Combination Of Bone Graft Research Articles

Efficacy study of platelet-rich plasma combined with core decompression and bone grafting in the treatment of early-stage avascular necrosis of the femoral head: a retrospective study

ObjectiveThis study aimed to evaluate the effectiveness of combined core decompression (CD), bone grafting (BG), and platelet-rich plasma (PRP) in treating early-stage avascular necrosis of the femoral head (ANFH).MethodsA retrospective study was conducted on 74 patients (85 hips) with Ficat-Arlet stage I-II ANFH who were treated at our hospital between May 2015 and May 2018. The control group (20 patients, 22 hips) received symptomatic treatments, including weight-bearing reduction and oral analgesics. The CD + BG group (29 patients, 34 hips) underwent CD and β-tricalcium phosphate bone grafting. The PRP combination group (25 patients, 29 hips) received PRP injections in addition to CD and BG. Patients were followed up for five years to assess the necessity for total hip arthroplasty (THA). Data analysis was performed on those from the CD + BG and PRP groups who did not require THA. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), Harris Hip Score (HHS), and the proportion of patients not accepting THA.ResultsAt the five-year follow-up, the rate of THA in the control group was 68.18% (15/22), while in the CD + BG group and the PRP combination group, the rates were 17.65% (6/34) and 10.34% (3/29), respectively. There was no statistically significant difference between the CD + BG group and the PRP combination group (P = 0.441), but both differed significantly from the control group (P < 0.001). Kaplan-Meier survival analysis showed that over time, the proportion of patients in the PRP combination group who did not require THA was consistently higher than that in the CD + BG group. Among patients who did not undergo THA, the proportion of Ficat-Arlet stage I-II patients in the PRP combination group was 88.46% (23/26), which was higher than the 64.29% (18/28) in the CD + BG group, showing a significant difference (P = 0.038). VAS score and HHS were compared between the two groups at 6 months, 12 months, and the last follow-up point, with patients in the PRP combination group showing better scores than those in the CD + BG group (p < 0.05) in both metrics.ConclusionThe combination therapy of CD, BG, and PRP demonstrates significant advantages in improving symptoms and delaying disease progression in early-stage ANFH.

Mechanism of low-intensity pulse ultrasound combined with Rhodiola to promote bone formation in spinal fusion.

This study aimed to explore the influence and mechanism of low-intensity pulsed ultrasound (LIPUS) combined with Rhodiola bone penetration on the formation of spinal fusion bone. Sixty clean-grade New Zealand white rabbits were selected for randomization and divided into combined group and Rhodiola group, with 30 rabbits in each group to construct a rabbit lumbar intervertebral fusion model, using Rhodiola intervention and Rhodiola combined with LIPUS intervention protocol, respectively. The axial strength, axial stiffness, maximum compressive load, vascular endothelial growth factor (VEGF), cycloxygenase-2 (COX-2), prostaglandin E2 (PGE2) and transforming growth factor-β (TGF-β) were compared after HE staining, immunohistochemistry and biomechanical detection. Spine fusion rate was 100.00%; the combined bone graft tissue had implanted bone cell degeneration, cell necrosis and cell hyperplasia, chondrocytes differentiated into trabecular bone and some hematopoietic cells, severe cell necrosis and fiber cell proliferation and late bone formation in the Rhodiola group, VEGF, COX-2, PGE2, TGF-β, axial strength, axial stiffness, and maximum compression load in the combined group significantly increased (P<0.05). Spinal fusion using LIPUS combined with Rhodiola can enhance biomechanical properties and promote the role of PGE2, COX-2, VEGF, TGF-β expression and bone formation, and this protocol is worthy of clinical application.

Comparison of 3D computer-assisted planning with and without patient-specific instrumentation for severe bone defects in reverse total shoulder arthroplasty

BackgroundPreoperative planning is an integral aspect of managing complex deformity in reverse shoulder arthroplasty (RSA). The purpose of this study was to compare the success of patient specific instrumentation (PSI) and 3D computer-assisted planning with standard instrumentation (Non-PSI) in achieving planned corrections of the glenoid among patients undergoing RSA with severe bony deformity requiring glenoid bone grafts. MethodsA retrospective case-control study was performed, including all patients that underwent RSA with combined bone grafting procedures (BIO-RSA or structural bone grafting) for severe glenoid deformity by a single between June 2016 and July 2023. Patients were required to have preoperative and postoperative CT scans as well as preoperative 3D planning performed for inclusion. Patients were divided into two groups based on the use of 3D computer-assisted planning with or without PSI (PSI vs. Non-PSI). The corrected inclination and version were measured by two separate reviewers on preoperative and postoperative 2D CT scans and compared to their corresponding preoperative planning goals utilizing bivariate analyses. ResultsWe identified 45 patients that met our inclusion criteria (22 PSI and 23 Non-PSI). Preoperative inclination (mean ± SD) (PSI 10.12° ± 15.86°, Non-PSI 9.43° ± 10.64°; P = 0.864) and version (PSI -18.78° ± 18.3°, Non-PSI -17.82° ± 11.49°; P = 0.835) measurements were similar between groups. No significant differences in the mean deviation (error) between the postoperative and planned inclination (PSI 5.49° ± 3.72; Non-PSI 6.91° ± 5.05; P = 0.437) and version (PSI 8.37° ± 5.7; Non-PSI 5.37° ± 4.43; P = 0.054) were found between groups. No difference in the rate of outliers (>10° error) was noted in inclination (P = 0.135) or version (P = 0.445) between groups. Greater planned version correction was correlated with greater error when PSI was utilized (PSI r = 0.519, P = 0.013; Non-PSI r = 0.362, P = 0.089). ConclusionBoth PSI and 3D computer-assisted planning without PSI (Non-PSI) appear to be useful techniques to achieve version and inclination correction among patients undergoing RSA with severe glenoid deformity required glenoid bone grafting with no clear superiority of one method over the other. Surgeons should be aware that when utilizing PSI, slightly greater error in achieving version goals may occur as version correction is increased.

Assessment of bone defect morphology for the adjunctive use of bone grafting combined with enamel matrix derivative: A 3-year cohort study.

There have been limited studies with statistically sufficient sample sizes for assessment of suitable bone defect morphology for combination therapy with enamel matrix derivative (EMD) and bone grafting. The aim of this study was to investigate the appropriate feature of intrabony defects, such as bone defect angle (DA) and the containment by bony wall, for yielding the additional benefit of bone grafting in combination with periodontal regenerative therapy using EMD. Following periodontal regenerative therapy using EMD with or without autologous bone grafting, 282 intrabony defects of 177 participants were maintained for 3 years. Multilevel linear regression analysis was performed to evaluate the radiographic bony defect depth (RBD) reduction after adjusting for confounders. The baseline parameters, except for the proportion of contained bony defects and tooth mobility, did not differ significantly between the groups with and without bone grafts. There was no significant difference in the improvement of clinical parameters between the groups. The 1- and 3-year reduction of RBD showed significant inverse correlations with preoperative DA only in the group without bone graft. Furthermore, multivariate analysis showed a significant interaction between DA at baseline ≥40° and adjunctive bone grafting in the reduction of RBD, regardless of the number of bony walls. Adjunctive autologous bone grafting with enamel matrix derivative might be significantly beneficial for defect depth improvement in the case of DA at baseline ≥40°.

Use of Injectable Platelet-Rich Fibrin Accompanied by Bone Graft in Socket Endurance: A Radiographic and Histological Study.

Background Ridge preservation became a crucial dental health issue and strategy to keep away from ridge defacement after post-tooth loss. The recent scientific evolution of platelet-rich fibrin (PRF) comprises a parenteral formulation of PRF. The combined allograft for socket preservation gives benefits. In this study, bone allografts, demineralized freeze-dried bone allografts (DFDBA) and freeze-dried bone allografts (FDBA) are used in a 30:70 ratio alone or in combination with injectable PRF (I-PRF) for socket preservation. Methods This study is a radiographic and histological examination conducted on 60 participants aged between 19-65 years. Participating patients agreed voluntarily that theywould not bear any fixed prosthesis for the next nine months and plan for implantedteethplacement, including multi-rooted mandibular molars denticles. Both groups received atraumatic extraction; then, the socket was preserved with bone allograft alone in the control group and bone allograft mixed with I-PRF, forming sticky bone, in the experimental group. Clinical, radiological, and histological assessments were taken at the inception stage, three months, six months, and nine months. A multivariate regression model and a generalized estimating equation (GEE) model were used to analyse the effects of these changes on outcomes. Results In all the parameters, the test group indicated a good amount of bone growth with increasing intervals of time for bone height radiographically with statistically significant difference present (p<0.05) and histologically after nine months when socket site grafted with bone graft in combination with I-PRF. Conclusion This study's results demonstrated thatI-PRF possesses the potential to regenerate and healin the tooth-extracted socket. This study further recommends the implementation of I-PRF in safeguarding and conserving the raised rim of the tooth. Future research should take place on the osteogenic capability of I-PRF in more comprehensive ridge accession surgical procedures and additional expanding and improving capacities in periodontal reconstruction.

Features of organotopic remodeling of bone tissue and implanted osteoplastic material in Charcot neuro/osteoarthropathy

Introduction Despite the recognition of MRI as the gold diagnostic standard for Charcot arthropathy, there is evidence in the literature that MSCT is more informative for objective qualitative and quantitative diagnosis of the condition, primarily of the bone skeleton of the Charcot foot, in comparison with standard radiography. The sensitivity and specificity of these methods are different.Purpose To reveal the features of organotopic remodeling of bone tissue and implanted osteoplastic material in the course of midfoot and hindfoot subtotal defects management in Charcot neuro-osteoarthropathy.Materials and methods The analysis of bone tissue and implanted osteoplastic material density was carried out in a case series that included 11 patients with Charcot neuro-osteoarthropathy who underwent a two-stage procedure for bone defects in the hindfoot and midfoot with the Ilizarov apparatus. We studied CT and MRI scans and measured bone regenerate density before treatment, at the stages of transosseous osteosynthesis, and 3, 6, and 12 months after surgery.Results In all patients, varying increase in the amount and volume of bone tissue was visualized due to intensive periosteal bone formation along with the formation of bone ankylosis in the joints along combined with a consistent increase in the optical density of bone regenerates. The formation of the new bone tissue ran without the signs of lysis or sequestration. The conducted studies indicate that the sizes and architectonics of bone fragments are more differentiated in CT than in MRI scans.Discussion It is known that the bone, despite its high mineralization, continuously rebuilds, restores and adapts itself to certain functional conditions. This constant dynamic process of adaptive remodeling depends mostly on optimal blood supply, metabolic activity and the coordinated work of bone cell elements. The data obtained show angiogenesis in the compromised tissues in patients with Charcot foot and consistent remodeling of the graft into the new bone tissue.Conclusion The allobone in the composition of the combined bone graft does not reduce the likelihood of complete remodeling of the newly formed bone tissue. Higher bone density by filling in a bone defect with a graft differs from distraction regenerate that initially has low bone density. CT and MRI are highly effective and informative diagnostic methods for surgical treatment. In reconstructive interventions in the patients with Charcot foot under the conditions of transosseous osteosynthesis, preference among radiological study methods should be given to CT.

Результаты хирургического лечения посттравматических деформаций дистального метаэпифиза лучевой кости с применением комбинированной костной пластики

Цель. Изучить результаты хирургического лечения посттравматических деформаций дистального метаэпифиза лучевой кости со значительным ее укорочением (более 1 сантиметра). Изучить и выявить причины таких деформаций, определить оптимальную тактику лечения. Материалы и методы. Нами накоплен опыт оперативного лечения 22 пациентов с посттравматическими деформациями дистального метаэпифиза лучевой кости, которые в течение 2012–2021 годов обратились за помощью в учреждение здравоохранения «6-я городская клиническая больница» г. Минска. Пациенты были госпитализированы в сроки от 4 месяцев до 2 лет с момента травмы. В зависимости от метода хирургического лечения пациенты были разделены на 2 группы: первая группа – оперативное вмешательство выполнено с применением костной аллопластики (13 человек), вторая группа – с применением комбинированной костной пластики (9 человек). Результаты. Произведен сравнительный статистический анализ результатов хирургического лечения посттравматических деформаций дистального метаэпифиза лучевой кости с импрессией в метафизарной зоне более 1 сантиметра. У пациентов второй группы отсутствовали удовлетворительные и неудовлетворительные результаты. В процессе лечения пациентов первой группы (только костная аллопластика) наблюдали 4 удовлетворительных результата и 1 неудовлетворительный. В обеих клинических группах отсутствовали гнойно-воспалительные осложнения. Выводы. Применение комбинированной костной пластики для закрытия больших дефектов при хирургической коррекции посттравматических деформаций дистального метаэпифиза лучевой кости – наиболее приемлемый, простой, безопасный и эффективный метод. Использование только аллопластики для закрытия больших дефектов сопряжено с риском несращения в зоне остеотомии и необходимостью повторного хирургического вмешательства. Purpose. To study the results of surgical treatment of malunions of the distal metaepiphysis of the radius with its significant shortening (more than 1 centimeter). To study and identify the causes of such deformities, to determine the optimal treatment tactics. Materials and methods. We have accumulated experience in surgical treatment of 22 patients with malunions of the distal metaepiphysis of the radius, who were treated at the 6th Minsk City Clinical Hospital during 2012–2021. The patients were hospitalized for 4 months to 2 years from the moment of injury. Depending on the method of surgical treatment, the patients were divided into 2 groups: the first group – surgical intervention was performed using a bone allograft (13 people), the second group – using combined bone grafting (9 people). Results. A comparative statistical analysis of the results of surgical treatment malunions of the distal metaphysis of the radius with an impression in the metaphysical zone of more than 1 cm was carried out. There were no satisfactory or unsatisfactory results in patients of the second group. During the treatment of patients of the first group (only bone alloplasty), 4 satisfactory results and 1 unsatisfactory were observed. There were no purulent-inflammatory complications in both clinical groups. Conclusions. The use of combined bone grafting to close large defects during surgical correction malunions of the distal metaepiphysis of the radius is the most acceptable, simple, safe and effective method. The use of only allografts to close large defects is associated with the risk of nonunion in the osteotomy area, which will entail repeated surgical intervention.

Treatment of mandibular Grade II furcation defects using demineralized freeze-dried bone allograft alone or in combination with guided tissue regeneration membrane – A randomized controlled clinical trial.

Background– Periodontal disease, if not interfered, will headway further with attachment loss involving the bifurcation or trifurcation of multirooted teeth. Furcation involved molar teeth respond less favorably to conventional periodontal therapy alone resulting into tooth loss. Combining osseous grafting with guided tissue regeneration membrane may enhance the response to treatment as compared to graft – only therapy by achieving mechanical stabilization and preventing micromovement of the bone graft material.&#x0D; &#x0D; Aim &amp; Objective – To compare the efficacy of demineralized freeze-dried bone allograft alone or in combination with guided tissue regeneration membrane in the treatment of mandibular Grade II furcation defects.&#x0D; &#x0D; Materials &amp; method - In this study a total number of 20 patients with 20 mandibular sites (buccal grade II furcation involvement) were evaluated. They were divided into two groups: Control group (bone graft only) and test group (bone graft + GTR). The clinical parameters assessed were vertical probing depth, horizontal probing depth and relative clinical attachment level.&#x0D; &#x0D; Results – In this study the statistical analyses comparing test and control sites at baseline revealed no significant differences between the two groups for any of the clinical parameters considered. At 6 month evaluation, significant difference was found between two groups regarding VPD, HPD and rCAL.&#x0D; &#x0D; Conclusion – It was concluded that there is a significant enhanced effect of using DFDBA bone graft in combination with GTR membrane over bone graft alone for the treatment of mandibular Grade II furcation defects.&#x0D;

Reconstruction of ametadiaphyseal bone defect after open comminuted fracture of the proximal femur using amodified Masquelet technique

The reconstruction of segmental bone defects after surgical treatment of infected delayed unions as well as nonunions, places the highest demands on the surgical technical implementation. After treating the fracture-related infection, guaranteeing biomechanical stability is crucial for the success of the treatment. The presented case describes the successful treatment of an infected delayed union after an open metadiaphyseal comminuted fracture of the proximal femur using amodified Masquelet technique. Asolid allogeneic bone graft in combination with autologous cancellous bone were inserted into a7 cm subtrochanteric defect zone and stabilized with acombined plate and nail osteosynthesis.

Cone-beam computed tomographic comparison of chin symphysis bone particles and allograft versus iliac crest bone graft alone for reconstruction of alveolar bone defects in cleft patients.

ObjectivesThe aim of this study was to compare morbidities and duration of surgery, as well as bone formation in alveolar defects reconstructed with symphysis bone combined with allograft and iliac crest bone graft in patients with cleft palate.Patients and Methods This randomized clinical trial was performed with 22 patients with unilateral alveolar cleft with a follow-up period of 12 months. In 12 patients, alveolar defects were reconstructed with chin bone graft plus allograft (Group A), while for the other 10 patients, iliac bone crest was used as donor site (Group B). Duration of surgery as well as occurrence of morbidities and complications were recorded. In addition, cone-beam computed tomographic (CBCT) scans were performed before surgery and 12 months after surgical procedures in order to compare bone formation between the two groups.ResultsPostoperative CBCT demonstrated a mean bone fill percentage of 76.9% of the alveolar defect in Group A, compared with 77.0% in Group B. Paresthesia in the lower lip or chin did not occur in any patients of Group A. The mean duration of the surgical process was significantly shorter for Group A (40 minutes vs 76 minutes, P<0.001). In addition, patients in Group A regained normal gait faster than patients in Group B (1 day vs 9.5 days).ConclusionMandibular symphysis bone graft in combination with allograft results in favorable outcomes in patients with unilateral alveolar clefts.

Evaluation of bone grafting for treatment of low-grade chondrosarcoma of long bones

ObjectiveTo retrospectively analyze the biological compatibility and oncologic outcomes of autogenous, allogeneic, or combined bone grafting.MethodsFrom April 2000 to December 2016, 37 patients with histologically confirmed low-grade intramedullary chondrosarcoma of the long bones at Kyungpook National University Hospital were enrolled in this retrospective study. All 37 patients underwent intralesional curettage (with or without cryotherapy) followed by bone grafting. Among the 24 patients who underwent cryotherapy, 13 were treated by prophylactic internal fixation (10 in the femur, 1 in the tibia, and 2 in the humerus). Thirteen patients underwent the same treatment without cryotherapy, whereas 12 did not undergo preventive internal fixation.ResultsA single intraoperative fracture was managed by plate fixation. One patient who underwent cryotherapy and internal fixation developed a fracture distal to the operation site 25 days after surgery, and this fracture was repaired with a long plate. None of the 37 patients showed any recurrence or metastasis.ConclusionsAdequate intralesional curettage (with or without cryosurgery) combined with bone grafting using autogenous and allogeneic bone chips was effective for the treatment of low-grade intramedullary chondrosarcoma. Therefore, prophylactic internal fixation using a plate is recommended in the cryotherapy of definite cortical invasion in weight-bearing bones.

The Effect of Application of Combined Bovine-Derived Anorganic Bone Graft and Hemostatic Plant Extract on Bone Regeneration.

To evaluate the effect of bovine-derived anorganic bone graft (ABB) in combination with hemostatic plant extract (ABS) on bone regeneration. Three bone defects were created via an extraoral approach on the mandibles of nine domestic pigs. The first defects were filled with ABS solution (0.3 mL/defect) in a transporting agent of ABB (0.3 cc/defect), whereas the second defects were filled with ABS (0.3 mL/defect) in microcapsules for controlled drug release, combined with ABB (0.3 cc/defect) again. The third defects were left empty. After a 10-week healing period and the sacrification, undecalcified sections were prepared for histomorphometric analysis. The mean total area of hard tissue was 29.54% ± 3.2% in the control group, 59.78% ± 5.4% in the conventional group, and 63.67% ± 4.2% in the microsphere group (P < .001). The mean area of newly formed bone was 29.54% ± 3.2% in the control group, 34.79% ± 3.9% in the conventional group, and 37.95% ± 5.3% in the microsphere group (P = .003). The mean residual graft area was 24.99% ± 2.4% in the conventional group and 25.71% ± 4.4% in the microsphere group (P = .730). The combined usage of ABS and ABB in both ways increased bone regeneration statistically. However, there was no significant difference between the two methods for ABS delivery systems in terms of new bone regeneration.

Gastrocnemius muscle flap with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone graft for the phase I treatment of localized osteomyelitis after tibial plateau fracture surgery

PurposeTo investigate the clinical effect of gastrocnemius muscle flaps combined with vancomycin/gentamicin-calcium sulfate combined and autologous iliac bone graft in the phase I treatment of traumatic focal osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery.MethodsFrom July 2009 to January 2018, 35 patients with localized osteomyelitis (Cierny-Mader type III) who met the inclusion criteria were followed up and treated. All patients were infected after undergoing internal fracture fixation surgery. Among them, 18 cases were plate-exposed, 14 cases were due to sinus tracts, two were due to skin necrosis, and one was bone-exposed. We treated patients with several measures. All cases were then followed up. The follow-up indicators included Hospital for Special Surgery knee scores (HSS), the time of laying drainage pipe, bone healing time, infection control rate, and the incidence of nonunion and other complications.ResultsAll patients were followed up for 24–60 months. None of them underwent amputation. For repairing soft tissue defects, 17 cases were covered with a muscle flap using the medial head of gastrocnemius alone, 15 cases were treated with the lateral head of gastrocnemius muscle, and three cases were covered with the combination of the two heads. Compared to the preoperative score, we found that the average HSS improved at the 1-year and 2-year follow-up (54 vs. 86 vs. 87).ConclusionUsing a gastrocnemius muscle flap combined with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone was an effective method for the phase I treatment of osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery. In the primary treatment of focal traumatic osteomyelitis, it can decrease the treatment time, number of surgeries, pain of patients, time of bone healing, postoperative exudation, and infection recurrence rate and increase the healing bone’s strength.

Radial shortening, bone grafting and vascular pedicle implantation versus radial shortening alone in Kienböck's disease.

We prospectively compared outcomes of two surgical procedures for Stage II and IIIa Kienböck's disease with negative ulnar variance. Group I (13 wrists) was treated with radial shortening alone, and Group II (14 wrists) with combined radial shortening, bone grafting and implantation of a vascular pedicle. At follow-up 3 to 7 years (mean 4.5) after operation, scores by the Quick version of the Disability of Arm, Shoulder and Hand questionnaire and scores for pain and grip strength were significantly better in Group II, but the differences were rather small. On MRI all patients in Group II had revascularization, but 11 patients in Group I had not. We conclude that combining radial shortening with the revascularization procedure improved revascularization. Clinically, both treatments were efficient, and the additional bone grafting and vascular pedicle insertion did not greatly improve function, although statistically there were differences in several follow-up variables. This study also could not identify the independent role of the three procedures (drilling, grafting and artery insertion) in Group II, because decompression or bone grafting alone may be effective.Level of evidence: II.

The Effect of Autogenous Bone Graft Mixed With Recombinant Human Vascular Endothelial Growth Factor on Bone Regeneration.

Bone regeneration depends on vascularization in the pertaining site. This study aims to investigate autogenous bone grafts mixed with recombinant human vascular endothelial growth factor (rhVEGF) effect on bone regeneration in rat mandibular bone defect. Using 32 Wistar Albino rats, our experimental study consists of 4 groups: Group1 (control group), the defect was empty; Group 2, autogenous bone graft only; Group 3, gelatin sponge plus rhVEGF applications; Group 4, autogenous bone graft plus rhVEGF applications. The rats were sacrificed on the 28th day after the operation. New bone regeneration was analyzed histologically and immunohistochemically. Our histological analyses revealed that new bone regeneration in Group 3 was enhanced in comparison to Group 1 and Group 2. However, autogenous bone grafts combined with rhVEGF provided the best outcome in conjunction with the increased remodeling of the new bone. In the light of our results, it can be concluded that autogenous bone grafts in combination with rhVEGF can, potentially, enhance neovascularization and bone regeneration.

Wrist function recovery course in patients with scaphoid nonunion treated with combined volar bone grafting and a dorsal antegrade headless screw

BackgroundSurgical treatment is necessary for scaphoid nonunion. Open surgery with a combined volar and dorsal approach is thought to have poor functional outcomes and a prolonged recovery course. However, the detailed recovery course for this approach is rarely reported. The aim of this study was to investigate the recovery course and radiographic outcome for patients with scaphoid nonunion who underwent a combined volar bone grafting and dorsal antegrade headless screw approach.Material and methodsEighteen patients with scaphoid nonunion who underwent combined volar bone grafting and dorsal antegrade headless screw fixation were enrolled in this retrospective study. Preoperative and serial postoperative wrist functional and radiographic outcomes were collected and analysed.ResultsAll 18 patients achieved bone union at a mean time of 14.3 weeks. Compared to the preoperative status, the grip strength, wrist motion arc, and Mayo Wrist score were improved significantly 6 months after surgery, whilst the Disabilities of the Arm, Shoulder, and Hand (DASH) score did not recover until 12 months after surgery. Significant improvements were found in all scaphoid radiographic parameters.ConclusionThe surgical outcomes for scaphoid nonunion treated with a combined volar bone grafting and dorsal antegrade headless screw achieved a high union rate, with great wrist functional and radiographic outcomes. The earliest recovered wrist functional parameters were grip strength, motion arc, Mayo Wrist score and finally the DASH score at postoperative 6 months and 12 months, respectively.

Transforaminal Interbody Impaction of Bone Graft to Treat Collapsed Nonhealed Vertebral Fractures with Endplate Destruction: A Report of Two Cases

Background A collapsed nonhealed vertebral fracture with endplate destruction is a challenging injury to address, as there is no single definitive treatment. We present two cases using an innovative transforaminal grafting technique to treat these patients. Case Presentation. Case 1: a 72-year-old woman had nonunion of an L1 compression fracture with destruction of both endplates. T12/L1 and L1/L2 transforaminal debridement and impaction of bone graft were performed followed by posterior instrumentation. At three years follow-up, the fusion mass between T12/L1 and L1/L2 was solid and the patient had minimal pain. Case 2: a 62-year-old woman had nonunion of an L1 burst fracture with destruction of the lower endplate. Hemilaminectomy and transforaminal interbody impaction of bone graft was performed. At three years follow-up, the patient had no back pain and a solid fusion. In both cases, local kyphosis was corrected and fusion obtained. Conclusions Collapsed nonhealed vertebral body fractures combined with endplate destruction can be successfully treated with a one-step posterior surgery consisting of transforaminal debridement and impaction of bone graft in combination with posterior pedicle instrumentation.

Survivorship of autologous structural bone graft at a minimum of 2 years when used to address significant glenoid bone loss in primary and revision shoulder arthroplasty: a computed tomographic and clinical review

Severe glenoid bone loss remains a challenge in patients requiring shoulder arthroplasty and often requires autogenous bone grafting. The purpose of this study was to assess the integrity of the bone graft at 2 years in a series of primary and revision shoulder replacements where glenoid bone loss was managed using a structural autograft (humeral head or iliac crest bone graft) in combination with a trabecular titanium (TT) implant. Ethical approval was sought, and the study has a portfolio study status by the NIHR (17/YH/0318). We contacted patients who had primary and revision shoulder arthroplasty with Lima Axioma TT metal-back glenoid with autologous bone graft and were more than 2 years since their operation. All eligible patients underwent computed tomographic evaluation, clinical review, and scoring. Early failures of composite fixation and patients who had revision procedures were excluded (2 patients). Forty-one patients (43 shoulders) with a mean age of 65 years (range 33-85 years) were reviewed. There were 24 women and 17 men. The average follow-up period was 40 months (range 24-59 months). Primary arthroplasty was performed in 24 shoulders, whereas 19 shoulders had revision arthroplasty. Twenty-five shoulders had reverse shoulder replacement and 18 had anatomicshoulder replacement. Twenty-four shoulders had graft taken from the humeral head, and 19 had iliac crest bone graft, reflecting the numberof revisions. We used Wrightington classification for porous metal implant and bone graft incorporation. Satisfactory bone graft incorporation (>50%) was seen in 40 shoulders, and only 3 patients had <50% graft incorporation. The scans at 2 years or later showed no significant deterioration in the bone graft from the early postoperative scans. Average forward elevation improved from 50° (preoperative) to 98° (range 35°-150°). The mean improvement in mean Oxford Shoulder Score was 16 (preoperative, 15; postoperative, 31) and the mean improvement in Constant score improvement was 36 (preoperative, 12; postoperative, 48). The mean postoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score was 64 (range 30-85). The use of TT in conjunction with autologous bone graft provides a reliable method of addressing glenoid bone defects in primary and revision shoulder arthroplasty. This graft-trabecular metal composite has been shown to integrate well and remain largely unchanged over a 2-year period. A stable baseplate is essential in difficult primary and revision arthroplasty situations. The stability of this construct in our series is reflected in the satisfactory outcomes.

Surgical Management of Periapical Lesion in Maxillary Incisors with Combined Bone Graft and Platelet – Rich Fibrin: A Case Report

Chronic periapical lesions usually occur as an inflammatory response due to bacterial infection within the root canals. Periapical surgeries are considered as an important alternative when non-surgical conservative endodontic treatment fails in resolution of the lesion. Commercially various bone substitutes and regenerative methods are available after degranulation of tissue in order to attain favourable healing promoting bone regeneration. This case report represents healing of periapical lesion in maxillary incisors after periapical surgery, in conjugation with bone graft and platelet-rich fibrin after 12 months follow up

THE EFFECT OF PLATELET RICH-FIBRIN WITH AND WITHOUT AUTOGENOUS BONE GRAFT ON BONE REGENERATION FOLLOWING ENUCLEATION OF MAXILLARY CYSTS

Introduction: Reconstruction of bony defects represents a challenging problem for the surgical community. Autologous bone grafting involves utilizing bone obtained from the same individual receiving the graft. Bone can be harvested from the mandibular symphysis (chin area). Autologous platelet rich-fibrin (PRF) is considered to be a healing biomaterial, which has been widely used for accelerating soft and hard tissue regeneration. The use of bone graft in combination with platelet rich-fibrin helps in rapid bone regeneration when compared to natural healing. Objectives: is to compare the effect of platelet rich-fibrin with and without autogenous bone graft on bone regeneration following enucleation of maxillary cysts. Materials and methods: Twenty-one patients with maxillary cysts had been treated with autogenous bone graft with platelet-rich fibrin versus platelet rich-fibrin without autogenous bone graft following cyst enucleation, and the follow up was done for 6 months using Cone Beam Computerized Tomography (CBCT) to evaluate bone regeneration in the defect site. Results:All groups showed increasing in bone density. Group A showed the best results with a mean 330.71, while Group B showed results with a mean 184. Group C showed results with a mean 117.71. Conclusions: PRF can be considered a healing biomaterial, as it features all the necessary parameters permitting bone regeneration without any adverse reaction. The addition of autogenous bone graft to PRF accelerates the regenerative capacity of bone. They give a predictable clinical and radiographic evidence of bone formation and faster healing than using PRF alone.