Free Iliac Crest Bone Graft Research Articles

Denosumab combined with en bloc resection and arthrodesis for recurrent grade 3 giant cell tumor of bone in distal radius

PurposeThis study aimed to analyse the clinical outcomes of preoperative adjuvant denosumab therapy (PADT) combined with resection and arthrodesis for recurrent grade 3 giant cell tumor of bone (GCTB) in the distal radius.MethodsA retrospective study was conducted on twenty-three patients (8 males, 15 females) who were treated with the adjuvant denosumab combined with en bloc resection (EBR) and arthrodesis for biopsy confirmed recurrent Campanacci III giant cell tumor of bone in the distal radius between January 2015 and December 2022. All 23 patients were treated with wrist arthrodesis reconstruction using autogenous free iliac crest bone graft (ICBG), bridging plate and screws. The local control, metastasis and overall survival were evaluated during the follow-up period. Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score, Musculoskeletal Tumor Society Score (MSTS-87 and MSTS-93), and grip strength in the follow-up period. Additionally, all surgical or denosumab-related complications that occurred were recorded in this study.ResultsTwenty-three patients were included in this retrospective study and no patients were lost in the follow-up period. The average patient age was 32.5 ± 10.2 years (range, 19–53 years) and the mean follow-up time was 35.5 ± 18.4 months (range, 13–72 months). The average tumor length was 71.7 ± 8.7 mm (range, 50 to 85 mm) and bone reconstruction length was 78.5 ± 8.5 mm (range, 60 to 90 mm). Four patients (17.4%) had secondary local recurrence after reoperation and two patients had (8.7%) multiple recurrences. One patient (4.3%) was deceased in the last follow-up due to multiple metastases. The estimated 5-year recurrence-free survival rate was 81.3% and 5-year metastasis-free survival rate was 95.7%. The mean union time was 8.5 ± 1.9 (6–12) months and the overall survivorship of the allograft was 82.7% (21/23) at an average 35 month follow-up. The average MSTS-87 and MSTS-93 scores were 27.8 ± 1.6 (range, from 23 to 30) and 91.5 ± 5.0 (range, from 76 to 100), and the average DASH score was 8.9 ± 3.2 (range, from 3 to 15), respectively. The average grip strength was 64.6 ± 15.7% (range, from 30 to 95%) of the uninvolved side. Eight patients (34.7%) had at least one complication in the follow-up time. Two autografts (8.7%) were removed due to local recurrence and bone nonunion, and the average autograft survival time was 32.8 ± 18.5 months (range, 12 to 72 months).ConclusionsPreoperative adjuvant denosumab therapy (PADT) combined with en bloc resection and arthrodesis is a promising method for the treatment of recurrent Campanacci III GCTB in distal radius with acceptable short-term local control and functional satisfaction.Level of evidence: level IV Therapeutic.

Posterior Shoulder Instability and Glenoid Bone Loss: A Review and a Free Bone Graft Technique.

Posterior glenoid bone loss (pGBL) is frequently associated with posterior shoulder instability. Posterior glenohumeral instability accounts for a small percentage of shoulder pathologies, and critical bone loss in posterior instability has not been well defined in the literature. Younger patient populations who participate in activities that repetitively stress the posterior stabilizing structures of the shoulder are more prone to developing posterior shoulder instability. A variety of surgical options have been described, ranging from isolated capsulolabral repair to glenoid osteotomy. Soft-tissue repair alone may be an inadequate treatment in cases of pGBL and places patients at a high risk of recurrence. Our preferred technique for posterior glenoid reconstruction in cases of pGBL involves the transfer of a free iliac crest bone graft onto the native glenoid. The graft is contoured to fit the osseous defect and secured to provide an extension of the glenoid track. In this study, we review pGBL in the setting of posterior instability and describe our technique in detail. Further long-term studies are needed to refine the indications for glenoid bone graft procedures and quantify what constitutes a critical pGBL.

Mandibular distraction of free iliac crest bone graft as treatment in a patient with a history of gunshot wound. Case Report

Introduction: The combination of non-vascularized iliac crest bone graft and distraction osteogenesis in a second surgical intervention has only been described to achieve alveolar ridge augmentation. This technique is not recommended to treat bone defects of the jaws caused by firearm projectile. Case presentation: 40-year-old woman with a segmental mandibular defect in the mandible body caused by the impact of a firearm projectile at the age of 1 year. The patient developed a severe Class II dentofacial anomaly that required a two-stage treatment; she underwent mandibular reconstruction with free iliac crest bone graft followed by a bilateral mandibular distraction at the level of the iliac crest bone graft. With these interventions, a remarkable improvement of the patient's malformation was achieved. Conclusion: Horizontal distraction of the free iliac crest bone graft is a safe and predictable procedure to treat dentolabial anomalies requiring mandibular reconstruction. This procedure was performed in the patient without complications. Further studies on the effectiveness of this technique are required.

Full-staged digital and prosthetic guided protocol for the insertion of dental implants in autogenous free bone grafts after reconstruction of segmental mandibular defects.

This study aims to evaluate the clinical and radiographic outcomes of dental implants, inserted in consolidated free bone grafts; postsegmental mandibular resection, after following a fully guided staged protocol, which established a systematic approach that correlates the grafted bone and the enclosed implants to the undisturbed mandibular segments and the maxillary occlusal plane. Seven patients were enrolled in the study; all were diagnosed for mandibular locally aggressive tumors. All of the patients were subjected to computer-guided segmental mandibular resections, secondary free iliac crest bone graft; aided by computer-guided harvest and prosthetic guidance of the graft positioning and fixation. Finally, the guided bone grafts; after being consolidated, received twenty-nine computer-guided dental implants. By the end of the period of osseointegration, the predetermined criteria of implant success judged the success of twenty-five implants, versus the failure of four implants, with (86.2%) percentage of success. The clinical and radiographic assessments demonstrated sound base bone grafts, which succeeded not only to restore the native mandibular continuity and configuration but also to direct the fair-sized embedded dental implants into favorable coastal locations and axial projections, which influenced a smooth prosthetic rehabilitation.

Immediate loaded implant-supported prosthesis after mandibular reconstruction with free iliac crest bone graft

The head and neck are commonly affected in gunshot injuries and this can cause functional and esthetic defects in the maxillofacial region. Mandibular discontinuity is an important esthetic and functional problem and its reconstruction represents a huge challenge. The opening, closing, lateral and protrusive movements of the mouth are diminished and malocclusion can occur. The purpose is to report a clinical case of a 44 years man who had an immediate loaded implant-supported prosthesis after six months of mandibular reconstruction with free iliac bone grafting of a greatmandibular defect caused by gun shot. Autogenous bone grafting is the most predictable treatment from the available reconstruction options for mandibular bone defects. Reconstructed patients can achieve good results with dental implants and implant-supported prostheses with immediate loading. This treatment can promote better masticatory function, improving the nutrition capacity, facial symmetry, muscular equilibrium, better diction and quality of life.

Rehabilitation of Severely Atrophied Mandible Using Free Iliac Crest Bone Grafts and Dental Implants: Report of Two Cases

The purpose of this study was to reveal the improvement in facial esthetics and maintenance of mastication in severely atrophied mandibles with inadequate alveolar ridges in 2 patients. Bone graft harvested from iliac crest was used for the reconstruction in the first case, followed by the application of 2 dental implants after 6 months. A free iliac bone graft and 2 dental implants were also used simultaneously with a 1-stage surgery in the second case; the patient had previously had a mandibular reconstruction with a rib graft. Both of the patients achieved remarkably functional and esthetic improvements after treatment. Free iliac bone graft is considered to be a favorable alternative for the maintenance of satisfactory functional and esthetic results in patients with severely atrophied alveolar ridges.

The prefabrication of a bone graft in a rat model

The prefabrication of bone grafts in a rat model was investigated. In 26 Sprague-Dawley rats, free iliac crest bone graft was harvested, bivalved, and reinserted heterotopically into the groin, where it was closed around the mobilized superficial inferior epigastric vascular bundle. In half the animals, the vascular bundle remained in continuity as a flow-through pedicle (group 1); in the remaining animals, the pedicle was ligated and divided distal to the bone graft. All grafts were isolated from other tissues by a silicone sheet envelope. At 3 or 6 weeks, the grafts were re-explored and analyzed by India ink perfusion and histologic examination for evidence of viability and neovascularization. Three weeks after insertion, India ink perfusion of the group 1 and 2 grafts revealed neovascularization extending to the periphery of the graft, and histologic examination showed extensive new bone formation on endosteal, periosteal, and trabecular surfaces of the graft. Six weeks after insertion, creeping substitution had almost completely remodelled the cortical and cancellous bone of both group 1 and 2 grafts to create a viable vascularized bone graft on a pedicle. In 3 control nonvascularized grafts (free iliac cortical bone without an implanted pedicle), all pre-existing bone of the graft was dead 3 weeks after insertion, and only very limited new bone formation was present within the graft.

Reconstruction of mandibular discontinuity defects with delayed nonvascularized free iliac crest bone grafts and endosseous implants: A clinical report

Reconstruction of mandibular discontinuity defects with delayed nonvascularized free iliac crest bone grafts and endosseous implants: A clinical report

Pectoralis major muscle flap with bone graft in intra-oral reconstruction

The use of the pectoralis major muscle only flap in conjunction with a free iliac crest bone graft for reconstruction of the mandible is described. These flaps were raised in 20 cadavers and found to be of consistently adequate length to be used as described.