Corticocancellous Graft Research Articles

Pseudarthrosis of the Carpal Scaphoid Treated with Non-Vascularized Corticocancellous Bone Graft

Objectives: To carry out an epidemiological study and to assess the evolutionary profile of patients with scaphoid non-union treated by anterior non-vascularized corticocancellous bone graft.
 Introduction: The non-union is a serious complication of carpal scaphoid fractures. Untreated, it leads to instability and osteoarthritis of the carp. The most used technique is that of Matti-Russe employing a corticocancellous graft.
 Materials and methods: We report in this retrospective study the experience of the department of Orthopaedic Surgery & Traumatology II, Mohamed V Military Hospital, Rabat, in the treatment of non-unions of the carpal scaphoid by anterior non-vascularized corticocancellous graft in nine cases collected between January 2012 and March 2016. We identified six cases of stage IIA and three cases of stage IIB. All our patients were operated by the Matti-Russian technique followed by an immobilization by plaster cast cuff on three months.
 Results: All our patients achieved a union within an average of three months. The Mayo Wrist score was excellent in 66.6% of cases. Our results were very satisfying in 90% of cases, satisfying in 10%.
 Conclusion: The treatment of non-unions of the carpal scaphoid without necrosis or osteoarthritis, using anterior non-vascularized bone graft remains the most widely used technique. The presence of initial instability is a factor of poor prognosis, its correction reduces the risk of arthritis.

Clinical and Radiologic Outcomes of the Matti-Russe Technique for Scaphoid Nonunions in Pediatric Patients.

Scaphoid fractures are a common injury, and a known complication is nonunion. One option to treat this nonunion is with the Matti-Russe technique, which takes a corticocancellous graft and fits it into the defect without internal fixation. The advent of modern methods of fixation has led the classic Matti-Russe technique to fall out of favor. In this study, we describe the classic technique and evaluate the results of the Matti-Russe method for treatment of scaphoid nonunions specifically for the pediatric population. Our purpose was to evaluate the long-term clinical and radiologic outcomes after surgery for scaphoid nonunion using the Matti-Russe technique in the pediatric population. A retrospective review was performed of patients less than 17 years of age, with a scaphoid nonunion that was treated with the Matti-Russe technique. This technique consisted of open reduction with intercalated bone graft and no internal fixation with hardware. Union was determined by radiographic evaluation. Computed tomography was obtained in 7 of 10 patients in this series and showed bony bridging in more than 50% of the scaphoid width in 3 different views. Intrascaphoid, scapholunate, and radiolunate angles were calculated. We reviewed wrist range of motion and complications. We obtained postoperative Mayo and Disabilities of the Arm, Shoulder and Hand (DASH) scores. There were 10 patients who underwent the Matti-Russe technique. The average age was 14.7 years old (±1.34, range: 13-17). All 10 of these patients had a scaphoid waist nonunion. There were 9 males and 1 female with an average follow-up of 13 months. The average amount of time to surgery from the date of injury was 12.3 months. All 10 patients went on to radiographic union at or before 6 months from surgery. Preoperative intrascaphoid, scapholunate, and radiolunate angles were 29° (±5.38), 62° (±18.28), and 20° (±9.22). Postoperative intrascaphoid, scapholunate, and radiolunate angles improved to 16° (±6.89), 38° (±8.50), and 10° (±4.69), which was significant. Seven out of 10 patients completed postoperative outcomes measures. The average postoperative Mayo wrist score was 87.9 (±14.10, range: 60-100). The average postoperative DASH score was 1.9 (±2.03, range: 0-4.5). There were no associated complications nor reoperations. The Matti-Russe technique is a safe and effective treatment for scaphoid nonunion in the pediatric population. It facilitates scaphoid union without the need for screw fixation and avoiding potential complications with hardware.

Assessment of radiological outcomes in gap non-union of long bones using non-vascularised fibular strut graft augmented with corticocancellous graft

Background: A prospective study was conducted in the department of Orthopaedics & Traumatology in Dr. D.Y Patil Hospital, Navi Mumbai from January 2015 to June 2017 to assess radiological outcomes in traumatic gap non-union of long bones after primary plate fixation failure using non-vascularised fibular strut graft augmented with corticocancellous graft. Methods: A total of 20 patients were included in study presenting with non-union of humerus. In 13 males and 7 females, age between 18-65 years (average 41 years), were operated using non-vascularized fibular strut graft taken from ipsilateral site augmented with auto corticocancellous graft. All the patients were operated by same surgeon with removal of previous plate and fixing with re-plating and intramedullary fibular grafting. The mean follow-up was 9 months (range 6-12 months). The patients were assessed for functional range of motion along with x-ray. Union was achieved after confirming on x-ray. Observations & Results: In study 20 patients there were 13 males and 7 females with average age being 41.35 yrs, average length of fibular graft was 6.3 cm and mean duration of union 21.15 weeks.1 patient was lost in follow up and none of patients showed non union or secondary intervention thus ensuring Bony union in all 20 patients treated with graft and plating Conclusion: This procedure successfully showed that union at nonunion site with adequate vascularity and good soft tissue coverage can be achieved with proper patient selection and using fibular graft in addition to traditional plating and CC graft technique. Even though procedure is lengthy but it’s simplicity, reproducibility and non expensive and patient compliant outcomes makes it a valid option to achieve union in nonunion.

Greffe cortico-spongieuse ou greffe spongieuse pure dans les pseudarthroses instables du scaphoïde

IntroductionThis study was undertaken to determine whether corticocancellous bone grafting and cancellous bone grafting differ in terms of bone union rate, restoration of scaphoid anatomy, and wrist function when unstable scaphoid nonunion are concomitantly treated by screw fixation. Materials and methodsThis is retrospective cohort study. In group A (17 patients), unstable scaphoid nonunion was treated with corticocancellous graft harvested from the iliac crest and headless compression screw using volar approach. In group B (18 patients), unstable scaphoid nonunion was treated with cancellous graft harvested from the distal radius or iliac crest and headless compression screw using volar approach. Mean time to union was measured using CT image. Scaphoid deformity was also measured using lateral intrascaphoid angle and height to length ratio using CT images. Wrist functional status was assessed by measuring grip strength, wrist range of motion and DASH score at 1 year postoperatively. ResultsMean time to union was significantly greater in group A (15 weeks vs. 11 weeks). No significant intergroup difference was observed for lateral intrascaphoid angle and height to length ratio after treatment of scaphoid nonunion. No significant intergroup difference was observed for grip strength, wrist range of motion, or DASH scores at 1 year postoperatively. ConclusionsCancellous bone grafting was found to lead to earlier bone union than corticocancellous bone grafting and to similar restorations of scaphoid deformity and wrist function when scaphoid nonunion was treated by headless compression screw fixation and bone grafting. Level of EvidencePrognostic III.

Osteosynthesis Results of Tibia Plateau Fractures at the Yalgado Ouedraogo University Hospital Center

The sophistication of the implants allows the extension of the surgical indications for tibia plateau fractures. These fractures, which are often comminuted, are caused by a high velocity trauma, making treatment difficult. Objective: The aim of this study was to determine the indications for osteosynthesis of tibia plateau fractures in the orthopaedic-traumatology department of the Yalgado Ouedraogo University Hospital, in order to evaluate the results for their better management. Patients and Methods: it was a 5-year retrospective study of the records of patients with tibia plateau fracture operated and hospitalized in our department. The anatomical-clinical and therapeutic aspects collected from the complete files were analysed. A cortico-cancellous graft was performed in 67.4% of cases. The results were evaluated according to the criteria of Merle d’Aubigne and Mazas [1]. Road traffic accidents (97.4%) were the predominant etiology, involving mainly motorcycles (97.8%). Results: Spino-tuberository and uni-tuberository fractures were the most common. The average consolidation time was 12.5 weeks. One urinary infection, 3 superficial suppurations, 3 vicious calluses and 2 equipment dismantlings were the main complications. Our results were excellent and good in 91.3% and fair in 6.5%. Osteosynthesis of tibial plateau fractures provides excellent results and remains the most appropriate procedure to treat these fractures. Conclusion: reduce the operating time, modernize the technical platform, will allow stable osteosynthesis and early functional rehabilitation to optimize their results.

Reconstruction of complex distal femur open fracture with distal femoral locking plate and primary autologous free fibular graft

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Distal femur fractures are high velocity injuries which accounts for 7-10% of all femoral fractures. These injuries are complex injuries which are difficult to manage. Despite advances in techniques and implants, treatment remains a challenge, in many situations.</span></p><p class="abstract"><strong>Methods:</strong> We present a retrospective review of 8 cases, involved in high velocity road traffic accident who presented to emergency department at St. John’s Medical College, Bangalore, Karnataka, India between September 2011 to December 2015, with complex open fracture of the distal femur with bone loss. All were managed with initial wound debridement and skeletal traction. Subsequently fractured femur was reconstructed with distal femoral locking plate stabilization, along with autogenous non vascularised fibular graft and cortical-cancellous graft bridging the bone defect. Radiological union, functional outcome measured with Tegner and Lyslom scores, KOOS score and complications were assessed.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">At average 5 years follow up, all the fractures have united well, with good functional outcome. X-ray showing united fracture with incorporation of the fibular graft. According to Tegner and Lyslom scoring, 6 patients had good rating, 2 had satisfactory rating. Average KOOS score was 82.15. Shortening of 2 cm and 4 cm in couple of patients was the major complication. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Delayed primary surgery, using autologous non vascularised free fibular graft in conjunction with a locking compression plate, with autogenous cortico-cancellous graft is an effective, less technically demanding and cost effective means of reconstruction option to manage bone defects in complex open fractures of the distal femur. An overall acceptable results in terms of fracture union, fibular incorporation, adequate restoration of knee motion and early rehabilitation can be expected.</span></p>

Recalcitrant aseptic atrophic non-union of the shaft of the humerus after failure of surgical treatment: management by excision of non-union, bone grafting and stabilization by LCP in different modes

Non-union of the humeral shaft is infrequently noticed after surgical fixation. Sixty eight patients whose osteosynthesis of humeral shaft had failed leading to non-union were identified over a duration of 10 years from (January 2006 to December 2015). Clinical and radiographical follow-up was available for 64 patients (4 patients were lost for follow-up), with a mean age of 58 years (range 25–78 years). All patients had aseptic atrophic non-union of either: proximal shaft (n=12), mid shaft (n=38), and lower shaft (n=14). All these patients had failure of primary fixation, with a minimum duration from 36 to 110 weeks. Non-unions were operated by excision of non-union, autogenous bone grafting and osteosynthesis by locking compression plating. Adequate fixation of non-union with bone grafting was achieved in all patients. All non-unions healed well at an average of 16 weeks (range 6–36 weeks). The mean length of follow-up was 120 weeks (range 60–250 weeks). The mean range of movements following healing of non-union was forward flexion of 140°, external rotation and internal rotation of 30° at shoulder and average fixed flexion deformity of 10° and flexion of 130° at elbow. Two patients had postoperative radial nerve palsy because of neuropraxia, which recovered in eight weeks. Three patient developed superficial infections at the iliac crest, which settled with antibiotics, dressings in 3 weeks time and two patients had some discomfort over the fibular graft harvest site. In all patients complete clinical and radiological union was achieved with satisfactory outcome in terms of relief of symptoms and functional improvement in the range of movements. The main points in surgical treatment were complete excision of non-union, correction of deformity, use of plenty of corticocancellous graft, furthermore the use of intramedullary fibula and osteosynthesis by long locking compression plating in different modes of fixation provided good to excellent results and clinical outcome.

Medial femoral condyle vascularised corticoperiosteal graft: A suitable choice for scaphoid non-union.

Introduction:Scaphoid fractures are not very common and frequently remain undiagnosed, presenting in non-union and persistent wrist pain. Options for scaphoid fracture treatment have been described over several decades, however, none with an optimal solution to achieve union along with good hand function. We describe here, the use of vascularised corticoperiosteal bone grafts from the medial femoral condyle (MFC) as a solution for the difficult problem of scaphoid fracture non-union.Materials and Methods:This series has 11 patients with non-union following a scaphoid fracture treated over 18 months ranging from January 2014 to January 2016 using a vascularised corticoperiosteal graft from the MFC. Bone graft fixation was done using K-wires and anastomosis was done with the radial vessels.Results:There were no cases of flap loss. Time of union was an average 3 months. All patients had a full range of movements.Discussion:MFC is an ideal site for harvesting vascularised corticoperiosteal grafts providing a large surface of tissue supplied by a rich periosteal plexus from the descending genicular artery. No significant donor site morbidities have been reported in any series in the past. The well-defined anatomy helps in a rather simple dissection. Corticoperiosteal grafts have a high osteogenic potential and hence, this vascularised graft seems ideal for small bone non-unions.Conclusion:Thin, pliable and highly vascularised corticocancellous grafts can be obtained from the MFC as an optimal treatment option for scaphoid non-unions.

Glenoid bone grafting in primary reverse total shoulder arthroplasty

Severe glenoid bone loss remains a challenge in patients requiring shoulder arthroplasty and may necessitate glenoid bone grafting. The purpose of this study was to determine results, complications, and rates of failure of glenoid bone grafting in primary reverse shoulder arthroplasty. Forty-one shoulders that underwent primary reverse arthroplasty between 2006 and 2013 with a minimum follow-up of 2 years (mean, 2.8 years; range, 2-6 years) were reviewed. Thirty-four (83%) received corticocancellous grafts and 7 (17%) structural grafts. Active range of motion and pain levels were significantly improved (P < .001), with mean American Shoulder and Elbow Surgeons score of 77, Simple Shoulder Test score of 9, and patient satisfaction of 93% at the most recent follow-up. Preoperative severe glenoid erosion and increasing body mass index were significantly associated with worse American Shoulder and Elbow Surgeons scores (P = .04). On radiographic evaluation, 7 patients (18%) had grade 1 or grade 2 glenoid lucency. Glenoid bone graft incorporation was observed in 31 patients (78%). Twelve patients (30%) suffered from grade 1 or grade 2 scapular notching. All of the patients with structural grafts showed graft incorporation and no signs of glenoid lucency. Although glenoid lucency, glenoid graft resorption, and scapular notching were present at short-term to midterm follow-up, none of the patients needed revision surgery. Primary reverse shoulder arthroplasty with glenoid reconstruction using bone graft relieved pain and restored shoulder function and stability.

Synostosis of proximal phalangeal bases for loss of distal metacarpal.

A finger rendered unstable due to loss of metacarpal head can be stabilized by creating a synostosis at the base of the proximal phalanx of the affected finger with the adjacent normal finger. A cortico cancellous graft bridges the two adjacent proximal phalanges at their bases which are temporarily stabilized with an external fixator. The procedure can be done for, recurrence of giant cell tumor of metacarpal and for traumatic metacarpal loss. The procedure and long term follow up of one patient is presented who had giant cell tumor. This option should be considered before offering ray amputation. There is no micro vascular surgery involved, nor is there any donor site morbidity. The graft heals well without any absorption. The affected finger shows excellent function in the long term followup.

Novel technique for harvesting the sternoclavicular graft.

Originally introduced for mandibular reconstruction more than 40 years ago, the sternoclavicular graft (SCG) has gained widespread popularity for the reconstruction of the ramus-condyle unit (RCU) owing to its anatomic and histological likeness to the normal mandibular condyle. Conventional longitudinal osteotomy design for its harvest has been fraught with considerable complications at the donor site including fracture clavicle and major neurovascular injury. In an attempt to alleviate these ill effects, a new technique for procuring the sternoclavicular graft is presented. A split-thickness cortico-cancellous graft was harvested form the sternal end of the clavicle along with the articular disk with the osteotomy cut oriented parallel to the coronal plane, with limited soft tissue dissection. Donor site complications were assessed in terms of incidence of clavicle fracture, neurovascular injury, pleural tear and radiographic healing as seen in the six-month postoperative chest radiograph. 17 patients suffering from unilateral temporomandibular joint ankylosis underwent SCG harvesting for RCU reconstruction following osteoarthrectomy. No adverse events were seen in the intra- and post-operative period in any patient and satisfactory radiographic osseous healing was observed after six months. The proposed harvest technique for SCG results in reduced donor site morbidity and favourable healing and greater patient comfort.

Maximum Quantity of Bone Available for Harvest From the Anterior Iliac Crest, Posterior Iliac Crest, and Proximal Tibia Using a Standardized Surgical Approach: A Cadaveric Study

The 3 most common sites for obtaining autogenous bone grafts are the anterior iliac crest (AIC), posterior iliac crest (PIC), and proximal tibia (PT). The purpose of this study was to determine the maximum amount of corticocancellous bone that could be harvested from the AIC, PIC and PT when using a standardized surgical approach. The maximum volume of cortical and cancellous bone from the AIC, PIC, and PT was harvested from 44 cadavers using approaches from a review of the literature. Uncompressed and compressed corticocancellous bone volumes were measured by water volume displacement. Bivariate analyses of bone volumes, gender, and medical comorbidities were performed using the exact Wilcoxon rank-sum test. A general linear model using ranks was used to assess the effect of gender, medical comorbidity, and site separately for total uncompressed and compressed bone measurements. Forty-two AIC corticocancellous grafts provided an uncompressed total average of 26.29mL and a compressed total average of 20.58mL. Thirty-three PIC grafts yielded a total average of 33.82mL of uncompressed bone and 24.11mL of compressed. Thirty-eight PT samples provided a total average of 18.11mL of uncompressed bone and 9.03mL of compressed bone. No statistically relevant correlations were found between compressed bone volumes and body mass index or age. No statistically relevant association was found between bone quantity and medical comorbidity for any of the graft sites. The average rank of bone volume per site after controlling for gender and medical comorbidity showed that the PIC yielded the most and the PT yielded the least compressed and uncompressed bone amounts (P< .001). Results indicate that the PIC has a larger maximum amount of corticocancellous bone than the AIC and PT with a standardized approach. The maximum volumes of attainable bone from the AIC, PIC, and PT were lower than commonly cited in the literature.

Fibular Allograft and Demineralized Bone Matrix for the Treatment of Slipped Capital Femoral Epiphysis.

Previous studies documented the use of fibular allograft in the treatment of slipped capital femoral epiphysis (SCFE) with bone graft epiphysiodesis (BGE). This study describes the results of using a 10-mm diameter premilled fibular allograft packed with demineralized bone matrix placed across the physis in an open surgical approach under image intensification. A review identified 45 cases of BGE using fibular allograft and demineralized bone matrix in 34 patients with a diagnosis of SCFE performed by a single surgeon during an 8-year period. Thirty-four cases (25 patients) had at least 1 year of follow-up and were included in the study. Medical records were reviewed for complications, subsequent surgeries, and time to physeal closure. Of the 34 cases included, there were no cases of acute chondrolysis. Complications included 1 case of bone graft extrusion that required surgical replacement and 1 re-slip requiring surgical stabilization. Five cases of avascular necrosis (AVN) were encountered (1 unstable slip with total head AVN, and 4 stable slips with 3 total head and 1 partial head AVN). In 1 patient, small loose bony fragments were noted on postoperative radiographs that appeared outside of the articular surface of the hip and were asymptomatic. Two patients encountered wound healing issues that resolved with appropriate wound care. In light of the occurrence of AVN in stable cases, BGE with autogenous corticocancellous graft is preferable to BGE with autologous fibular graft for the treatment of SCFE. [Orthopedics. 2016; 39(3):e519-e525.].

Une malformation nasale congénitale non retrouvée dans la littérature : à propos de 5 cas

Five cases of the same congenital malformation of the nose, affecting the nasal dorsum and the supra-tip, were supported in our university plastic surgery center. This malformation has not been described in the literature known to the authors. The aim of this study is to analyze this nasal deformity. Five children presented this congenital deformity between 1994and 2014. The patients were examined and the malformation precisely described. Genetic and histological examinations were carried on. The diagnosis and treatment of this pathology were discussed. This malformation associated 4anomalies: hypertrophy of soft tissue of the dorsum located in the middle third of the nasal bridge, deformed alar cartilages turned back downward and outside, advanced support default and median skin brand similar to a scar. These patients showed no other abnormalities of the midline or respiratory disorders. No genetic disorder was found for these five patients, and no histological arguments were found. Three patients were operated, one until adulthood with a satisfying cosmetic result. Bibliographic research has not allowed us to make an accurate diagnosis of this malformation that appears to be non-syndromic and to have a genetic origin. Our therapeutic approach became more clear and it now seems legitimate to propose early excision of fat mass to prevent alar deformations, associated with a cortico-cancellous graft, which in our experience grows with age, to support the tip.

Rehabilitation of the severely atrophied dentoalveolar ridge in the aesthetic region with corticocancellous grafts from the iliac crest and dental implants.

BackgroundThe aim of this study was to assess changes in bone volume after block bone augmentation and placement of dental implants and further evaluate the aesthetic outcome of the treatment.Material and Methods9 Patients with atrophied anterior maxilla were included in this study. They received total of 21 implants. Dimensions of the alveolar ridge were measured from cone-beam computed tomography x-rays. The bone level at the implant sites was analysed from intraoral x-rays and the aesthetic outcome was assessed from clinical photographs using a pink aesthetic score (PES) scaling.ResultsThe mean gained horizontal bone width at the marginal crest and 5 mm apically was accordingly 2.7mm and 5.0 mm. The mean PES rating was 9.8/14. The survival rate of.ConclusionsReconstruction of the atrophied anterior maxilla with bone blocks and dental implants is a safe procedure with high survival rate and acceptable aesthetic outcome. Key words:Dental implants, aesthetic region, corticocancellous bone grafts, pink aesthetic score, survival rate.

The chondromyxoid fibroma toe: About a case and review of the literature

The chondromyxoid fibroma is a rare benign bone tumor that represents less than 1% of all bone tumors and may raise diagnosis problems to the pathologist. We report the case of a 46 years old woman with no particular history, admitted for management of painful swelling of the 2nd left toe without alteration of her general condition. Clinical examination found a mass at the dorsum of the third phalanx of the second left toe, painful, hard and fixed at the deep plan. Foot X-ray showed an osteolytic lesion of the phalanx with dented outlines. The patient underwent a resection of the mass with the establishment of a small cortico-cancellous graft taken from the ipsilateral iliac crest and maintained by racking. Pathological examination of the piece of surgical resection showed a chondromyxoid fibroma. The outcome was favorable with no clinical or radiological abnormalities after 10 months of decline. Bone tumors are rarely located in the foot; this low incidence exposed to delays and errors in diagnosis and in treatment decisions. The chondromyxoid fibroma is a rare benign tumor of the bone (2% of benign tumors). Pain is the most common symptom. If it affects long bones most of the time, its location in short or flat bones is rare. Imaging makes the positive diagnosis, and its treatment is the surgical resection of tumor tissue with filling the residual cavity by cortico-cancellous tissue to prevent recurrence. The chondromyxoid fibroma is a rare benign tumor and radiology allows the diagnosis of lytic lesion, its treatment being surgery.

Mandibular Ridge Augmentation Using a Mineralized Ilium Block: A Case Letter

Mandibular Ridge Augmentation Using a Mineralized Ilium Block: A Case Letter

Is It Safe and Effective to Lengthen a Chin With Interpositional Allogenic (Iliac) Graft?

This is a retrospective review of a consecutive series of patients undergoing chin lengthening at the time of orthognathic surgery over a 3-year timeframe. The genioplasty procedures studied included lengthening to the extent that an interpositional graft was deemed necessary (n = 19). Allogenic (iliac) corticocancellous bone was used in all cases. Each patient underwent lateral cephalometric radiography within 2 months before and 5 weeks after surgery. From the radiographs, quantitative measurements (millimeters) were made to document the vertical lengthening and horizontal advancement achieved. Chin region wound healing parameters were reviewed to document evidence of infection, sequestra, need for reoperation, and evidence of fibrous union. Inpatient hospital and outpatient office records were reviewed for any evidence of sepsis or viral transmission. The patients' mean age at operation was 35 years (range, 15 to 58 yr). Analysis of preoperative and 5-week postoperative radiographs documented a mean vertical lengthening of 7 mm (range, 4 to 10 mm). The mean horizontal advancement at the pogonion was confirmed to be 2 mm (range, 1 to 3 mm). None of the study patients sustained chin region infection graft sequestra, fibrous union, or need for reoperation. There were no cases of postoperative sepsis or viral illness to indicate systemic infectious sequelae. The study confirms the safety of allogenic (iliac) corticocancellous grafting to fill interpositional defects associated with a transverse symphyseal lengthening osteotomy.

The effect of human freeze dried corticocancellous block onlay graft on bone formation in rat calvarium

The aim of this study was to investigate the effect of an onlay graft of human freeze dried corticocancellous bone block (FDBB) on bone formation and the added effects of collagen membrane (CM) in rat calvarium. Thirty male Sprague-Dawley rats were treated with either collagen sponge (CS), FDBB or FDBB with CM. FDBBs were placed on the calvarium surface with the CM covered or not. Rats were sacrificed at 2 and 8 weeks after surgery for histologic and histomorphometric analysis. At each period, total augmented area (TA; mm2), new bone area (NB; mm2), and bone density (BD; %) were measured. In the FDBB and the FDBB/CM group, new bone formation began at the lateral and inferior margins of the grafted block and projected into the central region of the recipient-graft interface. The cancellous portion of the graft underwent increased resorption with time. FDBB showed a significant decrease in the TA between 2 and 8 weeks (p<0.05), regardless of combined use of the CM. NB significantly increased in FDBB between 2 and 8 weeks (p<0.05), and the CM showed significant additional effect on new bone formation at 8 weeks (p<0.05). BD significantly increased in FDBB between 2 and 8 weeks (p<0.05). Within the limits of the present study, it was concluded that the maintenance of volume was achieved with onlay grafting of FDBB in early healing period to show new bone apposition onto the rat calvarial surface. In addition, using of CM improved new bone formation within in the grafted area.

Use of Allogenic (Iliac) Corticocancellous Graft for Le Fort I Interpositional Defects: Technique and Results

We performed a retrospective review of a consecutive series of 50 patients who had undergone Le Fort I with interpositional grafting during a 3-year period. Maxillary repositioning included horizontal advancement and vertical and transverse change to the extent that an interpositional graft was considered necessary. Allogenic (iliac) corticocancellous bone was used in all cases. Each patient underwent analytic model planning to document the maxillary vector change data points. The recorded data served as an indicator of the osteotomy site gaps requiring grafting. Standardized photographs in centric relation at a minimum of 12 months after treatment were analyzed to measure overjet, overbite, midline position, and first molar lateral occlusion. Specific maxillary region wound healing parameters were reviewed. The patients' mean age at surgery was 32 years (range 15 to 60). Analytic model planning clarified that the study patients had an average of 8 mm horizontal advancement, 2 mm vertical lengthening, and 2 mm of transverse expansion. The data confirmed a favorable occlusion at a minimum of 1 year after surgery with maintenance of a normal overjet (49 of 50 patients, 98%), normal overbite (48 of 50 patients, 96%), planned dental midline positioning (45 of 50 patients, 90%), and ideal first molar lateral occlusion (48 of 50 patients, 96%) for most patients. None of the study patients sustained wound healing complications. Also, no cases of postoperative sepsis or viral illness developed. The results of the present study have confirmed that iliac corticocancellous allograft has minimal systemic or recipient site complications and can be safely used to fill complex 3-dimensional interpositional defects associated with Le Fort I osteotomy and/or repositioning.