Cancellous Bone Harvesting Research Articles

Cancellous bone harvesting from the distal radius for reconstruction of bone defects in the hand

Extraction of cancellous bone from the distal radius for reconstructive procedures on the hand. All reconstructive procedures on the hand for which acorticocancellous and/or vascularized bone graft or alarge amount of cancellous bone is not required. Acute distal radius fracture, osteosynthesis material embedded in the distal radius, e.g., after palmar plate osteosynthesis of adistal radius fracture, tumor in the distal radius. Removal of cancellous bone from the distal radius radially from the dorsal radial tuberosity via asmall bone window at the base of the second extensor tendon compartment. Wound dressing on the distal radius, elevation of the arm above heart level until swelling has subsided, first dressing change on postoperative day1 or 2,depending on the primary procedure on the hand, dressing until wound healing is complete, removal of the skin sutures around postoperative day14. In 2023, cancellous bone was harvested from the distal radius of 17patients for reconstructive procedures on the hand (6mediocarpal partial arthrodeses, 3acute fractures, 5delayed bone healings, 1pseudarthrosis, 2bone tumors). In all cases, the available amount of radius cancellous bone was sufficient, resulting in satisfactory healing. All patients complained of short-term, slight discomfort at the donor site for the first few days after surgery, which resolved completely. There were no complications at the donor site on the distal radius.

Anatomical Basis for Preservation of Cartilaginous Apophysis in Pediatric Patients Undergoing Iliac Crest Bone Graft Harvest: A Cohort Study.

Background The anterior iliac crest is the workhorse for the harvest of cancellous bone in children undergoing cleft alveolar bone grafting. However, the complexity of the anatomy makes the process of harvesting graft technique sensitive. The aim was todescribe the outcomes of the medially based trap door method of graft harvest in pediatric patients undergoing cleft alveolar bone grafting. Methods A cohort study was conducted, including all the patients in the age group of 8-12 years.Alveolar bone grafting was performed after harvesting a cancellous graft from the iliac crest bone grafting (ICBG) using a medially based trap door approach.Intraoperative time, average blood loss, and postoperative outcomes, including pain score, paresthesia, and gait disturbances, were recorded. Results A total of 28 patients were included in the study based on the inclusion and exclusion criteria. The volume of cancellous bone harvested was between 4-9 cc. The mean intraoperative time was 42 minutes, with an average blood loss of 36 to 48 ml.The average visual analog scale (VAS) score in the postoperative period was 3.5, 6, and 4 on the first, third, and seventh postoperative days. All the patients were ambulated on the second postoperative day, and none of them reported paresthesia. Long-term evaluation of the anterior illum revealed intact crestal morphology with a bone refill on the posterior-anterior (PA) pelvic X-ray. Conclusion A medially based modified trap door approach is more efficaciousand less morbid for the harvest of ICBG in pediatric patients.

The application of a hollow trephine in femoral retrograde intramedullary nailing technique

PurposeThe purpose of this study was to describe and evaluate the use of a specially designed hollow trephine to create the entry point through the femoral condyle during retrograde interlocking intramedullary nailing for femoral fractures.MethodsFrom June 2019 to December 2021, we treated 11 patients (5 men, 6 women; mean age, 64 years; age range 40–77 years) with mid-distal femoral fractures by retrograde intramedullary femoral nailing using a self-designed hollow trephine for femoral condyle reaming and cancellous bone harvesting. The mode of all the nails is static. Patients were followed up at 1, 4, 8, and 12 weeks and for at least 6 months after surgery. The healing process and heterotopic ossification were evaluated by imaging. Partial weight bearing was permitted during the recovery period and complete weight bearing was permitted after clinical healing of the fracture displayed by X-ray.ResultsThe operation was successful in all patients. Over mean follow-up of 9.3 months (range, 6.0–12.0 months), all patients achieved clinical healing within three months. There were no complications such as knee joint infection, heterotopic ossification, knee joint adhesion and wedge effect.ConclusionThe use of the hollow trephine during femoral retrograde intramedullary nailing helps avoid postoperative complications such as heterotopic ossification, knee joint adhesions, and wedge effect. It also facilitates bone graft harvesting.

Arthroscopic reconstruction of scaphoid nonunions

Minimally invasive arthroscopically assisted reconstruction of scaphoid nonunions. Delayed union or nonunion of the scaphoid with sclerosis and with indication for bone transplantation. Limited arthritic changes at the radial styloid. Severe humpback deformity with dorsal intercalated segment instability. Midcarpal arthritic changes. Supine position with the forearm upright and in neutral position, the elbow flexed by90°, axial traction of 3 to 4 kg. Standard wrist arthroscopy via the 3-4 and the 4-5portal and the midcarpal joint via the radial and ulnar portal, respectively, with sodium chloride as arthroscopy medium. Change of the optic to the ulnar midcarpal portal and opening of the nonunion with an elevator via the radial midcarpal portal. Resection of the sclerosis with a3.0 mm burr while irrigating the joint. Harvesting of cancellous bone via the second extensor compartment. On the hand table, closed reduction by joy-stick K‑wires if needed and insertion of K‑wires for the scaphoid screw. Insertion of the screw without entering of the distal thread into the bone. Arthroscopic insertion of the bone transplant by ablunt drill sleeve via the radial portal with steady compression by the obturator. Complete insertion of the screw under arthroscopic control of the compression of the nonunion space with arthroscopic control of stability with the probe. Six weeks forearm cast including the thumb metacarpophalangeal joint, radiographic control and non-load bearing movements for two more weeks, CT scan in the oblique sagittal plane after 8weeks, and increase of load, as well as physiotherapy on demand depending on the radiographic results. To date, 17patients with amean age of the nonunion of 18months were treated. In14patients, bony union was achieved after 8weeks. In one patient, an extraosseous screw placement was corrected. In another patient with extraosseous screw placement, persisting nonunion was treated with an angular stable plate. One scaphoid demonstrated an asymptomatic tight nonunion after 14months, while one scaphoid with sclerosis of the proximal pole did not heal.

Long-term results of secondary alveolar bone grafting using a technique to harvest pure calvarial cancellous bone: Evaluation based on plain radiography and computed tomography

We introduce a method to extract the maximum amount of cancellous bone from the calvarium and analyze the outcomes using plain radiography and computed tomography. We retrospectively analyzed the medical records of patients who underwent secondary alveolar bone grafts using a maximal harvesting technique for calvarial cancellous bone. Bone survival was determined based on Enemark's grading system using plain radiographs. Alveolar thickness and height were analyzed by computed tomography and compared with radiographic measurements. Our study enrolled 27 patients, 22 unilateral and 5 bilateral, for a total of 32 alveolar clefts. The mean age at surgery was 9.04±0.41 years (range: 6-12 years). Donor sites were successfully recovered without complications, such as hematomas, seromas, infections, or tears in the dura mater. The mean follow-up duration for obtaining plain radiographs was 6.90±0.61 years (range: 2.0-18.50 years). The mean follow-up duration for computed tomography was 6.51±0.99 years (range: 2.0-14.83 years). A canine tooth erupted in 30 cases. Success (Enemark's grades I or II) was achieved in 26 cases. Alveolar height was strongly correlated with the Enemark scale results (γ=0.878, p<0.001), but alveolar thickness was not correlated (γ=0.4575, p=0.08). Our cancellous bone harvesting technique resulted in successful graft survival without serious complications, including dural or brain injuries. Although the ilium is widely accepted as the optimal donor site for secondary alveolar bone grafting, the calvarium could be an alternative donor site that results in equivalent outcomes.

Secondary Alveolar Bone Grafting and Iliac Cancellous Bone Harvesting for Patients With Alveolar Cleft.

To assess the efficacy of present interventions optimizing the result of secondary alveolar bone grafting (SABG) and the interventions alleviating the donor site morbidity after iliac cancellous bone harvesting. Researches were identified by searching the electronic database of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Chinese BioMedical Literature Database, and the China National Knowledge Infrastructure. In addition, relevant journals and references of the included studies were searched manually. The Oxford 2011 Levels of Evidence were applied to assess the methodological quality of selected studies, and the best evidence synthesis system was applied afterward to measure the strength of evidence. As a result, 42 studies were considered eligible and included, among which 4 were of high quality while 38 were of low quality. Thirty lines of evidences were acquired after the synthesis, among which 13 were rated as moderate while 17 were rated as insufficient. As for the interventions optimizing the result of SABG, moderate evidence confirmed the efficacy of preoperative orthodontic treatment, the superiority of performing SABG before the eruption of canine, and the accuracy of cone beam computed tomography in preoperative estimation of the cleft volume. As for the interventions alleviating the morbidity of iliac cancellous bone harvesting, moderate evidence confirmed the treatment benefit of the interventions below: minimally invasive technique, including trephine and Shepard osteotomy; preemptive analgesia, including continuous bupivacaine infusion or transversus abdominis plane block. As for the rest interventions, only insufficient evidence was found.

Elastomeric enriched biodegradable polyurethane sponges for critical bone defects: a successful case study reducing donor site morbidity.

Bone substitutes have been a critical issue as the natural source can seldom provide enough bone to support full healing. No bone substitute complies with all necessary functions and characteristics that an autograft does. Polyurethane sponges have been used as a surgical alternative to cancellous bone grafts for critical bone defect donor sites. Critical bone defects were created on the tibial tuberosity and iliac crest using an ovine model. In group I (control-untreated), no bone regeneration was observed in any animal. In group II (defects left empty but covered with a microporous polymeric membrane), the new bone bridged the top ends in all animals. In groups III and IV, bone defects were implanted with polyurethane scaffolds modified with biologically active compounds, and bone regeneration was more efficient than in group II. In groups III and IV there were higher values of bone regeneration specific parameters used for evaluation (P<0.05) although the comparison between these groups was not possible. The results obtained in this study suggest that biodegradable polyurethane substitutes modified with biologically active substances may offer an alternative to bone graft, reducing donor site morbidity associated with autogenous cancellous bone harvesting.

Tibial Cancellous Bone Grafting in Jaw Reconstruction: 10 Years of Experience in Taiwan

Use of proximal tibia as a donor site has been applied in jawbone reconstruction since the 1990s. Catone and colleagues described a U-shaped incision made on the iliotibial tract during tibial cancellous bone procurement for maxillofacial reconstruction in 1992. We used a curvilinear incision on the iliotibial tract in lateral approach in our tibial cancellous bone harvesting procedure. The objectives of this retrospective study are to describe our modified lateral approach for procuring cancellous graft from the proximal tibia and to assess the bone volume, donor site morbidity, and associated complications. Eighty consecutive jawbone reconstructions utilizing autogenous tibial cancellous bone grafts in 78 patients from March 1998 through March 2008 were reviewed. The patient group consisted of 45 males and 33 females, ages 18 to 76 (average age 36.1 ± 12.3). Minimal postoperative follow-up period was 3 months. Unlike the traditional U-shaped trapdoor incision on the iliotibial tract, our curvilinear incision was made almost parallel to the fibers of that tract. Only mild complications were observed at donor sites, including temporary paresthesia, gait disturbance, and an unpleasant scar. The average procured graft volume was 17.8 mL. We also present the first case of reconstruction of mandibular continuity defects of up to 6 to 7 cm lengthwise by tibial cancellous bone grafting, which has not previously been reported in the English literature. The modified incision on the iliotibial tract allowed access to obtain an equally good bone volume from the lateral aspect of the proximal tibia, and it rendered wound closure much easier than the procuring techniques described in the earlier literature.

Alloplastischer Spongiosaersatz mit Fibrinkleber in der Handchirurgie

Alloplastic replacement of cancellous bone is being increasingly used in the clinical setting. The use in hand surgery, however, is only sparsely documented. We report about the use of micro- and macroporous biphasic calicium phosphate granulate (Tricos (®)) in combination with fibrin sealant (Tissucol (®)) in six patients undergoing surgery of the hand involving cancellous bone deficits. The indications ranged from carpal stabilisation to DIP athrodesis. Follow-up time was up to 15 months. Because cancellous bone harvesting could be avoided, morbidity and the extent of surgery could be reduced in all patients. Healing was uneventful and the clinical course as documented by X-ray controls, toleration of physiotherapeutic exercises and stability was analogous to that of conventional surgery involving cancellous bone grafting. These first results indicate that alloplastic replacement of spongiosa grafts, especially by micro- and macroporous biphasic calcium phosphate granulate can possibly be successfully used in surgery of the hand. The extent of bony remodelling still needs to be determined by further examination.

Usefulness of Skin Trephine in Minimally Invasive Cancellous Bone Harvesting for Secondary Alveolar Bone Grafting in Young Patients

Usefulness of Skin Trephine in Minimally Invasive Cancellous Bone Harvesting for Secondary Alveolar Bone Grafting in Young Patients

Retrospective review of donor site complications after harvest of cancellous bone from the anteriomedial tibia

Donor site morbidity is important in deciding the site for harvest of cancellous bone for alveolar bone grafts. Many studies have supported the view that tibia is safe with few complications in the short term. We know of no studies on the long-term complications to the donor site after tibial bone grafting in children with alveolar clefts. The casenotes of 40 children who had had tibial bone grafts for alveolar clefts were studied retrospectively, and parents or patients were contacted by telephone and a standardised questionnaire was used to assess any long term complications at the donor site. We found none. We found no evidence of long-term complications at the donor site in children who had had proximal tibial bone grafting for secondary repair of alveolar clefts. We conclude that the proximal tibia is a safe site from which to obtain cancellous bone graft for alveolar clefts in children. This study is preliminary, and highlights the need for a randomised trial.

Harvesting of Cancellous Bone From the Proximal Tibia Under Local Anesthesia: Donor Site Morbidity and Patient Experience

The objective of this retrospective study was to evaluate postoperative morbidity, risk of complications, and patient discomfort after ambulatory tibial bone harvesting procedures under local anesthesia. Between 2000 and 2005, bone was harvested from the head of the tibia for internal or external maxillary augmentation in 79 patients. A medial osteoplastic approach to the donor region was used. All patients' records were reviewed. Forty-five of the 79 patients later came in for follow-up examination. A traumatologist examined the donor region both clinically and radiologically. Subjective disorders and experiences of the patients were documented using a standardized questionnaire. The patient records revealed that 80% did not report significant complaints or gait disturbances after bone harvesting, and only 5% reported postoperative complaints or gait disturbances lasting longer than 2 weeks. In 1 case, a nondisplaced fracture healed without further complications. Clinical and radiologic examinations of 45 patients revealed full regeneration of the donor region in all cases. Some 91% of the patients described the outpatient bone harvesting procedure under local anesthesia as "not distressing" and would undergo such an intervention again if required. This study demonstrates that both complaints and risk of complications after outpatient bone harvesting from the proximal tibia under local anesthesia can be considered very low, especially as far as outpatient maxillary augmentation (eg, sinus floor elevation) is concerned.

Donor site morbidity after harvesting of proximal tibia bone

Bone-grafting procedures are common in head and neck surgery. Donor site morbidity is an important factor in deciding the site for harvest of cancellous bone. The tibia has been recommended as a harvest site. Use of the proximal tibia as a donor site is associated with few complications. Our present study used proximal tibia bone grafts to reconstruct maxillofacial defects and augment bone volume for implantation. A retrospective study was undertaken to analyze 40 proximal tibia bone grafts in maxillofacial reconstruction. Minimal follow-up was 6 months. There were no major complications during the follow-up period. Early minor complications (15%) included temporary sensory loss and ecchymosis. Late minor complication (2.5%) was gait disturbance for 2 months. Long-term minor complication (2.5%) was an unsightly scar. The procedure for proximal tibia bone graft is easy, has less operative risk, and results in a lower postoperative morbidity rate. Based on our findings, we believe the proximal tibia offers a reliable site for harvest of sufficient quantities of good-quality cancellous bone.

The proximal tibia donor site in cleft alveolar bone grafting: experience of 75 consecutive cases

Background: The optimum donor site for cleft alveolar bone grafting is still debated. Donor site morbidity is an important factor in deciding the site for harvest of cancellous bone. Use of the proximal tibia as donor site is associated with few complications. The occurrence of a proximal tibia fracture following cancellous bone harvest from this site, prompted a review of the last 75 consecutive cases carried out at our unit. Material and Method: The medical notes of 75 consecutive patients undergoing cleft alveolar bone graft were reviewed and postal questionnaires were sent to patient's parents and family physicians. The review focused on donor site morbidity. Results: Fracture of the proximal tibia, a hitherto unreported complication, occurred in two out of 75 cases (2.7%) within our series. Post-operative mobilization was achieved rapidly with normal joint function and donor site healing progressed satisfactorily in all cases. In 1 out of 75 cases the graft was repeated at a later date due to recipient site infection. The incidence of other morbidity was low with most representing local complications only. Length of hospital stay was 3 days (range 2–5 days). Conclusion: Based on our findings we feel that the proximal tibia offers a reliable site for harvest of sufficient quantities of good quality cancellous bone. Recommendations are made as to the technique of bone harvest, to minimize the fracture risk. Copyright 2002 European Association for Cranio-Maxillofacial Surgery. Published by Elsevier Science Ltd. All rights reserved.

A Comparison between Xenogenic Deproteinized Bone Substitute Pyrost® and Autologous Bone Graft in the Surgical Management of Simple Bone Cysts Clinical and Radiographic Results

The basic principle of surgical treatment of simple bone cysts has remained unchanged over the years, with curettage followed by packing of the defect with autogenic bone graft. With the introduction of ceramic biomaterials, an alternative packing material is available, avoiding the complications associated with cancellous bone harvesting or the use of a bioceramic implant. The aim of this study was to compare bony union and recurrence rate after packing of surgically treated simple bone cysts with either Pyrost® or autogenic spongiosa.

Ossification in the rectus sheath following free rectus flap

Heterotopic1999 The British Association of Plastic Surgeonsossification (HO) is a rare complication of laparotomy wounds. In this report, we describe an unusual presentation of ossification within the closed sheath following the harvest of a free rectus flap for lower limb reconstruction. Of specific interest to this case is that access to the rectus was gained through a lower transverse approach. Furthermore, the extremities of this incision were utilised for harvest of cancellous bone from the iliac crests. Given that one explanation for HO is intraoperative seeding it is of note that no problem was encountered in the wound intimately associated with the bony disruption.

Harvest of cancellous bone from the ilium by a closed technique with a trephine

Harvest of cancellous bone from the ilium by a closed technique with a trephine