Cortical Grafts Research Articles

O-227 First successful ovary allotransplants to Turner’s syndrome patients requiring immunosuppression

Abstract Study question To determine whether we can safely and successfully transplant an ovary tissue allograft from a non-identical donor to her Turner’s syndrome sister. Summary answer We report the first successful cases (with pregnancy) of ovarian tissue allotransplantation to Turners syndrome women using a safe immunosuppression protocol. What is known already Young women with Turner’s have been unable to have children without the use of donor egg IVF, but many Turner’s women would like to have normal hormonal function and to become pregnant naturally. Frozen ovarian cortex tissue can be successfully auto-transplanted back to women with ovarian failure and result in normal pregnancy and live birth with a success rate of 41-76%. This has never been accomplished between a non-identical donor to her Turner syndrome sister. Added benefits are hormonal function obviates the need for hormone replacement, and pregnancy can occur naturally rather than with donor egg IVF. Study design, size, duration 1.) 20 year-old woman with non-mosaic XO Turner’s, no menses, and AMH (Anti-Mullerian hormone) of 0.015 ng/mL, whose 22 year-old sister had two children, normal menses, and an AMH of 4.97. They were HLA identical but ABO incompatible. 2.) A 21 year-old woman with non-mosaic XO Turner’s, no menses and AMH of 0.015 whose 28 year old sister had 2 children, normal menses, and AMH of 2.92. They were ABO compatible, but one HLA mismatch. Participants/materials, setting, methods The left ovary of the donor was removed and dissected. One third of the cortex was transplanted to the right streak ovary of the recipient and the remaining two-thirds were cryopreserved. The immunosuppression protocol consisted of methylprednisolone the morning of surgery along with anti- thymocyte globulin, and for maintenance, tacrolimus 3 mg orally BID with a target trough of 5-10 ng/mL, azathioprine 100 mg orally, and prednisone only 5 mg po daily. Main results and the role of chance By 168 days post-op the first Turner’s recipient was menstruating and ovulating normally with no sign of rejection. Her AMH began to rise at 168 days from 0.05 to 0.35ng/mL by 223 days, typical for a successful ovary cortical graft, and her FSH varied from 4.5 to 8.5 mIU/mL. By one year her uterus grew from infantile to that of a normal adult and she became spontaneously pregnant 10 months later and delivered a healthy baby. The donor FSH was 6.8 mIU/mL, unchanged from pre-op, she continued menstruating normally, and became spontaneously pregnant with her third child (despite having an IUD in place) by six months post op. The second Turner’s syndrome began menstruating monthly at 4 months post-op, and her AMH rose to 0.25 mg/mL as her FSH dropped to 5.3 mIU/mL. At the time of this writing she is 6.5 months post-op and continues to menstruate and ovulate normally. Limitations, reasons for caution There are only the first two cases and therefore at this stage, the conclusions are only a proof of concept. Wider implications of the findings We have demonstrated successful ovarian tissue transplantation with spontaneous pregnancy to Turner’s syndrome females using a safe immunosuppression protocol. The fact that ABO incompatibility did not cause rejection indicates that an ovary tissue graft can survive on diffusion alone. Furthermore, HLA mismatch does not preclude success with this immunosuppression protocol. Trial registration number not applicable

Cortical Block Grafting Successfully Augments Alveolar Cleft Sites for Dental Implant Placement

BackgroundSupplemental bone grafting is regularly required before dental implant placement in patients with cleft lip and palate (CLP). PurposeThe study purpose was to measure and compare implant osseointegration and changes in graft dimensions following lateral incisor onlay cortical bone grafting in CLP and non-CLP patients. Study design, setting, sampleRetrospective cohort study composed of patients who presented to Boston Children’s Hospital and underwent autogenous onlay cortical block bone grafting at lateral incisor sites from 2015 through 2023. Patients were excluded if the cone beam computed tomography (CBCT) quality was insufficient for accurate measurements. Predictor variableThe predictor variable was CLP status coded as CLP or non-CLP. Main outcome variableThe primary outcome variable was successful implant osseointegration confirmed by a torque of 35 N/cm or more after 3 months of implant healing. Secondary outcomes were change in bone width between pre- and post-operative CBCT scans at lateral incisor sites and the need for additional bone augmentation prior to or during implant placement. CovariatesCovariates were age, sex, cleft location, and time from bone graft to postoperative CBCT and implant placement. AnalysesData analyses were performed using T-tests, Fisher’s Exact Tests, Mann-Whitney U Tests, and Pearson’s correlation. P<0.05 was considered statistically significant. ResultsA total of 22 subjects (16 with CLP) were evaluated. The mean age at the time of graft was 19.3 ± 2.4 years with 52.6% males. Implants osseointegrated at 20 of 22 lateral incisor sites (one CLP failure, one non-CLP failure). There was significant change in bone width after grafting for patients with CLP (p<0.001). Patients with CLP experienced a 3.32 (± 1.80) mm and 2.99 (± 1.61) mm increase in bone width at two different levels. Patients with CLP achieved greater boney changes near the alveolar crest than non-cleft patients (p=0.008) but the change was not significantly different more apically (p=0.86). One subject with CLP required additional grafting during implant placement. Conclusions and RelevanceCortical block onlay bone grafting is a predictable technique to augment lateral incisor sites in patients with cleft lip and palate for placement of a dental implant.

Biomechanical Stability of Third-Generation Adjustable Suture Loop Devices Versus Continuous Loop Button Device for Cortical Fixation of ACL Tendon Grafts.

Concerns regarding the primary stability of early adjustable loop button (ALB) devices for cortical fixation of tendon grafts in anterior cruciate ligament reconstruction (ACLR) have led to the development of new implant designs. To evaluate biomechanical stability of recent ALB implants in comparison with a continuous loop button (CLB) device. Controlled laboratory study. ACLR was performed in a porcine model (n = 40) using 2-strand porcine flexor tendons with a diameter of 8 mm. Three ALB devices (Infinity Button [ALB1 group]; Tightrope II RT [ALB2 group]; A-TACK [ALB3 group]) and 1 CLB device (FlippTack with polyethylene suture) were used for cortical tendon graft fixation. Cyclic loading (1000 cycles up to 250 N) with complete unloading were applied to the free end of the tendon graft using a uniaxial testing machine, followed by load to failure. Elongation, stiffness, yield load, and ultimate failure load were recorded and compared between the groups using a Kruskal-Wallis test with post hoc Dunn correction. Elongation after 1000 cycles at 250 N was similar between groups (ALB1, 4.5 ± 0.7 mm; ALB2, 4.8 ± 0.8 mm; ALB3, 4.5 ± 0.6 mm; CLB, 4.5 ± 0.8 mm), as was load to failure (ALB1, 838 ± 109 N; ALB2, 930 ± 89 N; ALB3, 809 ± 103 N; CLB, 842 ± 80 N). Stiffness was significantly higher in the ALB1 group compared with the CLB group (262.3 ± 21.6 vs 229.3 ± 15.1 N/mm; P < .05). No significant difference was found between the 4 groups regarding yield load. Constructs failed either by rupture of the loop, breakage of the button, or rupture of the tendon. The tested third-generation ALB devices for cortical fixation in ACLR withstood cyclic loading with complete unloading without significant differences to a CLB device. The third-generation ALB devices tested in the present study provided biomechanical stability comparable with that of a CLB device. Furthermore, ultimate failure loads of all tested implants exceeded the loads expected to occur in the postoperative period after ACLR.

Calcar reconstruction in bipolar hemiarthroplasty for unstable intertrochanteric fractures

: The increasing popularity of primary bipolar hemiarthroplasty for comminuted and osteoporotic intertrochanteric femur fractures is well-documented. However, the absence of posteromedial calcar support due to fracture presents a unique challenge: implant instability and varus collapse. Existing solutions, relying on stem modifications or bone cement void filling, encounter limitations in cost-effectiveness and biomechanical performance.: This study evaluated the efficacy of posteromedial calcar reconstruction using autologous cortical grafts harvested from the extracted femoral head and neck in 30 patients with intertrochanteric femur fractures. Following strict inclusion and exclusion criteria, primary bipolar hemiarthroplasty was performed with meticulous graft implantation. Weight-bearing and range-of-motion exercises commenced on postoperative day 1. Functional and radiological outcomes were assessed at 12 months follow-up. The demographic distribution revealed a 50:50 split between patients above and below 75 years old. 73.33% (n=22) fractures were right-sided, and AO 31-A2.2 emerged as the most prevalent fracture pattern (46.67%, n=14). An acceptable functional and radiological outcome was achieved in 93.33% (n=28) patients. Two complications (superficial infection and implant breakage) resulted in unacceptable outcomes. Notably, the calcar grafts demonstrated robust healing in patients with favorable functional outcomes (Excellent and Good), as evidenced by a mean Harris Hip Score of 93.11 at 1 year follow-up. This study demonstrates the potential of a well-shaped, wedged autologous cortical graft harvested from the femoral head and neck as an effective strategy for calcar reconstruction in intertrochanteric femur fractures. This technique facilitates graft union, prevents implant subsidence, and offers enhanced biomechanical stability with optimal stress distribution. Furthermore, it eliminates the need for allograft or donor site morbidity, leading to reduced costs and patient burden.

Comparison of Time-Zero Primary Stability Between a Biodegradable Magnesium Bone Staple and Metal Bone Staples for Knee Ligament Fixation: A Biomechanical Study in a Porcine Model.

Bone staples have been shown previously to be a viable modality for cortical tendon graft fixation in ligament knee surgery. However, soft tissue reactions have been reported, making implant removal necessary. Magnesium alloys are a promising material for biodegradable orthopaedic implants, with mechanical properties closely resembling those of human bone. To compare the primary stability of a biodegradable bone staple prototype made from magnesium to bone staples made from metal in the cortical fixation of tendon grafts during knee surgery. Controlled laboratory study. Primary stability of peripheral tendon graft fixation was assessed in a porcine model of medial collateral ligament reconstruction. Two commercially available metal bone staples (Richards fixation staple with spikes [Me1] and spiked ligament staple [Me2]) were compared with a magnesium bone staple prototype for soft tissue fixation. Primary stability was assessed using a uniaxial materials testing machine. Cyclic loading at 50 and 100 N was applied for 500 cycles each, followed by load-to-failure testing. After 500 cycles at 50 N, elongation was 1.5 ± 0.5 mm in the Me1 group, 1.9 ± 0.5 mm in the Me2 group, and 1.8 ± 0.4 mm in the magnesium group. After 1000 cycles of loading (500 cycles at 50 N and 500 at 100 N), elongation was 3.6 ± 0.9 mm in the Me1 group, 3.5 ± 0.6 mm in the Me2 group, and 4.1 ± 1.0 mm in the magnesium group. No significant differences regarding elongation were found between the groups. Load to failure was 352 ± 115 N in the Me1 group, 373 ± 77 N in the Me2 group, and 449 ± 92 N in the magnesium group, with no significant difference between the groups. In this study, the magnesium bone staples provided appropriate time-zero biomechanical primary stability in comparison with metal bone staples and may therefore be a feasible alternative for cortical fixation of tendon grafts in knee surgery. The biodegradability of magnesium bone staples would eliminate the need for later implant removal.

Cell Replacement Therapy for Brain Repair: Recent Progress and Remaining Challenges for Treating Parkinson's Disease and Cortical Injury.

Neural transplantation represents a promising approach to repairing damaged brain circuitry. Cellular grafts have been shown to promote functional recovery through "bystander effects" and other indirect mechanisms. However, extensive brain lesions may require direct neuronal replacement to achieve meaningful restoration of function. While fetal cortical grafts have been shown to integrate with the host brain and appear to develop appropriate functional attributes, the significant ethical concerns and limited availability of this tissue severely hamper clinical translation. Induced pluripotent stem cell-derived cells and tissues represent a more readily scalable alternative. Significant progress has recently been made in developing protocols for generating a wide range of neural cell types in vitro. Here, we discuss recent progress in neural transplantation approaches for two conditions with distinct design needs: Parkinson's disease and cortical injury. We discuss the current status and future application of injections of dopaminergic cells for the treatment of Parkinson's disease as well as the use of structured grafts such as brain organoids for cortical repair.

Cortical Mandibular Bone Blocks Grafts and Piezoelectric Surgery in Complex Anterior Maxillary Alveolar Defects: A Case Report and Literature Review

The aim of this study is to assess the indication and efficacy of alveolar ridge reconstructions for complex horizontal and vertical augmentation procedures in the maxillary anterior area with Cortical Mandibular Bone Block Grafts (CMBBG). Localized alveolar three-dimensional bone defects are among the most challenging problems in surgical implant dentistry. Treatment protocols, such as short implants or small diameter implants are not always offering the desired clinical and esthetic results. The autogenous augmentation procedure can serve as an option, which allows a more biological reconstruction of the vertical and horizontal dimension of a complex bone defect in order to obtain sound replicas of natural teeth. The clinical case of a cortical autogenous block graft in an anterior complex maxillary defect is presented along with a literature review. The presented case and the selected articles demonstrate that cortical ramus bone block grafts show relatively low graft resorption, low donor site morbidity and high implant success rates.

Oligodendrocytes in human induced pluripotent stem cell-derived cortical grafts remyelinate adult rat and human cortical neurons.

Neuronal loss and axonal demyelination underlie long-term functional impairments in patients affected by brain disorders such as ischemic stroke. Stem cell-based approaches reconstructing and remyelinating brain neural circuitry, leading to recovery, are highly warranted. Here, we demonstrate the invitro and invivo production of myelinating oligodendrocytes from a human induced pluripotent stem cell (iPSC)-derived long-term neuroepithelial stem (lt-NES) cell line, which also gives rise to neurons with the capacity to integrate into stroke-injured, adult rat cortical networks. Most importantly, the generated oligodendrocytes survive and form myelin-ensheathing human axons in the host tissue after grafting onto adult human cortical organotypic cultures. This lt-NES cell line is the first human stem cell source that, after intracerebral delivery, can repair both injured neural circuitries and demyelinated axons. Our findings provide supportive evidence for the potential future use of human iPSC-derived cell lines to promote effective clinical recovery following brain injuries.

Autologous Cranioplasty Using a Dental SafeScraper Device.

Conventional methods to reconstruct cortical bone defects introduced by pediatric cranial vault remodeling (CVR) procedures have shortcomings. Use of bone burr shavings as graft material leads to variable ossification, and harvesting split-thickness cortical grafts is time-intensive and often not possible in thin infant calvaria. Since 2013, the authors' team has used the SafeScraper, originally developed as a dental instrument, to harvest cortical and cancellous bone grafts during CVR. The authors assessed the effectiveness of this technique by analyzing postoperative ossification using computed tomography scans of 52 patients, comparing cohorts treated with the SafeScraper versus those who received conventional methods of cranioplasty during fronto-orbital advancement. The SafeScraper cohort had a greater reduction in total surface area of all defects (-83.1% ± 14.9 versus -68.9% ± 29.8; P = 0.034), demonstrating a greater and more consistent degree of cranial defect ossification compared with conventional methods of cranioplasty, suggesting potential adaptability of this tool. This is the first study that describes the technique and efficacy of the SafeScraper in reducing cranial defects in CVR. Therapeutic, III.

Emerged donor limb growth morbidity and malalignment after combined ipsilateral tibial and fibular cortical harvest graft in children. Early follow-up report.

The quantity of bone grafts required in certain pediatric conditions is sometimes substantial. This retrospective study details the radiological changes occurring in the donor leg and ankle following the simultaneous harvest of large diaphyseal cortical grafts from the tibia and fibula in 14 children (16 legs). The following preoperative and follow-up radiological parameters were measured and compared for donor legs: the longitudinal continuous regeneration of fibula, distal fibular station, medial proximal tibial angle, lateral distal tibial angle, posterior proximal tibial angle (PPTA), anterior distal tibial angle and interphyseal angle (tibia diaphyseal angulation) in both coronal and sagittal planes. Additionally, the impact of fibular regeneration in combined harvests was separately analyzed. Children were operated at the mean age of 52 months. Mean follow-up of 25.2 months was available. At follow-up, the donor tibia healed completely in all legs whereas fibular regeneration was complete only in 10 legs (62.5%). At follow-up, ankle valgus was present in 6 out of 16 legs (37%) and tibia valga increased in all legs except one (94%). Procurvatum was present in 7 legs. The fibular nonregeneration group was prone to ankle valgus deformity ( P = 0.014), valgus angulation of tibial diaphysis ( P = 0.0076) and lower mean PPTA ( P = 0.026) when compared to the regenerate group. There was a complication of stress fracture in one donor tibia. Combined tibial and fibular harvest is a major surgical undertaking in children. The donor limbs have their share of complications postharvest, more so when the fibula remains nonregenerated. Serial monitoring of donor sites is emphasized.

Hybrid Fixation of Failed Internally Fixed Distal Femoral Fracture with an Extramedullary Locking Plate and an Intramedullary Cortical Strut Allograft Construct- A Case Report

Abstract Introduction: Fractures in osteoporotic bones present a surgical challenge for fixation and are often associated with significant morbidity. Case presentation: We present a case of failed internal fixation of fracture femoral shaft in a 74-year-old patient with osteoporosis. Fracture fixation was undertaken using an extra medullary locking plate and an intramedullary cortical strut graft, a hybrid fixation technique, a Locking Plate Allograft Construct. Discussion: Bone grafts are often used to support the native bone. By using a hybrid technique, the locking plate allograft construct achieves an enhanced stability of fracture fixation compared to plate alone, thus improving the outcome of surgery in osteoporotic bone fractures. Conclusion: Hybrid fixation using locking plate allograft constructs are relatively easy to perform and provide superior fixation to routine methods in osteoporotic bone fractures.

Management of aseptic non-union of shaft femur using intramedullary nailing combined with bone grafting: a case report

&lt;p&gt;Despite the advances in trauma care, improved surgical techniques, latest implants and therefore the evolution of new adjuvants to healing, biologic agents, non-union still persists thanks to high energy trauma as initial event. Non-union of femur shaft represents a significant socioeconomic problem to the patient, related to prolonged patient morbidity, inability to return to figure, gait abnormality, re-operations and psycho-emotional impairment. Here we discuss the case of such non-union of fracture shaft femur presented to us with shortening of 3.5 cm managed with bone graft and intramedullary nailing. 22-year-old male patient had a history of trauma due to fall from bike due to dash from behind by tractor (high velocity road traffic accident) sustaining injury over right thigh leading to closed fracture mid-shaft femur of the same side treated immediately by femur nailing. After 6 months post-surgery, he noticed swelling over operated thigh which was increasing and causing difficulty in walking. X-rays revealed broken nail, re-operated at the same centre with dynamic compression plating (DCP) probably after freshening the fracture edges using 12-hole DCP, implant failure with whole plate and screw construct extrusion and re-fracture at the same site. This time patient presented to our institute. We planned of implant removal and intramedullary nailing with bone grafting. Management of aseptic femoral non-union with fracture gap of 2.5-4 cm range with intramedullary nailing combined with autologous fibular cortical and cancellous grafts showed good functional results at the end of 1 year post operative interval after prior repetitive failure of implants due to non-union. &lt;/p&gt;

Fixation by Autogenous Cortical Plate Technique on Sites of Subtrochanteric Shortening Osteotomy Contributes to Early Bone Union in Total Hip Arthroplasty for Crowe Type IV Developmental Dysplasia of the Hip

Subtrochanteric shortening osteotomy (SSO) is often applied during total hip arthroplasty (THA) in high hip dislocations. The aim of the present paper was to evaluate the results of fixation by autogenous cortical plate technique on sites of SSO in THA for patients with Crowe type IV developmental dysplasia of the hip (DDH). We conducted a historical prospective cohort study and reviewed 67 patients (82 THAs) with SSO performed between March 2016 and May 2020. Thirty-nine patients (48 hips) obtained stability by intramedullary pressure provided by the S-ROM modular prostheses and with or without prophylactic binding by stainless-steel wire after osteotomy and before stem implantation (group A). Twenty-eight patients (34 hips) were fixed with autogenous cortical plate technique and stainless-steel wire or cables (group B). Time of operations, complications, radiographic results and clinical scores were compared. One intraoperative fracture and a dislocation occurred, while component loosening, ectopic ossification and osteolysis were not observed. Group B had a higher union rate at the 4th month than group A (P = 0.015) while there were no significant differences of union rates at the 8th (P = 0.811) and the 12th month (P = 0.722) and of the average healing time (P = 0.181). No significant differences were found in hip function scores (HHS and WOMAC Osteoarthritis Index) between two groups. Fixation with autogenous cortical plate from the cylinder of femoral bone contributes to early bone union of osteotomy ends in Crowe type IV DDH patients compared to those who do not apply the technique. Besides of application of autogenous cortical strut grafts, relevant measures are as well recommended to prevent nonunion after SSO.

Mechanical Evaluation of Salvage Fixation Techniques for a Lateralized Fibular Tunnel in Posterolateral Corner Reconstruction of the Knee.

Posterolateral corner (PLC) reconstruction of the knee involves precise drilling of a single tunnel from anterolateral to posteromedial in the fibular head (FH) to ensure adequate graft fixation. Misplacement of the tunnel in a too lateral or too superior trajectory can lead to cortical breach and inadequate graft fixation. To (1) determine the mechanical consequence of a lateralized FH tunnel in PLC reconstruction and (2) compare the mechanical strength of 3 salvage fixation techniques for a lateralized FH tunnel. Controlled laboratory study. Sawbones models of a uniform density were utilized. FH tunnels (7-mm diameter) were drilled from anterolateral to posteromedial in positive controls (lateral cortex thickness, 7.6 ± 0.7 mm) to represent an improperly placed FH tunnel at risk of lateral cortical breach. For negative controls and salvage experimental groups, FH tunnels were drilled from anterolateral to posterolateral (lateral cortex thickness, 2.7 ± 0.9 mm). Three salvage fixation techniques were compared: suture anchor fixation, tunnel redrilling, and nitinol staple fixation. Samples (n = 5 per group) underwent uniaxial tension testing, and the ultimate tensile strength (UTS) and mode of failure were recorded. Data were analyzed using the 1-sample t test and nonparametric 1-sample Wilcoxon signed-rank test. The negative control group had a 4-fold lower mean UTS relative to the positive control group (1.49 ± 0.17 vs 6.25 ± 1.98 MPa; P < .01) and exhibited failure through the lateral cortex and tunnel. Nitinol staple fixation improved the mean UTS by >16 times compared with the negative control group (24.06 ± 6.49 vs 1.49 ± 0.17 MPa; P < .01). Suture anchors and tunnel redrilling exhibited similar UTS and mode of failure to those of negative controls. Reinforcement of a thinned lateral FH cortex with a single nitinol staple improved graft fixation strength in a sawbones model. A lateralized FH tunnel can be a common intraoperative pitfall during PLC reconstruction. Salvage of a thinned lateral FH cortex with a single nitinol staple may reduce the risk of cortical breach and graft failure.

Surgical management of deficient alveolar ridges by means of guided bone regeneration in oral implantology

Dimensional changes in the alveolar ridge after extraction often compromises on achieving optimal implant stability and placement of implants in the right prosthodontic positions. These situations demand augmentation of the residual ridge to achieve successful implant placement and long-term survival. A minimum amount of bone width and height is essential for the successful placement of implants. Unfavourable local conditions, due to atrophy, trauma and periodontal disease, may provide insufficient bone volume or an unfavourable interarch relationship, which does not allow correct and a prosthodontically guided positioning of dental implants. Guided bone regeneration, ridge splitting, block graft, or distraction osteogenesis have all been applied for this purpose and have shown some promising results. Nonetheless, autogenous block graft remains one of the main methods for reconstructing severely resorbed maxilla. These block grafts can be harvested from intraoral or extraoral sites. Significant amounts of autogenous bone can be procured from symphysis or ramus region of the mandible. The cortical grafts of this area provide predictable increase in bone volume with a short healing time and yield a highly dense osseous architecture for implant placement.This review discusses the use of autogenous block grafts and bovine bone allograft for predictable bone augmentation in atrophic ridges.

The effect of onlay cortical fibula strut grafts on biomechanical features of Vancouver type B1 periprosthetic femoral fractures.

This study aimed to investigate biomechanically the effects of onlay fibula grafts on Vancouver Type B1 Periprosthetic Femoral Fractures (PPFs). Vancouver Type B1 PFF models were created in 25 fourth-generation synthetic femurs and fixed with locking plates using bicortical, unicortical screws, and cables. While no graft was used in group 1, onlay fibula grafts were placed anteriorly in group 2 and medially in group 3. In group 4, the cortical strut allograft was placed on the medial femoral cortex, and a locking compression plate (LCP) was applied to the lateral femoral cortex. In group 5, the strut allograft was placed over the anterior cortex of the femur and fixed with the same technique as in group 4. All models were then subjected to rotational and axial cyclical stiffness tests and load to failure to measure and compare the mechanical strengths of the constructs. The mean stiffness values of group 4 with medial allograft, before and after cyclical loading, were higher than all other groups, under both rotational and axial forces. The mean stiffness values of fibula autografts (groups 2 and 3) were similar to that of anterior allografts (group 5) in each test except that the mean initial axial stiffness of group 5 was higher than group 2. Failure loads were also not different between the groups. Although the rigidity of Vancouver type B1 periprosthetic femur fractures is highest if allografts are placed medially, fibula autografts can also provide similar fixation strengths to allografts if locking plates with unicortical and bicortical screws and cables are used.

Intraoral onlay block bone grafts versus cortical tenting technique on alveolar ridge augmentations: a systematic review.

Background To review systematically the bone gain and superficial resorption rate of the onlay block bone grafts versus the cortical tenting technique, as well as secondarily study the postoperative complications, implant survival and success rates, and peri-implant marginal bone loss.Material and Methods Following the recommended methods for systematic reviews and meta-analyses (PRISMA), an electronic search was performed in the PubMed (MEDLINE), EMBASE and the Cochrane Library of the Cochrane Collaboration (CENTRAL) databases to identify all relevant articles published up to March 2021 on onlay block bone grafts and cortical tenting technique.Results Eighteen papers complied with the inclusion criteria. In onlay grafts, the vertical bone gain mean was 4.24 mm, and resorption 20.91%; and 4.29 mm in the horizontal augmentation with a resorption of 10.28%. The complication rate was 14.8%. The implant survival and success rates were 100% and 92%; and the mean peri-implant bone loss ranged from 0.6 to 1.26 mm.In cortical tenting technique, the vertical bone gain mean was 6.17 mm and the resorption of 9.99%; and 5.55 mm in the horizontal augmentation with a 6.12% of resorption. The complication rate was 24.6%. The implant survival and success rates were 96.63% and 100%; and the mean peri-implant bone loss ranged from 0.27 to 0.77mm.Conclusions Despite the limitations, both techniques offer a predicTable way to reconstruct atrophic alveolar ridges, though the cortical tenting technique seems to achieve a greater bone gain and a lower surface resorption. Current evidence is still limited due to the inadequate follow-up, lack of information referred to methodological quality and sample attrition. Key words:Onlay graft, cortical graft, intraoral bone, augmentation procedure.

A comparative study of three different fixation methods after subtrochanteric shortening osteotomy in total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip

To compare the effectiveness of three different fixation methods after subtrochanteric shortening osteotomy (SSO) in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH). A clinical data of 63 patients (78 hips) with Crowe type Ⅳ DDH, who underwent THA with SSO between November 2014 and May 2019, was retrospectively analyzed. Among them, 18 patients (20 hips) obtained stability by intramedullary pressure provided by the S-ROM modular prostheses (group A); 22 patients (30 hips) underwent prophylactic binding by stainless steel wire after osteotomy and before stem implantation (group B); 23 patients (28 hips) were fixed with autogenous cortical strut grafts and stainless steel wire or cables (group C). There was no significant difference in gender, age, body mass index, affected limb side, and preoperative Harris score between groups ( P>0.05). The operation time, complications, imaging results, hip functional score of the three groups were recorded and compared. There was no significant difference in the operation time between groups ( P>0.05). All incisions healed by first intention. All patients were followed up, and the follow-up time was 2.5-4.0 years (mean, 3.1 years) in group A, 1.5-5.5 years (mean, 3.2 years) in group B, and 1.0-5.0 years (mean, 1.6 years) in group C. There was no significant difference in Harris score or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between groups at 4 and 12 months after operation ( P>0.05). X-ray films showed that there was no significant difference in osteotomy healing rate at 4, 8, and 12 months after operation and the osteotomy healing time between groups ( P>0.05). There was no complications such as joint dislocation, prosthesis loosening, prosthetic joint infection, or heterotopic ossification during follow-up, except for the distal femoral fracture of 1 hip during operation in group B. In THA for patients with Crowe type Ⅳ DDH, the stainless steel wire binding alone and autogenous cortical strut grafts combined with stainless steel wire or cable binding can not significantly promote the osteotomy healing compared with femoral prosthesis intramedullary compression fixation. For patients with nonmatched medullary cavity after SSO, it is recommended to apply autogenous cortical strut grafts with wire or cables for additional fixation.

Current approach to bone augmentation with allogeneic cortical graft: A case report

Aim: Today, dental implant applications have become the most preferred option in the treatment of tooth deficiencies. Long-term successful results in dental implant applications depend largely on the volume and quality of the hard and soft tissues in the relevant region. Insufficient soft tissues and alveolar crest resorption complicate implant applications. Grafts and additional surgical procedures are required to compensate for resorption and to provide bone augmentation. Shell technique, one of the augmentation methods used in the treatment of alveolar bone defects, is an important procedure for guided bone regeneration. The purpose of this case report is to describe the treatment of vertical and horizontal bone loss with the Shell technique using allogeneic cortical grafts.&#x0D; Methodology: A 58-year-old female patient without any systemic disease was admitted to our clinic with the complaint of tooth loss in the right posterior mandibular region. In the intraoral and radiological examinations, it was determined that the bone volume in the relevant region was not sufficient for dental implant. Two-stage surgical treatment was planned for the patient. First, vertical and horizontal bone defects were augmented with allogeneic cortical graft application under local anesthesia. After the healing process, dental implants were placed in the sufficient volume of the alveolar bone and the patient's treatment was completed.&#x0D; Conclusion: Allogeneic grafts in the treatment of alveolar crest defects; it is a good alternative to autogenous bone grafts,there is no need for a second surgical field and the resulting reduction in morbidity.&#x0D; &#x0D; How to cite this article: Eriş Derkuş F, Yılmaz UN. Current approach to bone augmentation with allogeneic cortical graft: A case report. Int Dent Res 2021;11(Suppl.1):299-302.&#x0D; https://doi.org/10.5577/intdentres.2021.vol11.suppl1.44&#x0D; &#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Outcomes of Vancouver B2-type and B3-type proximal femur periprosthetic fractures after revision surgery using cementless tapered modular stem: a retrospective case series of 39 fractures

Objective. Evaluate outcomes of Vancouver B2-type and B3-type proximal femur periprosthetic fractures (PPFs) in elderly patients treated with a cementless tapered modular femoral stem. Methods. 37 patients with a proximal femur PPF (34 B2-type and 5 B3-type) on primary or revision implants, with a minimum of 2-year follow-up, treated with revision of the failed stem using uncemented MP® reconstruction system stem (Waldemar Link®), were included.Results. At last follow-up, the average Harris Hip Score was 91 ± 9.8, and average Numerical Rating Score was 0.7 ± 0.8, without a significant difference between B2-type and B3-type PPFs. X-rays at last follow-up revealed bone union in all patients. According to Beals and Tower’s criteria, we found excellent radiological findings in 89.7% patients. Fourteen local surgery-related complications were reported (35.9%), and 4 patients required revision surgery (10.2%), without significant differences between B2-type and B3-type PPFs. We found involvement of both trochanters in fracture as a possible risk factor for dislocation.Conclusions. Vancouver B2-type and B3-type PPFs can be effectively treated using a cementless modular stem, even without cortical struts graft, although further studies are needed regarding B3-type PPFs.