Iliac Bone Research Articles

The effect of radiotherapy time and dose on acute hematologic toxicity during concurrent postoperative chemoradiotherapy for early high-risk cervical cancer.

Objective: This study aims to analyze the characteristics and factors that influence acute hematological toxicity (HT) during concurrent chemoradiotherapy (CCRT) for cervical cancer, as well as to provide reference data for clinical practice. Methods: Patients with FIGO IB1-IIA2 cervical cancer who underwent CCRT from May 2018 to August 2020 were included in this study retrospectively. All patients had received external beam radiation therapy and platinum-based concurrent chemotherapy. HT was assessed according to CTCAE 5.0. The pelvic bone marrow was redrawn on the original CT images and divided into four parts: the whole pelvic bone marrow (WP-BM), iliac bone marrow (IL-BM), lower pelvic bone marrow (LP-BM), and lumbosacral bone marrow (LS-BM). The radiation dose and volume of each part of the pelvic bone marrow were recalculated in a new plan created using the original planning parameters. The corresponding dose-volume histogram (DVH) was generated to obtain the bone marrow volumes receiving 10Gy, 20Gy, 30Gy, 40Gy, 45Gy, and 50Gy. Results: In 112 patients, the incidences of grade 2 or higher leukopenia, anemia, thrombocytopenia, and neutropenia were 49.1%, 2.7%, 1.8%, and 20.5%, respectively. Leukopenia was linked to LS-V20 (r = -0.310; P = 0.006) and radiotherapy treatment lengths (days) (r = -0.416; P = 0.013). Anemia was associated with WP-V30, WP-V40, WP-V45, WP-V50, IL-V20, IL-V40, ILV45, IL-V50, LP-V30, LP-V40, LP-V45, and LP-V50 (P <0.05). Thrombocytopenia (r = -0.304, P = 0.007) and neutropenia (r = -0.368, P = 0.009) was associated only with the length of radiotherapy treatment (day). Multiple regression analysis showed that only anemia was negatively correlated with WP-V30, IL-V40, and LP-V40 (P <0.05). Conclusions: Acute HT during CCRT in early-stage high-risk cervical cancer may be related to the duration of radiotherapy and the volume of different radiotherapy doses received at different parts in the pelvic bone marrow.

Early results of intramedullary nail fixation in distal tibia oblique osteotomy for the reduction of soft tissue complications.

During distal tibial oblique osteotomy, external fixators can increase pin site infection risk, whereas plates can cause wound necrosis, necessitating a compromise between soft-tissue position and length. We provide the first report of the early results of intramedullary nail fixation in these osteotomies for avoiding soft tissue complications. Ten ankles, classed as Takakura-Tanaka stages 3a to 4 and unclassified and treated via distal tibial oblique osteotomy for ankle osteoarthritis between 2017 and 2021, were included. Osteotomy was performed obliquely from the distal medial tibia to the tibiofibular joint. The distal tibial fragment was rotated distally in the coronal plane for realignment. An intramedullary nail fixation was applied for stabilization. The resulting gap was filled with iliac bone graft. Ankles were evaluated on the Japanese Society for Surgery of the Foot ankle-Hindfoot Scale and Self-Administered Foot Evaluation Questionnaire before surgery and at final follow-up. Radiographic assessments were performed. Bone union was achieved within 3 months in all patients. There were no cases of wound necrosis or correction loss postsurgery. Japanese Society scale scores significantly improved from 40.3 ± 15.9 to 87.5 ± 12.6 (P < 0.01). Mean self-evaluation scale scores (pain and pain-related, physical functioning and daily living, social functioning, general health and well-being) improved significantly. shoe-related scores did not change significantly but improved. There was no correction loss after surgery, with an average widening of 24.2 mm and opening angle of 22.6° at the osteotomy site. Our study showed that intramedullary nail for fixation of the osteotomy site in distal tibial oblique osteotomy effectively prevents soft tissues complications even in osteotomy sites with large openings.

Functional and radiological outcome after cervical arthrodesis using polyetheretherketone or tricortical iliac bone graft for degenerative and traumatic spine pathologies: A single-center experience

Functional and radiological outcome after cervical arthrodesis using polyetheretherketone or tricortical iliac bone graft for degenerative and traumatic spine pathologies: A single-center experience

Correction of cubitus valgus and reconstruction of lateral humerus condylar defect using tricortical iliac graft in pediatric patients.

Neglected non-united lateral humeral condyle fractures in pediatrics are a probable cause of cubitus valgus deformity which is a disabling complication. The ideal management for this condition is still debatable. This study aimed to evaluate the reconstruction of a non-united lateral humerus condylar fracture complicated by cubitus valgus using a tricortical iliac crest graft in pediatric patients. Twenty children suffering from cubitus valgus as a complication after a non-united fracture of the lateral humeral condyle were included in this study. They were managed by open reduction, screw fixation, and reconstruction by an autologous tricortical iliac bone graft. We compared the preoperative and postoperative range of motion of the elbow, alignment, and elbow function using the Mayo elbow performance index. There was a statistically significant improvement in the elbow range of motion postoperatively, and there was a highly significant improvement regarding the elbow alignment and function. Open reduction, screw fixation, and reconstruction by the autologous tricortical iliac bone graft is an effective technique for the management of cubitus valgus due to neglected non-united lateral humeral condyle fractures in pediatrics.

A comparison of anterior cervical discectomy and fusion (ACDF) using bone substitute with polyetheretherketone (PEEK) cage versus iliac bone graft and plate : A retrospective study with 2-year follow-up

A comparison of anterior cervical discectomy and fusion (ACDF) using bone substitute with polyetheretherketone (PEEK) cage versus iliac bone graft and plate : A retrospective study with 2-year follow-up

Decision to Preserving Ankle Joint Function in Neglected Neck Talus Fracture with Type 2 Diabetic Mellitus Patient : A Case Report

Talus fractures are rare injuries to the hindfoot that still challenging in treatment. The anastomotic ring is likely to be damaged in neck talus fractures, which disrupt the blood flow and cause significant problems affecting fracture healing. Poor fracture healing and an increased risk of surgical complications were also associated with complex diabetes mellitus. We follow the progress of the illness from a 47 year old female complaint pain on her left ankle after falling down 6 months before outpatient. Physical examination shows swelling and varus deformed on affected ankle. Ankle x-ray and CT scan were done. Patient diagnosed as neglected close fracture left neck talus Hawkins type IV with type 2 diabetes mellitus. Then patient undergo an ankle arthroscopy to evaluate ankle joint and preserving ankle joint procedure by subtalar arthrodesis and iliac bone graft. This procedure achieved an excellent result in preserve ankle aligment, stability and soft tissue management. After 2 weeks wound heals without signs of infection and 3 weeks of followup VAS score mention from 0 to 1, with good compliance of the patient. Arthroscopy is safe procedure obtaining anatomical joint surface and reduce tissue damage. While arthrodesis enhance blood supply to encourage bone union, though loss of its ankle motion also has significant effect on ambulation.

Antibiotic artificial bone implantation for the treatment of infection after internal fixation of tibial plateau fractures

ObjectiveTo explore the clinical effect of antibiotic artificial bone (Calcium phosphate) in the treatment of infection after internal fixation of tibial plateau fractures.MethodsWe retrospectively reviewed the clinical data of 32 patients with infection after internal fixation of tibial plateau fractures treating from March 2010 to October 2021. There were 18 males and 14 females, aged from 23 to 70 (average 49.66 ± 10.49), 19 cases of the left side and 13 cases of the right side. Among them, 7 cases were open fractures with initial injury and 25 cases were closed fractures. On the basis of thorough debridement and implanting antibiotic artificial bone, the internal fixation of 18 patients were tried to be preserved and the internal fixation of 14 patients were removed completely. In order to provide effective fixation, 14 patients also received external fixation. Postoperative wound healing, infection control, Hospital for Special Surgery knee scores (HSS), related inflammatory indicators and bone healing time were recorded and followed up.ResultsThirty-two patients were followed up for 12 ~ 82 months (average 36.09 ± 19.47 months). The redness, swelling and pain of pin site occurred in 2 patients, which returned to normal after applying antibiotics and continuous dressing change. One patient retained the internal fixation during the first-stage operation. Redness and swelling of incision, subcutaneous undulation occurred after two months. In order to avoid the recurrence of infection, the internal fixation was removed completely and antibiotic artificial bone was filled again. The infection was controlled and fracture healed. Four patients’ wounds could not be closed directly due to soft tissue defect and was covered with skin flap. After the first-stage operation, 12 patients received second-stage autologous iliac bone grafting due to residual bone defects and poor healing of the fracture end. The bone healing time was 4 ~ 16 months (average 7.31 ± 2.79 months). Inflammatory indicators including CRP, ESR, and WBC returned to normal levels within 2 ~ 10 weeks (average 4.97 ± 2.58 weeks). The HSS of all patients were 54 ~ 86 points (average 73.06 ± 8.44 points) at the last follow-up.ConclusionImplantation of antibiotic artificial bone, retention or removal of internal fixation according to infection and fracture healing, application of external fixation timely is an effective method to treat infection after internal fixation of tibial plateau fractures, which can control infection effectively and promote functional recovery.

Maxillary Ossifying Fibroma Managed Using Cosmetically Acceptable Facial Degloving Approach with Iliac Bone Graft Reconstruction.

Ossifying fibroma is benign, slowly expansile, painless, well defined fibro-osseous tumour composed of calcified products such as bone, cementum, or both [1]. We opted for a novel approach for the management of ossifying fibroma of maxillary region through scarless midfacial degloving approach with iliac bone graft reconstruction. A 20 years old young female presented with left sided facial swelling involving anterior wall of maxilla and lifting the ala of nose. CT and FNAC suggested a benign lesion. Surgery was performed to remove the tumour completely and managed with scarless midfacial degloving approach with iliac bone graft reconstruction. The iliac crest free flap is an optimal method for maxillary defect reconstruction. The main advantages of the flap are the large amount of bone provided, its height, and the possibility of including the internal oblique muscle [2].

Quantitative MRI evaluation of bone marrow in sickle cell disease: relationship with haemolysis and clinical severity

To evaluate bone marrow fat fraction using the Dixon technique (FFDix) of magnetic resonance imaging (MRI) as a potential biomarker of haemolysis and clinical severity in the overall assessment and follow-up of sickle cell disease (SCD) patients. The present study was a cross-sectional study in which healthy individuals and SCD patients (matched for age, sex, and weight) were subjected to MRI of the lumbar spine and pelvis to quantify FFDix in the bone marrow using the Dixon technique. SCD severity was analysed by clinical and laboratory data, and an online calculator. A high degree of haemolysis was defined using the cut-off values haemoglobin (Hb) ≤10 g/dl, lactate dehydrogenase (LDH) ≥325 U/l, reticulocytes ≥3% and total bilirubin (TB) ≥1.2 mg/dl. Pearson's correlation, receiver operating characteristic (ROC) curve and binary logistic regression analysis were performed. Forty-eight SCD patients (26 homozygous: HbSS and 22 compound heterozygous: HbSC) and 48 healthy individuals participated in the study. FFDix was lower in SCD patients than in the control group, showing even lower values in the HbSS subtype and patients with a higher degree of haemolysis. HbSC patients with a higher degree of haemolysis using hydroxyurea (medium dosage 9.8 mg/kg/day) had lower FFDix. ROC curves and odds ratios for detecting patients with a higher degree of haemolysis at the different FFDix measurement sites demonstrated excellent performance: iliac bones (cut-off ≤16.75%, AUC=0.824, p<0.001), femoral heads (cut-off ≤46.7%, AUC=0.775, p=0.001), lumbar vertebrae (cut-off ≤7.8%, AUC=0.755, p=0.002). Decreased FFDix is indicative of higher degree of haemolysis and SCD severity with great potential as a non-invasive biomarker contributing to the overall assessment and follow-up of SCD patients.

Iliac crest towards alveolar processes or mandibular inferior margin in mandibular reconstruction with a vascularized iliac bone flap: which is better?

The study aims to compare differences among iliac bone flaps with different iliac crest orientations for the repair of mandibular defects with an aim to analyze their advantages, disadvantages, and effects. Clinical data and computed tomography scans of all patients who underwent iliac bone flap repair of the mandible in Peking University School and Hospital of Stomatology from January 2016 to April 2021 were collected. Patients were divided into the iliac crest towards alveolar process (Group A) and the iliac crest towards mandibular inferior margin (Group B). Software was used to measure corresponding indicators. The results obtained for the groups were statistically analyzed. The study included 78 patients (25 and 53 in groups A and B, respectively). The symmetry of the LC-type defect was better in group A (p < 0.05). The all-bone width of the alveolar process side in group A was greater than 6mm; in 15 cases of group B, the width was less than 6mm (p < 0.05). The intermaxillary distance of two sites were higher in group B (p < 0.05). The bone cortical thickness was significantly thicker in group A (p < 0.05). One year after the mandibular body defect was reconstructed with a vascularized iliac bone flap, the iliac crest towards alveolar process group showed better bone symmetry, width, intermaxillary distance, and cortical thickness to meet the planting requirements. The use of an iliac crest towards alveolar process may be a better approach for mandible reconstruction.

Hip Arthroscopy With Bone Marrow Aspirate Injection for Patients With Symptomatic Labral Tears and Early Degenerative Changes Shows Similar Improvement Compared With Patients Undergoing Hip Arthroscopy With Symptomatic Labral Tears Without Arthritis

To define the clinical effect of intra-articular injection of iliac crest-derived bone marrow aspirate concentrate (BMAC) at the time of hip arthroscopy in patients with symptomatic labral tears and early radiographic degenerative changes. A retrospective review of a prospectively collected hip registry database was performed. Patients with symptomatic labral tears and Tönnis grade 1 or 2 degenerative changes who underwent labrum-preserving hip arthroscopy with BMAC injection were included and were matched with patients who underwent hip arthroscopy without BMAC injection. Patient-reported outcomes (PROs) collected preoperatively and up to 2 years postoperatively included the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport, and International Hip Outcome Tool 33 score. Clinical relevance was measured with the minimal clinically important difference, patient acceptable symptom state, and substantial clinical benefit for each outcome score. A total of 35 patients underwent labrum-preserving hip arthroscopy with BMAC injection and were matched with 35 control patients. There were no differences in demographic characteristics between the groups (P > .05). The BMAC group consisted of 22 patients (62.9%) with Tönnis grade 1 changes and 13 (37.1%) with Tönnis grade 2 changes, whereas all 35 control patients had Tönnis grade 0 hips. All PROs were significantly improved in both groups at 2 years, with no difference in improvement. The rate of failure requiring conversion to total hip arthroplasty was 14.3% (mean, 1.6 years postoperatively) in the BMAC group and 5.7% (mean, 7 years postoperatively) in the control group (P= .09). The difference in the frequency of patients achieving the minimal clinically important difference, patient acceptable symptom state, and substantial clinical benefit was not statistically significant between cohorts. In a challenging group of patients with symptomatic labral tears and early radiographic degenerative changes, hip arthroscopy with BMAC injection results in statistically and clinically significant improvement in PROs comparable to a group of patients with nonarthritic hips undergoing hip arthroscopy at short-term follow-up. Level III, retrospective comparative therapeutic trial.

Surgical bone augmentation procedures for oral rehabilitation of patients with oligodontia: A review with a systematic approach

Oligodontia is a developmental dental anomaly defined by the absence of 6 or more permanent teeth, excluding the third molars. We performed a review with a systematic approach and proposed a guideline for the choice of the bone augmentation surgery. The different bone augmentation technique terms were searched in the PubMed and Science Direct database. Clinical studies were eligible if they reported on pre-implant surgery in patients with oligodontia. The database search yielded 400 studies after duplicates removed. Thirty studies were finally included, involving 410 patients. Sixty-three sinus lifts were performed in 37 patients with no failure. Thirteen out of 33 patients with iliac bone transplantation and two out of 24 with parietal bone transplantation had resorption, one out of 4 patients who received allogeneic bone block had complete failure. Seventy-eight patients underwent guided bone regeneration, none had bone loss. No failure was found with the alveolar distraction osteogenesis technique. Four out of thirteen patients developed permanent hypoesthesia after inferior alveolar nerve transposition. The cumulative implant survival rate was 94.4% after bone augmentation procedures. Extensive edentulous areas should be grafted with parietal bone, as iliac grafts present a greater risk of resorption. Smaller edentulous areas should be treated by endobuccal harvesting or guided bone regeneration. Osteogenesis distraction and nerve transposition are effective surgeries for medium-to-large mandibular edentulous spaces. The implant survival rate is not significantly different between implants placed in grafted and nongrafted bone, the appropriate choice of bone augmentation technique can reduce the risk of peri‑implant bone resorption.

Influence of a resorbable collagen membrane for alveolar bone graft on clinical outcomes and ridge volume stability in cleft alveolus

This study compared the clinical outcomes, graft quality, and graft quantity after alveolar bone grafting with and without a resorbable collagen membrane. Twenty unilateral cleft patients undergoing defect repair with cancellous iliac bone were assigned to either the collagen membrane group (Mb group) or standard group without a membrane (St group). Postoperative pain and swelling, bone density, and bone volume and quality were assessed. The Mb group showed significantly lower postoperative pain than the St group (P < 0.001) and significantly less swelling (P < 0.01) on day 3 postoperative. The reduction in bone density was significantly greater in the St group than in the Mb group at 1 and 3 months postoperative (P ≤ 0.001), but not at 6 months. The reduction in bone volume in the St group was significantly greater than that in the Mb group at 3 months (29.11 ± 6.26% vs 17.67 ± 11.89%, P = 0.016) and 6 months postoperative (40.95 ± 6.81% vs 25.67 ± 11.51%, P = 0.002). Nine cases in the Mb group versus six in the St group showed good bone quality. In conclusion, the collagen membrane facilitated predictable clinical outcomes in bone maturation, bone volume preservation, and bone bridging in the alveolar bone graft.

Effect of vitamin D metabolites on bone histomorphometry in healthy black and white women: An attempt to unravel the so-called vitamin D paradox in blacks

An apparent vitamin D paradox, characterized by lower serum 25-hydroxyvitamin D (25(OH)D) levels and higher bone mineral density, is present in black population. In contrast, blacks have higher serum 1,25-dihydroxyvitamin D (1,25(OH)2D) levels. The effect of 1,25(OH)2D on the skeleton is not fully understood. We examined serum 25(OH)D, 1,25(OH)2D and bone histomorphometry in 50 black and white women (25 each) matched for age, menstrual status, and BMI. Histomorphometric indices related to bone structure, remodeling and mineralization were measured in cancellous bone in iliac bone biopsies. Data analyses led to the following results: 1) serum 25(OH)D was significantly lower and 1,25(OH)2D was significantly higher in black than in white women, but neither blacks nor whites revealed significant correlation between these two vitamin D metabolites. 2) there was no significant difference in PTH levels between blacks and whites. 3) except for greater trabecular thickness (Tb.Th) in blacks, there were no significant differences in other histomorphometric variables between the two ethnic groups. 4) osteoid surface (OS/BS), unlabeled osteoid surface (ulOS/BS), and osteoblast surface (ObS/BS) significantly correlated with serum 1,25(OH)2D levels. We conclude that lower serum 25(OH)D levels in blacks do not impair bone structure and remodeling, nor decrease bone mineralization. Higher serum 1,25(OH)2D levels in blacks may help preserve bone mass by stimulating bone formation via increasing osteoblast number and function, but moderately inhibit terminal bone mineralization as shown by higher ulOS/BS.

An Analysis of the Viability of Nonvascular Iliac and Fibula Grafts in Mandibular Reconstruction in Patients with Circulatory Diseases: A Prospective Randomized Study.

Vascularized bone grafts are considered as the gold standard for mandibular reconstruction. However, there are certain limitations of them, such as they are contraindicated in patients with circulatory disturbances. Therefore, Non-vascular bone grafts become the viable option for reconstruction. Our study aims to prospectively compare the long-term viability of avascular iliac and fibula bone grafts in the reconstruction of mandibular defects. Objectives were to evaluate the difficulty in swallowing, mastication, speech problems, infection, wound dehiscence, restricted limb movement, and altered gait among the iliac and fibula group. A total of 14 patients, planned for the reconstruction of mandibular defects from 2016 to 2018 were randomly allocated into two groups; nonvascular iliac and fibula graft groups. Clinical assessment for improvement in function, esthetics, wound healing, pain, and donor site morbidity was done and was followed up for one year. Digital orthopantomogram was taken for radiographic evaluation for up to one year. Difficulty in swallowing, mastication, speech, infection, restricted limb movement, and altered gait was statistically significant and was seen more in the fibula group. Wound dehiscence with graft exposure was found in one subject. The overall success rate was 100% in the iliac group and 85.7% in the fibula group. Considering the long-term complications and success rate, the nonvascular iliac graft was found to be superior and can be used as an alternative to a nonvascular fibula graft for a defect length up to 7cm.

Elucidation of adipogenic differentiation regulatory mechanism in human maxillary/mandibular bone marrow-derived stem cells

ObjectiveThis study aims to investigate the underlying molecular mechanisms that regulate the adipogenic differentiation of maxillary/mandibular bone marrow-derived mesenchymal stem cells (MBMSCs). DesignMBMSCs and iliac bone marrow-derived MSCs (IBMSCs) were compared for osteogenic, chondrogenic, and adipogenic differentiation. Cell surface antigen expression was examined using flow cytometry, and stem cell marker expression was assessed using real-time polymerase chain reaction (PCR). Various adipogenic regulatory factors’ expression was evaluated using real-time PCR and western blotting. ResultsNo significant differences in cell surface antigen profiles or stem cell marker expression in MBMSCs and IBMSCs were observed. MBMSCs and IBMSCs displayed similar osteogenic and chondrogenic potentials, whereas MBMSCs showed significantly lower adipogenic potentials than those shown by IBMSCs. Expression of CCAAT/enhancer binding protein β (C/EBPβ), C/EBPδ, early B-cell factor 1 (Ebf-1), and Krüppel-like factor 5 (KLF5), which are early adipogenic differentiation factors, was suppressed in MBMSCs compared to that in IBMSCs. Peroxisome proliferator-activated receptor-γ (PPARγ) and C/EBPα, which play important roles in the terminal differentiation of adipocytes, was lower in MBMSCs than that in IBMSCs. Furthermore, the level of zinc finger protein 423 (Zfp423), which is involved in the commitment of undifferentiated MSCs to the adipocyte lineage, was significantly lower in MBMSCs than that in IBMSCs. ConclusionsMBMSCs are negatively regulated in the commitment of undifferentiated MSCs to the adipocyte lineage (preadipocytes) as well as in the terminal differentiation of preadipocytes into mature adipocytes. These results may elucidate the site-specific characteristics of MBMSCs.

Using Delay Principle to Create Two Viable Flaps Within one Distant Pedicled Flap: How We Did it-A Case Report.

From the time reconstruction is being performed, delay is a part of standard surgical staged procedure, wherein the procedure results in inducing ischemia to the tissues and hence flap viability.[1] We present here a case, wherein we did a delay from the distal margin of an elevated flap, which bisected a single flap into two flaps to provide cover to two different regional defects with one flap acting as a distant pedicled flap and the other as a local transposition flap. A 24-year-old man presented with high-tension electrical burns with multiple exposed bones at multiple locations. The patient had 4-degree burn with an exposed left iliac crest bone and an exposed ulnar bone ([Fig. 1A, B]). The patient was planned for a single pedicled thoraco-umbilical flap (TU flap), which could cover both the ulna and iliac crest bones, the intention was to resurface two exposed bones with a single pedicled flap of two different anatomical regions. After 3 weeks, the flap was delayed from the distal margin and bisected from the middle of flap to produce two different individual flaps to resurface both the exposed bones without any pull in the opposite direction; hence flaps were lying snugly on their respective position ([Fig. 2]). The delay to bisect the flap was done in two stages of 5 cm, 7 cm length, respectively, with an interval of 1 week. After bisecting the whole flap, the inset was given to cover both the defects without any tension ([Fig. 3A, B]). The mechanism of delay makes the flap ischemic, wherein the length to breadth ratio of the harvested flap tissue may also be increased.[2] [3] Partial inset requires a staged delay that will help in increasing the dilatation of the existing vasculature, with proliferation in the choke area;[4] also, it obtains perfusion from the recipient bed. Most of the time, the standard practice of performing delay is from the base of the flap; in our case, a TU flap with the per umbilical perforator being the main supply was elevated. The delay principle was used in bisecting the flap in the middle with an intention to increase blood supply[5] in both halves of the flap to create two different flaps. Being an electrical burn, we were skeptical to perform a microvascular flap, in view of the high rates of failure due to intimal vascular damage. Delay done from the distal margin of the flap has been described for the first time. We conclude that the principle of delay may be applied in creating two viable flaps within one distant pedicled flap, with adequate care being taken on the timing of delay, length of incision on the flap, and the area of inset given on the defect.

Application of the Locking Compression Pediatric Hip Plate™ in children with proximal femoral tumors

BackgroundPediatric proximal femoral tumors often present with accumulative and severe bone destruction and are often complicated by pathological fractures and malunion. Such tumors are treated clinically by lesion scraping and graft reconstruction with autologous iliac bone alone or in combination with artificial bone. This study aimed to determine the efficacy of the Locking Compression Pediatric Hip Plate™ in treating pediatric proximal femoral tumors.MethodsFrom 2012–2017, the Locking Compression Pediatric Hip Plate™ was applied for internal fixation in 28 children in the Department of Pediatric Surgery. The complications were pathological fractures in 19 patients and multiple lesions in 5 patients. Tumors were removed by tumor curettage and reconstruction with autogenous iliac bone or artificial bone graft. The Locking Compression Pediatric Hip Plate™ was then applied. Postoperative pathological examination confirmed the diagnosis.ResultsThe cohort comprised 20 males and 8 females (mean age 7.8 ± 2.9 years). The mean follow-up duration was 26.1 ± 8.1 months (range 18–48 months). Post-treatment radiography showed that the lesions and local pathological fractures were healed in 3.2 ± 0.4 months (range 3–4 months), with no complications. Four patients continued to receive antineoplastic therapy postoperatively. Four patients experienced recurrence in situ, while another four developed distant metastases. The radiographic and joint function findings indicated that the affected limbs had excellent function. The mean Enneking score was 28.7 ± 1.0 points (range 27–30 points).ConclusionsInternal fixation with the Locking Compression Pediatric Hip Plate™ in children achieves good therapeutic effects. Moreover, the Locking Compression Pediatric Hip Plate™ resolves the shortcomings of external fixation by traditional plaster casts and internal fixation by Kirschner wires and elastic intramedullary screws.

Primary lung sebaceous carcinoma successfully treated with radiotherapy and pembrolizumab: A case report

Sebaceous carcinoma is a rare cutaneous malignant tumor, usually occurring on the eyelids, head, neck, and trunk. There have been few reports about sebaceous carcinoma with primary lung cancer, for which optimal therapy has not yet been established. A 70-year-old man presented with a mass in the left iliac bone and tumor of the lower left lung. The morphological characteristics of the iliac bone biopsy pathology and immunostaining results showed sebaceous gland differentiation. After systemic examination, we diagnosed a primary lung sebaceous carcinoma with intrapulmonary and bone metastases. PD-L1 was positive in 1%-24% of tumor cells, and microsatellites were stable. We detected protein kinase B (AKT1) mutations using the Oncomine Dx target test. Palliative radiotherapy (RT) of a total of 45 Gy was provided in 15 fractions to the left iliac region, which resulted in a 25% reduction in the tumor size. Subsequently, four courses of first-line pembrolizumab led to a 30% reduction in the total tumor count. RT and pembrolizumab may be treatment options for certain rare primary sebaceous carcinomas of the lungs. A synergistic effect from RT and subsequent administration of immune checkpoint inhibitors may have contributed to tumor reduction.

Outcomes of free vascularized iliac bone flap for severe traumatic osteonecrosis of femoral head in young adults.

To explore the clinical and radiological effects of the free vascularized iliac bone flap (FVIBF) based on deep iliac circumflex vessels for Association Research Circulation Osseous (ARCO) stage 3 traumatic osteonecrosis of the femoral head (TONFH) in young adults. From February 2017 to August 2020, a total of 29 (29 hips) TONFH patients with ARCO stage 3 were enrolled in this study. Following the FVIBF standard procedure, the necrotic area of the femoral head was removed and a free vascularized iliac bone flap was harvested and grafted. X-rays were performed at 1, 3, 6, 9, and 12months and every 6months thereafter postoperatively for evaluation of the degree of femoral head collapse. The Beijing University of Chinese Medicine X-ray Evaluation Method (BUCMXE) was used to evaluate the hip preservation effects based on anteroposterior hip radiographs. Hip functions were evaluated using the Harris hip score (HHS) every 6months and annually after 24months, and the quality of life was assessed using the SF-36 questionnaire at 18months postoperatively. The mean follow-up time was 30months (range 12-54months). None of the patients was lost to follow-up, and the wounds healed primarily without infection and deep venous thrombosis of lower limbs. The HHS at 12months postoperatively was significantly improved than that before surgery (83.4 ± 7.4 vs. 64.8 ± 14.1; p < 0.05). The BUCMXE radiographic score at 12months postoperatively did not reveal any significant differences in femoral head morphology and osteonecrotic lesion, when compared to preoperation. The SF-36 questionnaire showed significant improvements in social functioning, role physical, bodily pain, and general health (p < 0.05). However, eight patients had varying degrees of femoral head collapse after surgery, and only one of them underwent THA due to pain and collapse aggravation. BUCMXE-Osteoarthritis scores showed that 23 hips were stable and six hips were advanced, among which five hips staged ARCO 3B and one staged ARCO 3A preoperatively, with statistically significant differences (p < 0.05). Although some patients showed no improvement of radiological outcomes, most patients with severe TONFH could still benefit from the FVIBF procedure. Further studies should attempt to improve this surgical procedure and explore its long-term efficacy.