral Osteotomy: An Experimental Study

A new model for vascularized and nonvascularized iliac bone autograft transfer to a femoral shaft osteotomy site is presented in this experimental study. As demonstrated on roentgenograms taken at 4 to 6 weeks postoperatively, callus formation between vascularized grafts and recipient sites was 1.5 to 2 times faster than in the nonvascularized graft transfer. According to densitometric analysis, conventional free grafts lost more hydroxyapatite and restored their mineral structure at a slower rate than vascularized grafts. There was no difference between free vascularized and pedicled grafts in the rate of mineral deposition changes, but the pedicle grafts had more significant loss of bone density. Formation and mineralization of periosteal callus between the femoral-shaft fragments took place more rapidly in the first 12 weeks after pedicled bone transplantation. The correlation between the densitometric results and morphologic behavior of transplanted bones was examined. It was demonstrated that all of the grafts at the recipient site underwent remodeling into cortical bone. However, vascularized, and especially pedicled, grafts maintained their cancellous structure relatively longer.

Les chondromes de la main. Etude d'une série de trente-cinq cas

Twenty-nine patients were treated in the department of orthopedic surgery of Purpan (Toulouse), with thirty-five chondromata of the hand. Follow-up was over one year. Chondroma is a bone tumor predominantly of the left side, second ray of the hand and phalanx. Some multifocal cases have been observed. The diagnosis was made in half the cases through a pathological fracture. Chondroma is characterized by a diaphyseal or a metaphyso-diaphyseal lacuna, wearing away the cortical bone. Treatment consisted of curetting the tumor and filling the cavity with iliac cancellous bone graft. The clinical result was been excellent in 15 cases (60%), good in 6 cases (25%), with only some residual pain, and/or digital swelling. In two cases the finger was stiff, but functionally not disabling. In one case the stiffness was important and very disabling; after several recurrences it evolved into a chondrosarcoma.

Nonunion of the Humeral Shaft

Retrospective review of records of 26 patients with nonunion of the humeral shaft revealed several factors frequently associated with the development of nonunion. The fractures were transverse and short oblique and treated per primam with hanging casts or open reduction. Surgical fixation was unstable. The types of nonunion were atrophic in 19 patients, hypertrophic in five patients, and synovial pseudarthrosis in two patients. Twenty-four of 26 nonunions (92%) treated with bone grafts and rigid internal fixation healed in an average of 5.6 months. Overall, 47 surgical procedures, including prior procedures, were performed on these 26 nonunions. The average number of operations per patient was 1.8. Successful platings produced immobilization, consisting of an average of 6.8 points of cortical fixation above the nonunion and 7.1 cortices below. Rigid fixation was not obtained in the unsuccessful procedures. Unsuccessful platings were noted to have unstable fixation, with an average of 2.7 points of cortical fixation above the nonunion and 3.0 cortices below. Bone grafting was performed in only 55% of the unsuccessful platings. Optimal treatment of nonunions of the humeral shaft consists of resecting atrophic nonunions, shortening the bones, drilling sclerotic areas, and apposing bleeding diaphyseal surfaces; open reduction with internal fixation with a broad compression plate, including at least six points of cortical fixation above and below the nonunion; compression of the nonunion by means of interfragmentary lag screws, prestressing of the plate, dynamic compression by the plate, or direct compression by the external compression device; and autogeneic cancellous iliac bone grafts.

Titanium tray mandibular reconstruction.

Mandibular reconstructions still present a difficult and challenging problem. Failures experienced in using rib or iliac bone grafts stimulated clinical and research activities in evaluating the following new techniques: composite myocutaneous bone flaps, bone transplants with microvascular anastomoses, and freeze-dried homografts. This article describes the usefulness of the titanium tray with or without cancellous iliac bone grafts for mandibular reconstruction. The series presented herein includes 12 patients who underwent mandibular reconstruction after trauma or ablative cancer surgery, No immediate or delayed extrusion of the titanium tray was observed with follow-up as long as eight years after surgery. Advantages and disadvantages of this technique will be discussed.

TREATMENT OF NON-UNION IN COMPOUND FRACTURES WITH INFECTION

A method of bone grafting has been used successfully in nine of ten difficult cases of ununited fractures, in eight of which infection was present. Multiple autogenous cancellous iliac-bone grafts are advocated for this procedure, because they are rapidly revascularized and are readily incorporated into the host bone. They do not tend to sequestrate in the presence of infection. Adequate treatment of associated soft-tissue wounds and infection is most important. Our procedure has been: (1) to attempt to control the infection; (2) to replace devitalized scar with adequate skin; (3) to proceed with bone-grafting.