Bone Graft Harvesting Research Articles

Transfusion after harvesting bone graft with RIA: Practice changes reduced transfusion rate by more than half

IntroductionThe Reamer Irrigator Aspirator (RIA) is frequently used as a tool for bone graft harvesting procedures. The initial use of this instrument for bone grafting was met with significant blood loss and high transfusion rates. However, the RIA remains an excellent tool to obtain large volumes of viable autologous graft. The aim of this study was to investigate how changes in the technical use of the RIA may affect blood loss. Materials and methodsWe conducted a retrospective chart review of all patients who underwent RIA bone graft harvest over a 12-year study period. The patients were divided into two cohorts based upon changes in the technique used to obtain autograft harvest with the RIA. The traditional cohort (2008–2012) connected the RIA to dilation and curettage suction and selected reamer size based on radiographic parameters. The modified cohort (2012–2020) connected the RIA to wall suction, used improved techniques for reamer head sizing, and more diligence was paid toward the time the RIA was suctioning in the canal. Demographic information, surgical details, pre- and post-operative hematocrit (HCT), transfusion rate, intra-operative blood loss, reported volume of graft harvested, and iatrogenic fracture were recorded. Results201 patients were included in the study with 61 patients in the traditional and 140 patients in the modified cohorts respectively. The average age was 51 years (range: 18–97) with 107 (53%) males. There was no difference in the demographic data between the two cohorts. No difference was noted between the traditional and modified cohorts in terms of the amount of average graft harvested (54cc vs 51cc; p = 0.34) or major complications (1 vs 2; p = 0.91). However, when comparing the traditional versus modified cohorts the traditional group demonstrated a larger average blood loss (675cc vs 500cc; p=<0.01) and HCT drop (13.7 vs 9.5; p=<0.01) with a higher transfusion rate (44% vs 19%; p = 0.001). ConclusionThis series demonstrated a significant improvement in blood loss and transfusion with modified techniques used to obtain autologous bone graft with the RIA. Importantly, these techniques do not appear to limit bone graft harvest yield and can therefore be efficiently implemented without limiting the utility of the RIA.

Autologous drill dust bone graft a novel technique of bone graft harvesting

This paper, describes a novel technique of graft harvest from the drill site during plate osteosynthesis of fractures of upper limb. The grafts harvested are corticocancellous chips which we prefer to name as 'Drill dust'. This drill dust usually goes wasted as surgeons tend to ignore to collect the drilled out bone which is usually washed out during or after the procedure. We decided to collect these drilled out bone in a meticulous and systematic manner and found that they form a significant amount of bone to be used as a graft at the fracture site which can potentially enhance fracture union. We did a study utilising our technique assessing clinical and radiological union in a subset of patients undergoing upper limb fracture plate osteosynthesis between July 2018 to Jun 2019. We found that there was an enhanced radiological and clinical union in all 28 of our cases where this technique was used. There were no complications noted with the procedure.

Problematic Imaging Diagnostics of Musculoskeletal Gossypiboma with Chronic Expanding Hematoma Mimicking Malignant Lesion.

Both musculoskeletal gossypibomas and chronic expanding hematomas have been rarely reported; the reports that do exist are usually case reports. Our objective is to demonstrate problematic imaging diagnostics of an unusual presentation mimicking a malignant lesion. We report the case of a 47-year-old man who underwent bone graft harvesting from the iliac crest for spinal fusion due to scoliosis at 18 years of age, and 29 years later, he developed a growing, painful tumor at the original donor site (a bone defect in the iliac crest). It was challenging to differentiate a hematoma from a malignant tumor based solely on clinical and radiological workup, including an ultrasound-guided needle biopsy focused on viable tissue. The definitive diagnosis of a gossypiboma with a chronic expanding hematoma was based on histopathological assessment after wide surgical resection-a chronic expanding hematoma with multiple foamy macrophages and giant cells engulfing foreign material (original surgical hemostatic sponge).

An Evaluation of Core Decompression and Cancellous Bone Grafting for Early-Stage Avascular Necrosis of the Femoral Head.

Background Avascular necrosis (AVN) is characterized by bone death due to impaired blood supply leading to its collapse causing pain and suboptimal joint function. The blood supply of the femoral head is so tenuous that even a slight vascular injury can predispose to AVN. Hence, AVN is commonly seen in the femoral head. Core decompression can arrest or even reverse the process of AVN and can avoid femoral head collapse and its sequelae. A lateral trochanteric approach is used for core decompression. The necrotic bone is removed from the femoral head. The use of a non-vascularized bone graft is more attractive than a vascularized graft because it is significantly less technically challenging. The regenerative properties due to the presence of osteoblasts in the trabecular bone and the ability to procure a large amount of graft make the iliac crest the gold standard site of cancellous bone graft harvesting. Core decompression can be considered an effective treatment modality in early-stage AVN(up to stage 2B) of the femoral head. Methodology A prospective, interventional study was conducted in a tertiary care teaching hospital in southern Rajasthan, India. 20 Patients with AVN of the femoral head (up to grade 2B of Ficat and Arlet classification) who met the inclusion and exclusion criteria and presented to the orthopedic outpatient department of our institute were included in this study. Patients were treated with core decompression and cancellous bone grafting with a graft taken from the iliac crest. The Harris Hip Score (HHS) and Visual Analog Scale (VAS) score were used to assess the outcomes. Results In our study, the majority (50%) of the patients were in the 20-30-year age group, making it the most common age group with a male predominance (85%). In this study, the final result was calculated according to the HHS and VAS scores. The mean HHS was 69.45 preoperatively and 83.55 at six months postoperatively. Similarly, the mean VAS score was 6.3 preoperatively and 3.8 at six months postoperatively. Conclusions Core decompression with cancellous bone grafting is a promising procedure in stages 1 and 2 as it reduces the symptoms in the majority of cases and improves functional outcomes.

Retrospective Evaluation of Challenging Delayed Union and Non-union Encountered in Dogs: 16 Cases (2012-2018)

This paper aims to showcase some challenging delayed union and non-union cases, explain their possible causes and the treatment processes they underwent. Most non-union cases included in this study required at least two surgical interventions, and the main reasons for the consecutive interventions were either compromised vasculature of the soft tissues due to extreme trauma or infection. The final successful procedure for cases with excessive soft tissue trauma was external fixator application in most cases. Bone plates were more successful in cases with infection or had poor owner compliance. Minimally invasive external fixator implementation seems to be efficient in preserving the compromised vasculature of the bone while bone plates show better results in cases with localized infection. Harvesting bone grafts from the iliac crest was very practicable, required little time and should be utilized in every possible non-union case given their obvious benefits.

SURGICAL TECHNIQUE AND COMPARISON OF AUTOLOGOUS CANCELLOUS BONE GRAFTS FROM VARIOUS DONOR SITES IN RATS

Autologous cancellous bone graft is the gold standard in large bone defect repair. However, studies using autologous bone grafting in rats are rare and donor sites as well as harvesting techniques vary. The aim of this study was to determine the feasibility of autologous cancellous bone graft harvest from 5 different anatomical sites in rats and compare their suitability as donor sites for autologous bone graft.13 freshly euthanised rats were used to describe the surgical approaches for autologous bone graft harvest from the humerus, iliac crest, femur, tibia and tail vertebrae (n=4), determine the cancellous bone volume and microstructure of those five donor sites using µCT (n=5), and compare their cancellous bone collected qualitatively by looking at cell outgrowth and osteogenic differentiation using an ALP assay and Alizarin Red S staining (n=4).It was feasible to harvest cancellous bone graft from all 5 anatomical sites with the humerus and tail being more surgically challenging. The microstructural analysis showed a significantly lower bone volume fraction, bone mineral density, and trabecular thickness of the humerus and iliac crest compared to the femur, tibia, and tail vertebrae. The harvested volume did not differ between the donor sites. All donor sites apart from the femur yielded primary osteogenic cells confirmed by the presence of ALP and Alizarin Red S stain. Bone samples from the iliac crest showed the most consistent outgrowth of osteoprogenitor cells.The tibia and iliac crest may be the most favourable donor sites considering the surgical approach. However, due to the differences in microstructure of the cancellous bone and the consistency of outgrowth of osteoprogenitor cells, the donor sites may have different healing properties, that need further investigation in an in vivo study.

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.

GOING LOW: LOW MODULUS GRAFT-FREE 3D-PRINTED TITANIUM INTERBODY CAGES SHOW COMPARABLE BONE FORMATION TO PEEK WITH GRAFT

Polyetheretherketone (PEEK) interbody fusion cages combined with autologous bone graft is the current clinical gold standard treatment for spinal fusion, however, bone graft harvest increases surgical time, risk of infection and chronic pain. We describe novel low-stiffness 3D Printed titanium interbody cages without autologous bone graft and assessed their biological performance in a pre-clinical in vivo interbody fusion model in comparison to the gold standard, PEEK with graft.Titanium interbody spacers were 3D Printed with a microporous (Ti1: &lt;1000μm) and macroporous (Ti2: &gt;1000μm) design. Both Ti1 and Ti2 had an identical elastic modulus (stiffness), and were similar to the elastic modulus of PEEK. Interbody fusion was performed on L2-L3 and L4-L5 vertebral levels in 24 skeletally mature sheep using Ti1 or Ti2 spacers, or a PEEK spacer filled with iliac crest autograft, and assessed at 8 and 16 weeks. We quantitatively assessed bone fusion, bone area, mineral apposition rate and bone formation rate. Functional spinal units were biomechanically tested to analyse range of motion, neutral zone, and stiffness. Results: Bone formation in macroporous Ti2 was significantly greater than microporous Ti1 treatments (p=.006). Fusion scores for Ti2 and PEEK demonstrated greater rates of bone formation from 8 to 16 weeks, with bridging rates of 100% for Ti2 at 16 weeks compared to just 88% for PEEK and 50% for Ti1. Biomechanical outcomes significantly improved at 16 versus 8 weeks, with no significant differences between Ti and PEEK with graft.This study demonstrated that macroporous 3D Printed Ti spacers are able to achieve fixation and arthrodesis with complete bone fusion by 16 weeks without the need for bone graft. These significant data indicate that low-modulus 3D Printed titanium interbody cages have similar performance to autograft-filled PEEK, and could be reliably used in spinal fusion avoiding the complications of bone graft harvesting.

Experience With Recombinant Human Bone Morphogenetic Protein-2 in Posterior Lumbar Interbody Fusion: A Retrospective Review of 1019 Procedures.

Recombinant human bone morphogenetic protein-2 (rhBMP-2) combined with an activated collagen scaffold (Infuse; Medtronic, MN) has been used to facilitate lumbar intervertebral fusion; however, data regarding its efficacy are inconsistent. We aimed to assess the efficacy of rhBMP-2 when used in posterior lumbar interbody fusion (PLIF) by analyzing the rate of reoperation for nonunion and patient-reported outcome measures in a large retrospective case series. We also aimed to assess the impact of patient and surgical factors on rates of reoperation and determine frequency of complications. Prospectively collected data from a single-surgeon database of consecutive PLIFs (minimum 18-month follow-up) were retrospectively analyzed. PLIF was performed with pedicle screw instrumentation, intervertebral spacers, and locally harvested bone graft to which rhBMP-2 and bone marrow aspirate (BMA) were added. Multivariate logistic regression was used to determine the influence of patient and surgical factors on the primary outcome: reoperation for confirmed nonunion. A total of 1019 operations at 1485 levels across 908 patients were analyzed. Mean duration of follow-up was 51.7 ± 30.0 months (range 18-172). Twelve patients required reoperation for nonunion (1.2%). Increasing body mass index was found to be significant in predicting reoperation (OR 1.114, P = 0.046). Postoperative radiculitis was common (42%) but transient in most cases. There were significant and sustained improvements in patient-reported outcome measures postoperatively. Four cases of osteolysis and 5 of epidural cyst were recorded, and a reduction of rhBMP-2 dose seemed to ameliorate these sequelae. In this large retrospective observational study, PLIF performed with rhBMP-2 and BMA resulted in a low rate of clinically significant nonunion and significant improvement in patient-reported outcomes. Transient radiculitis was common. Osteolysis and epidural cyst formation were rare and possibly related to dosage. rhBMP-2 is effective when used in PLIF, resulting in a high rate of fusion and improved patient outcomes, and it has an acceptable safety profile.

Multi-regional anesthesia for ulnar fracture and iliac crest bone graft harvesting in a patient with severe aortic stenosis: a case report

Multi-regional anesthesia for ulnar fracture and iliac crest bone graft harvesting in a patient with severe aortic stenosis: a case report

A Systematic Review Comparing Bone Graft Harvest From the Iliac Crest, Tibia, and Calcaneus Donor Sites in Foot and Ankle Surgery

Category: Basic Sciences/Biologics; Other Introduction/Purpose: Bone autografts are frequently harvested for use in foot and ankle surgery. The gold standard harvest site is the iliac crest; however there is known morbidity with this harvest site. Alternative harvest sites include the tibia and calcaneus which are easily accessible for lower extremity surgery. Controversy exists regarding the osteogenic potential of autografts from each location. We performed a systematic review of the known data on cellular autografts from the iliac crest, tibia, and calcaneus focusing on the total cells harvested from each site as well as the presence of the critically important osteogenic osteoprogenitor cells. We also reviewed autograft volume, autograft consistency, surgical techniques, and the morbidities and complications associated with each bone autograft harvest location. Methods: In accordance with the PRISMA 2020 guidelines, a literature search of the PubMed, Cochrane Library, Web of Science, and Google databases from inception through January 2022 was performed. The search terms included: 'autograft,' 'bone graft,' 'foot and ankle surgery,' 'iliac crest,' 'tibia,' 'calcaneus,' reamer irrigator aspirator,' 'RIA,' 'mesenchymal cells,' 'osteoprogenitor cells,' 'quantity,' 'number,' 'amount,' 'yield,' 'concentration,' 'surface antigens,' 'surface markers,' 'CD markers.' Studies were included if autologous bone graft was harvested from the iliac crest, femur, tibia, or calcaneus and the cells in the harvest underwent histologic evaluation, quantification, or CD surface antigen identification. We included studies with bone graft as well as bone marrow aspirates used as samples. The nucleated cell and osteoprogenitor cell yield was recorded from each location; and MSC CD markers present at each harvest site were extracted from the eligible studies. Results: 13 studies met our inclusion criteria. Eight studies performed cell quantification from the harvest sites. Notably these studies only provide counting of total nucleated cells without specific identification of the osteoprogenitors. Colony-forming units were also reported and their findings are reviewed. Total cellular material was on average greatest in the iliac crest, with intermediate counts in the proximal tibia, and lowest in the calcaneus autograft samples. Five studies identified mesenchymal stromal cell (MSC) cluster of differentiation (CD) antigens at the harvest sites of interest. CD markers confirm osteoprogenitor cells are present in each sample location. Total number of osteoprogenitor cells remains unknown, however authors have attempted to extrapolate this number based on number of total nucleated cells and other data. Conclusion: Osteoprogenitor cells can be harvested from the iliac crest, tibia, and calcaneus. Greater total nucleated cell yields were identified in harvests from the iliac crest with descending amounts moving location distally in the limb. Nucleated cells were counted to provident estimates of osteoprogenitor cells yields in most studies, with flow cytometry confirmation that osteoprogenitors are present. Strict quantification of osteoprogenitor cells remains unknown. Multiple studies compared cellular material from bone marrow aspirates versus bone graft harvests themselves. Studies with modern techniques are needed to identify the true number of osteoprogenitors in each location.

Harvesting Bone Graft from Zygomaticofrontal Suture to Reconstruct the Inferior Orbital Rim in Delayed Zygomaticomaxillary Complex Fracture: A Technical Note.

Harvesting Bone Graft from Zygomaticofrontal Suture to Reconstruct the Inferior Orbital Rim in Delayed Zygomaticomaxillary Complex Fracture: A Technical Note.

Surgical technique and comparison of autologous cancellous bone grafts from various donor sites in rats.

Autologous cancellous bone graft is the gold standard in large bone defect repair. However, studies using autologous bone grafting in rats are rare. To determine the feasibility of autologous cancellous bone graft harvest from different anatomical donor sites (humerus, ilium, femur, tibia, and tail vertebrae) in rats and compare their suitability as donor sites, a total of 13 freshly euthanized rats were used to describe the surgical technique, determine the cancellous bone volume and microstructure, and compare the cancellous bone collected quantitatively and qualitatively. It was feasible to harvest cancellous bone grafts from all five anatomical sites with the humerus and tail being more surgically challenging. The microstructural analysis using micro-computed tomographyshowed a significantly lower bone volume fraction, bone mineral density, and trabecular thickness of the humerus and iliac crest compared to the femur, tibia, and tail vertebrae. The harvested weight and volume did not differ between the donor sites. All donor sites apart from the femur yielded primary osteogenic cells confirmed by the presence of alkaline phosphatase and Alizarin Red S stain. Bone samples from the iliac crest showed the most consistent outgrowth of osteoprogenitor cells. In conclusion, the tibia and iliac crest may be the most favorable donor sites considering the surgical approach. However, due to the differences in microstructure of the cancellous bone and the consistency of outgrowth of osteoprogenitor cells, the donor sites may have different healing properties, that need further investigation in an in vivo study.

63. Bone morphogenetic protein and cancer in spinal fusion: a propensity matched analysis

<h3>BACKGROUND CONTEXT</h3> Since its FDA approval in 2002, recombinant human bone morphogenetic protein-2 (rhBMP-2) has been increasingly used in spinal surgery to promote arthrodesis and avoid the morbidity of autologous iliac crest bone graft harvest. Recent data estimate its utilization in 25% of spinal fusions. Because growth factors such as rhBMP-2 stimulate cellular proliferation, the association of rhBMP-2 with tumorigenesis in spinal fusion is an area of concern. Previous research has generated conflicting conclusions on the risk of cancer in patients receiving rhBMP-2 for spinal fusion. <h3>PURPOSE</h3> The purpose of this study is to compare the incidence of new solid organ and hematopoietic malignancies in patients undergoing spinal arthrodesis with or without BMP in a large administrative database. <h3>STUDY DESIGN/SETTING</h3> Retrospective propensity-matched analysis. <h3>METHODS</h3> Patients undergoing thoracolumbar fusion with or without BMP utilization between 2015-2020 were identified from the PearlDiver Mariner Patient Claims Database (PearlDiver Technologies, Colorado Springs, CO, USA) using ICD-10 codes. Patients with pre-existing malignancy diagnosis were excluded. Data were analyzed for incidence of solid organ malignancy (lung, breast, kidney, prostate, thyroid) and hematopoietic malignancy (lymphoma, myeloma, leukemia) diagnosed after spinal surgery. Propensity score matching was performed between patients who did and did not receive BMP. Propensity matched variables were selected a priori and included age, sex, and year of surgery. <h3>RESULTS</h3> Among patients without a history of solid organ malignancy undergoing thoracolumbar fusion, BMP was used in 9,593 patients and was not used in 193,713. In the propensity matched group, 1.5% of the BMP group developed solid organ malignancy following surgery compared to 1.9% of the non-BMP group. The odds ratio of developing solid organ malignancy in the BMP group compared to the control group was 0.80 (95% CI 0.64-1.00); P=0.056. Among patients without a history of hematopoietic malignancy undergoing thoracolumbar fusion, BMP was used in 9,913 patients and was not used in 191,006 patients. In the propensity matched group, 0.3% of the BMP group developed hematopoietic malignancy compared to 0.5% of the non-BMP group. The odds ratio of developing hematopoietic malignancy in the BMP group compared to the control group was 0.69 (95% CI 0.44-1.07); P=0.12. <h3>CONCLUSIONS</h3> BMP use in a large patient population undergoing thoracolumbar fusion was not associated with increased risk of new solid organ or hematopoietic malignancy. Limitations of this study include its reliance on accurate documentation and coding, including documentation of BMP use which may not be as robust as CPT coding since BMP coding may not be reimbursable. However, for the subset of patients with clear documentation of BMP use, this study further supports emerging data on the lack of a causal relationship between BMP use and malignancy. <h3>FDA DEVICE/DRUG STATUS</h3> Bone morphogenetic protein: Approved for certain types of spinal fusion.

Distinct Cell-Intrinsic Functional Differences Between Iliac Crest and Distal Radius Autografts

Autologous bone grafts demonstrate osteoconductive, osteoinductive, and osteogenic properties. Hand surgeons commonly augment surgical fixation with autografts to promote fracture healing. This study compared the intrinsic stem cell-like properties of 2 commonly used autograft sources in hand surgery: the iliac crest and distal radius. A total of 9 subjects who received an iliac crest bone graft and distal radius bonegraft harvest as a part of the standard care of distal radius malunion or nonunion correction or scaphoid nonunion open reduction and internal fixation were enrolled in the study. Cells were isolated by serial collagenase digestion and subjected to fibroblast colony-forming units, osteogenesis, and adipogenesis assays. The expression levels of genes involved in osteogenesis and adipogenesis were confirmed using quantitative polymerase chain reaction. The cells isolated from the iliac crest bone graft compared with those isolated from the distal radius bone graft demonstrated significantly higher mean fibroblast colony-forming unit efficiency; increased osteogenesis, as measured using alizarin red quantification; increased adipogenesis, as measured using oil red O quantification; and higher expression levels of genes involved in osteogenesis and adipogenesis under the respective differentiation conditions. The cells isolated from the iliac crest bone graft demonstrated a higher fibroblast colony-forming unit capacity and an increased capability to undergo both osteogenesis and adipogenesis. Limited evidence exists comparing the intrinsic stem cell-like properties of the iliac crest and distal radius despite the widespread use of each source in hand and wrist surgery. The information from this investigation may assist hand and wrist surgeons with the selection of a source of autograft.

Fusion Revision Surgery With Reamer-Irrigator-Aspirator to Harvest Autograft After Spinal Pseudarthrosis.

Background and purposeSpinal pseudarthrosis (SPA) is a common complication after attempted cervical or lumbosacral spinal fusion surgery. Revision surgeries usually necessitate bone graft implementation as an adjunct to hardware revision. Iliac crest bone graft is the gold standard but availability can be limited and usage often leads to persistent postoperative pain at the donor site. There is scant literature regarding the use of reamer-irrigator-aspirator (RIA)-harvested bone graft in lumbar spinal fusion. This is a collaborative study between orthopedic surgery and neurosurgery departments to utilize femur intramedullary autograft harvested using the RIA system as an adjunct graft in SPA revision surgeries.Materials and methodsA retrospective review was conducted at a single center between August 2014 and December 2017 of patients aged ≥ 18 years and diagnosed with cervical, thoracic, or lumbar SPA who underwent revision fusion surgery using femur intramedullary autograft harvested using the RIA system. Plain radiographs and CT scans were utilized to confirm successful fusion.ResultsEleven patients underwent 12 SPA revision surgeries using the RIA system as a source for bone graft in addition to bone morphogenetic protein 2 (BMP-2) and allograft. The mean amount of graft harvested was 51.3 mL (range: 20-70 mL). Nine patients achieved successful fusion (81.8%). The average time to fusion was 9.1 months. Four patients (36.4%) had postoperative knee pain. Regarding patient position and approach for harvesting, 66.7% (n = 8) of cases were positioned prone and a retrograde approach was utilized in 91.7% (n = 11) of cases.InterpretationThis is the first case series in known literature to report the RIA system as a reliably considerable source of autologous bone graft for SPA revision surgeries. It provides a useful adjunct to the known types of bone grafts. Patient positioning and the approach choice for graft harvesting can be adjusted according to the fusion approach and the surgeon’s preference.

Donor site morbidity in autologous bone grafting – A comparison between different techniques of anterior iliac crest bone harvesting: A prospective study

Background: The aim of this study is to compare morbidities at the donor site in autologous bone harvesting from an anterior iliac crest via the outer cortex, inner cortex and table splitting technique. Methods: The randomized, prospective and comparative study was conducted in 60 patients who were treated with bone grafting as a part of their treatment plan. Group A underwent the outer cortex technique (20 patients), Group B underwent the inner cortex technique (20 patients) and Group C underwent the table splitting technique (20 patients). The comparison of morbidities associated with various techniques of anterior iliac crest bone graft harvesting was done for a period of one year. Results: Most common morbidity observed was pain, measured by the visual analogue scale score (60/60, 100% of patients). The visual analogue scale score was significantly higher for the outer cortex group followed by the inner cortex group, and then the lowest score was for the table splitting group ( p &lt; 0.05). Followed by numbness (40/60, 66%), least in the table splitting group and maximum in the outer cortex group ( p &lt; 0.05). Next was abnormal gait, which was mostly seen in patients with the outer table method and least in the table split group ( p &lt; 0.05). Other complications were infections (4), itching at the surgical site (3) and hematoma (1). There were no significant difference regarding scar satisfaction among comparison groups. Conclusion: we conclude that few differences do exist in harvest-site morbidities between different techniques used in our study. Overall, the most common morbidity observed were pain, numbness and abnormal gait. However, the table splitting group has the lowest morbidity, therefore bone harvesting by the table splitting appears to be a very good option.

Assessing donor site pain after Iliac Crest Bone Graft

Objective: The aim of the present study was to evaluate the intensity of donor site pain after autogenous iliac crest bone graft harvest for arthrodesis of joints and non-union of fractures.&#x0D; Methodology: This prospective cross-sectional study was conducted at the Orthopedics Department of Khalifa Gul Nawaz Teaching Hospital in Bannu. A total of 156 patients who underwent iliac crest bone graft harvest were included in the study. The frequency and intensity of donor site pain were assessed using the visual analogue scale (VAS) after one month of postoperatively.&#x0D; Results: Out of 156 patients, the majority were males (61.5%). The mean age and pain score observed in the enrolled patients was 34.7 ± 9.5 years and 2.24 ± 2.01, respectively. Mild pain was present at one-month follow-up postoperatively in 50.6% of the patients. The pain intensity was assessed in relation to gender and age; there was no significant difference in the mean VAS scores between males and females (p=0.45). Furthermore, stratification with respect to age also displayed no significant variation in the pain scores with respect to age (p=0.99).&#x0D; Conclusion: Donor site pain remains significant morbidity associated with iliac crest bone graft, mild pain was observed in half of the enrolled cases, and only 23% were pain-free after one month of the surgery.

Secondary Alveolar Bone Grafting in Patients with Cleft Lip and Palate: A Step-by-Step Video Series.

Secondary alveolar bone grafting is one of the key surgical procedures performed to restore dental arch continuity and facilitate tooth eruption in patients with cleft lip and palate. Harvest of cancellous bone graft from the iliac crest has become the gold standard; however. there is no consensus regarding the ideal technique. An optimal bone harvest technique must be aimed at producing minimal donor-site morbidity and patient discomfort. The success of the bone grafting procedure depends largely on the surgical technique. To restore cleft alveolar defects, one must be able to conceptualize the different underlying aspects of the problem to perform an effective surgical repair. It is important for surgeons-in-service to adopt newer techniques that significantly enhance the overall outcome. This article describes two techniques of iliac bone harvest and the principles involved in execution of the alveolar bone grafting procedure. The accompanying four-part video series depicts the bone harvest, flap design, dissection of the recipient cleft alveolus, and bone grafting in a step-by-step manner.

Two-Corner Fusion or Four-Corner Fusion of the Wrist for Midcarpal Osteoarthritis? A Multicenter Prospective Comparative Cohort Study.

Midcarpal osteoarthritis is a debilitating wrist pain, and a mainstay treatment is midcarpal fusion. The accepted standard for midcarpal fusion is four-corner fusion, but lately, two-corner fusion (i.e., capitolunate fusion) has gained popularity. This is the first prospective, multicenter, cohort study comparing capitolunate fusion with four-corner fusion for midcarpal osteoarthritis. Patients with scaphoid nonunion advanced collapse or scapholunate advanced collapse wrist of grade 2 to 3 undergoing capitolunate fusion or four-corner fusion between 2013 and 2019 were included. Sixty-three patients (34 with capitolunate fusion, 29 with four-corner fusion) were included. Patient demographics were similar between groups. Patient-Rated Wrist Hand Evaluation questionnaire score, visual analog scale pain score, grip strength, range of motion, and complications were measured at baseline and 3 months and 12 months postoperatively. Complications (i.e., nonunion, hardware migration, conversion to wrist arthrodesis, or arthroplasty) were determined. A significant difference in Patient-Rated Wrist Hand Evaluation or visual analog scale pain score at 3 and 12 months postoperatively between the capitolunate fusion and four-corner fusion groups was not found. There were no differences in grip strength between patient groups preoperatively or 12 months postoperatively. At 12 months postoperatively, capitolunate fusion patients had better flexion compared with that in the four-corner fusion group (p = 0.002); there were no differences in complications and reoperation rates between groups. Capitolunate fusion and four-corner fusion were comparable in terms of functional scores (i.e., Patient-Rated Wrist Hand Evaluation and visual analog scale pain scores) and complication scores. Capitolunate fusion showed favorable wrist mobility compared with four-corner fusion in treatment of midcarpal osteoarthritis. Capitolunate fusion advantages include use of less material, less need for bone-graft harvesting, and easier reduction of the lunate during fixation. Therapeutic, II.