Need For Bone Grafting Research Articles

Treatment of Aseptic Hypertrophic Nonunion of the Lower Extremity with Less Invasive Stabilization System (New Approach to Hypertrophic Nonunion Treatment)

Aim. To evaluate whether aseptic hypertrophic nonunion in the long bones of the lower extremity can be treated successfully with LISS applied with closed methods without grafting. Materials and Methods. The study included 7 tibias and 9 femurs of 16 patients. All cases had hypertrophic nonunion. Initial surgical treatment was with intramedullary nailing in 14 cases, 6 of which had required an exchange of intramedullary nail. All the patients were treated with LISS plate with closed methods. Results. Union was obtained at mean 7 months in all patients. No implant loosening or breakage of the implant was observed and there was no requirement for secondary surgery. Conclusion. Cases of hypertrophic nonunion have excellent blood supply and biological potential. Therefore, there is no need for bone grafting and the addition of fracture stability is enough to achieve full union. Using a limited approach and percutaneous screw insertion, LISS provides fracture stabilization with soft tissue protection.

Closing Verses Opening Wedge High Tibial Osteotomy: an Evidence-Based Review.

Knee osteoarthritis is a common and disabling disorder made worse by lower extremity malalignment [3]. Medial knee arthrosis is the most common indication for high tibial osteotomy (HTO). Surgical techniques include closing wedge osteotomy, opening wedge osteotomy, dome osteotomy, progressive callus distraction, and chevron osteotomy [4, 7]. Opening and closing wedge osteotomies are the most common. While lateral closing wedge HTO was once considered standard of care, both techniques have advantages and disadvantages, and neither has proven clinical superiority [3]. Technique selection, therefore, is largely driven by surgeon preference. Jackson [4] first described the closing wedge technique in the 1960s and demonstrated improvements in patient function and pain. This technique, however, is associated with fibular osteotomy or proximal tibiofibular joint release, possible peroneal nerve injury, longer rehabilitation, and a more challenging conversion to total knee arthroplasty [1, 6, 9]. Disadvantages of medial opening wedge osteotomy, on the other hand, include the possible need for bone graft, higher rates of nonunion, and the risk of collapse [9]. Reviewed here, Duivenvoorden’s article describes the mid-term follow-up on 92 patients randomized to high tibial opening wedge or closing wedge osteotomy for varus deformity and medial compartment OA. They investigated clinical and radiographic outcomes, in addition to survival rate, at a mean of 7 years postoperatively. The specific aims of this review are to (1) interpret this study’s findings and (2) to evaluate the validity of the authors’ conclusions and recommendations.

Patient Outcomes and Predictors of Success After Revision Anterior Cruciate Ligament Reconstruction.

Background:Patient outcomes and predictors of success after revision anterior cruciate ligament (ACL) reconstruction are currently limited in the literature. Existing studies either have a small study size or are difficult to interpret because of the multiple surgeons involved in the care of the study sample.Purpose:To determine patient outcomes and predictors of success or failure after a single-stage revision ACL reconstruction by a single fellowship-trained senior surgeon at a single institution.Study Design:Case series; Level of evidence, 4.Methods:A total of 78 patients who underwent revision ACL reconstruction by a single surgeon from 2010 to 2014 were contacted and available for follow-up. The mean time from revision procedure to follow-up was 52 months. Those patients who were able to participate in the study sent in a completed Tegner activity level scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and IKDC Current Health Assessment Form. The patients’ medical records were also thoroughly reviewed.Results:Five patients had subsequent failure after revision surgery. The median Tegner score was 6 at follow-up, and the mean subjective IKDC score was 72.5. There was no statistically significant difference in outcome scores when comparing revision graft type, body mass index, sex, need for bone grafting, and time from failure to revision. Patients with failures after primary ACL reconstruction secondary to a traumatic event were found to have statistically significantly higher IKDC scores (mean, 76.6) after revision when compared with nontraumatic failures (mean, 67.1), even when controlling for confounders (P < .017).Conclusion:Revision ACL reconstruction is effective in improving patient activity levels and satisfaction. However, the subjective IKDC results are quite variable and likely based on multiple factors. Patients with traumatic injuries contributing to graft failure after primary ACL reconstruction had a statistically significantly, although not clinically significant, higher IKDC score after revision surgery compared with nontraumatic failures. These data may be useful when counseling a patient on whether to pursue revision ACL reconstruction surgery.

Measurement of the zygomatic bone and pilot hole technique for safer insertion of zygomaticus implants

The zygomaticus implant was developed for patients with severe bone resorption of the posterior maxilla. These may eliminate or minimize the need for bone grafting. Although the zygomaticus implant has shown a remarkable success rate in this difficult-to-treat patient population, the method requires an advanced surgical technique and carries an increased risk of complications. There have been few anatomical studies on the zygomatic bone in relation to the insertion of zygomaticus implants. The height and thickness of the zygomatic bone for the insertion were measured in this study. The thickness at the 90° angle point, where the upper margin of the zygomatic arch and the temporal margin of the frontal process of the zygomatic bone intersect and where the apex of the implant penetrates, was found to be 1.8±0.4mm; this gradually increased inferiorly and anteriorly. Thus, the penetration point of the apex of the zygomaticus implant should be located more inferoanterior to the 90° angle point, as the thickness in this region is thinner than the diameter of the implant. Based on the results of this study, a newer and safer insertion method for the zygomaticus implant using a drill guide is proposed.

Compressive fatigue and fracture toughness behavior of injectable, settable bone cements

Bone grafts used to repair weight-bearing tibial plateau fractures often experience cyclic loading, and there is a need for bone graft substitutes that prevent failure of fixation and subsequent morbidity. However, the specific mechanical properties required for resorbable grafts to optimize structural compatibility with native bone have yet to be established. While quasi-static tests are utilized to assess weight-bearing ability, compressive strength alone is a poor indicator of in vivo performance. In the present study, we investigated the effects of interfacial bonding on material properties under conditions that re-capitulate the cyclic loading associated with weight-bearing fractures. Dynamic compressive fatigue properties of polyurethane (PUR) composites made with either unmodified (U-) or polycaprolactone surface-modified (PCL-) 45S5 bioactive glass (BG) particles were compared to a commercially available calcium sulfate and phosphate-based (CaS/P) bone cement at physiologically relevant stresses (5–30MPa). Fatigue resistance of PCL–BG/polymer composite was superior to that of the U-BG/polymer composite and the CaS/P cement at higher stress levels for each of the fatigue failure criteria, related to modulus, creep, and maximum displacement, and was comparable to human trabecular bone. Steady state creep and damage accumulation occurred during the fatigue life of the PCL–BG/polymer and CaS/P cement, whereas creep of U-BG/polymer primarily occurred at a low number of loading cycles. From crack propagation testing, fracture toughness or resistance to crack growth was significantly higher for the PCL–BG composite than for the other materials. Finally, the fatigue and fracture toughness properties were intermediate between those of trabecular and cortical bone. These findings highlight the potential of PCL–BG/polyurethane composites as weight-bearing bone grafts.

Management of hypertrophic nonunion with failure of internal fixation by distraction osteogenesis

Introduction and aimDistraction osteogenesis is employed in the management of hypertrophic nonunion associated with angular deformity and shortening. This study was aimed at evaluating the outcomes of Ilizarov apparatus without bone graft or open osteotomy in cases of hypertrophic nonunion not responding to treatment with internal fixation. MethodsWe retrospectively reviewed the data of 12 patients (mean age, 46.5 years) treated for hypertrophic nonunion at our institution. All patients had two-plane angular deformities (mean, 19° and 23.5° in sagittal and frontal plane, respectively) and limb-length discrepancy (mean, 3.8cm). The Ilizarov apparatus was used to simultaneously treat the nonunion, malalignment, and limb-length discrepancy. ResultsThe mean follow-up duration after the removal of the apparatus was 42 months. In all cases, bone union had been achieved within an average of 8 months after a single surgery, without the need for any additional procedure. Additionally, none of the patients had recurrence of limb-length discrepancy or malalignment during the follow-up period. Complications of superficial pin-tract infections and mild Achilles tendon contracture were observed, but they resolved over time. All patients were satisfied with the outcome of the surgery. ConclusionPatients with hypertrophic nonunion associated with internal fixation failure can be treated by using the Ilizarov apparatus, thereby eliminating the need for bone graft or open osteotomy. Distraction osteogenesis appears to be effective as a minimally invasive percutaneous procedure in the treatment of hypertrophic nonunion with deformity and shortening.

A preclinical large animal study on a novel intervertebral fusion cage covered with high porosity titanium sheets with a triple pore structure used for spinal fusion.

To evaluate the osteoconductivity and the bonding strength of the newly developed interbody cage covered with the porous titanium sheet (porous Ti cage) to vertebral bodies in a sheep model. Twelve sheep underwent anterior lumbar interbody fusion at L2-3 and L4-5 using either the new porous Ti cages (Group-P) or conventional Ti cages with autogenous iliac bone (Group-C). The animals were euthanized at 2 or 4 months postoperatively and subjected to radiological, biomechanical, and histological examinations. Computed tomography analyses showed that the ratio of bone contact area in Group-P was significantly increased at 4 months compared with that at 2 months (p = 0.01). Although the ratio of bone contact area in Group-C was significantly higher than Group-P at 2 months (p < 0.001), there was no statistically significant difference between the two groups at 4 months. Biomechanical test showed that there was no significant difference in bonding strength between the two groups at either 2 or 4 months. Histological analyses revealed that the bone apposition ratio increased significantly with time in Group-P (p < 0.001). Although Group-C showed significantly higher bone apposition ratio than Group-P at 2 months (p = 0.001), there was no statistical difference between the two groups at 4 months. There was bone ingrowth into the porous Ti sheet, and bonding capacity of the porous Ti cage to the host bone increased with time. However, the speed of union to the bone with a porous Ti cage was marginally lower than a conventional cage along with an autogenous bone graft. Although it needs further experiment with a larger sample size, the results of the current study suggested that this material could achieve interbody fusion without the need for bone grafts.

Distal radius fractures: Should we use supplemental bone grafts or substitutes in cases of severe osteoporotic or comminution?

ObjectivesThe purpose of this study was to assess the need of bone graft or bone substitutes in unstable distal radius fractures (DRF) treated with locking compression plates (LCP). Patients and methodsAn observational and prospective study was conducted on 60 patients with DRF AO-type A3 and AO-type C3, treated surgically by LCP plates without bone grafts or substitutes. Ranges of motion in flexion (F), extension (E), pronation (P), and supination (S) were measured in the injured wrist and compared with the healthy contralateral wrist. X-ray parameters: palmar tilt (PT), radial inclination (RI), ulnar variance (UV), and radial height (RH) were calculated in the injured wrist one year after surgery and then compared, with those parameters in the healthy contralateral wrist and in the follow-up postoperative X-ray of the injured wrist. PRWE and DASH scores were used to evaluate patient satisfaction. ResultsThe range of motion loss was F 12°±16.1°, E 9°±13.1°, P 2.5°±7.5°, and S 5°±10°, but they remained within functional parameters. Good results were also obtained in the PRWE and DASH scores (DASH 12.6±14.16 and PRWE 9.5±9.5). All the fractures were healed without significant collapse (IP 0.55±1.7°, IR 0.31±1.5°, VC 0.25±0.8mm, and AR 0.1±0.9mm). ConclusionsAll fractures healed without problems or with significant loss of reduction. Bone graft and bone substitutes are not mandatory for treatment of unstable DRF with LCP plates. Their use increases the cost and is not exempt of morbidities. This study also reinforces the role of LCP plates in surgical treatment of unstable DRF.

Three-dimensional computed tomographic evaluation of Le Fort III distraction osteogenesis with an external device in syndromic craniosynostosis

There is little anteroposterior growth of the midface in patients with syndromic craniosynostosis who are followed up over time without intervention. A Le Fort III with distraction osteogenesis can be done to correct this. This is a controlled way in which to achieve appreciable stable advancement of the midface without the need for bone grafting, but the vector of the movement is not always predictable. The purpose of this study was to evaluate the 3-dimensional effect of Le Fort III distraction osteogenesis with an external frame. Ten patients (aged 7–19 years) who had the procedure were included in the study. The le Fort III procedure and the placement of the external frame were followed by an activation period and then a 3-month retention period. Computed tomographic (CT) images taken before and after operation were converted and loaded into 3-dimensional image rendering software and compared with the aid of a paired sample t test and a colour-coded qualitative analysis. Comparison of the CT data before and after distraction indicated that the amount of midface advancement was significant. Le Fort III distraction osteogenesis is an effective way to advance the midface. However, the movement during osteogenesis is not always exactly in the intended direction, and a secondary operation is often necessary. Three-dimensional evaluation over a longer period of time is necessary.

The Success Rate of Implants Placed in Reconstructed Alveolar Ridges Using Iliac Bone Graft Compared to Non-augmented Jaw

Aim: This study is aimed to investigate the success rate and clinical outcome of placed implants in reconstructed alveolar ridges using iliac cortico-cancellus bone graft compared to normal nonaugmented alveolar ridge. Materials and Methods: In this clinical trial study, 30 patients who were selected and assigned in case and control groups. The case group included patients with severe alveolar bone loss, who needed bone grafting. The control group included patients with sufficient alveolar ridge and no Original Research Article Attar et al.; BJMMR, 9(2): 1-7, 2015; Article no.BJMMR.18216 2 need for bone grafting. The prosthesis was placed on implants after 3 to 8 months. Plaque index, bleeding, pocket depth, mobility, pain, pus secretion and bone loss were evaluated after 24 month. Data were analyzed by SPSS 13. P-value less than 0.05 was considered as significant. Results: Out of 30 patients, two were excluded due to their requirements. Totally 97 implants were placed in patients, which included 52 implants in control group and 45 implants in case group. All of the implants were successfully osseointegrated and loaded. There was no significant difference between the success of inserted implants between both groups (P=0.05). The mesial and distal bone losses were significantly more in patients without iliac bone graft (P=0.05). There was no statistically significant difference between measured outcomes including plaque, bleeding, pocket depth, mobility, pain, and pus secretion (P=0.05). Conclusion: Inserted implant in free non-vascularized iliac bone graft has high rate of success comapred to non-augmented alveolar ridges and has shown to be a reliable method for reconstruction of severe atrophic jaws.

Minimally invasive plate osteosynthesis for the treatment of high-energy tibial shaft fractures

Background The most notable change in the treatment of fractures has been the shift from the mechanical aspects of internal fixation with absolute stability and primary bone union as the goal to the biological aspects of internal fixation with relative stability and healing with callus as the preferred method, with a huge focus on preservation of the blood supply of bone and soft tissue to ensure the continued vitality of the individual fragments to improve fracture healing. Percutaneous plate fixation minimizes soft tissue compromise with decreased incidence of wound breakdown and deep infection. It also preserves the vascularity of the bone fragments, and thus reduces the time for union, decreases the need for bone grafting even in comminuted fractures, and also decreases the incidence of nonunion, which requires a second major open intervention. Aim The aim of this study was to evaluate the outcome of minimally invasive plate osteosynthesis for the treatment of high-energy tibial shaft (upper and middle thirds) fractures in adults using conventional nonlocked plates through the medial approach. Patients and methods This prospective study included 16 adult male patients who had high-energy closed tibial shaft fractures (upper and middle thirds) with varying degrees of displacement and comminution. All patients were evaluated clinically and radiologically before and after surgery, followed up for a mean time of 14 months postoperatively, and evaluated radiologically and functionally according to the Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system. All patients were treated using conventional nonlocked plates inserted percutaneously on the medial surface of the tibia. Results All the fractures united with a mean union time of 16.2 weeks, ranging from 13 to 36 weeks. Clinical and radiological outcomes according to the ASAMI scoring system in this study showed excellent results in 14 patients, representing 87.5% of the studied group, and good results in two patients, representing 12.5% of the studied group. No neurovascular complications, no persistent limitation of the knee or ankle motions, no deep wound infection, and no implant failure occurred in any of the patients until the last follow-up, and none of the patients required a second major open intervention. Conclusion The minimally invasive percutaneous plate fixation technique is an effective method of stabilization for closed tibial shaft fractures, yielding good bone alignment and protecting soft tissues, leading to higher union rates with good functional outcome. The use of conventional nonlocked plates applied through the medial approach decreases the surgical time and the risk of postoperative compartmental syndrome.

The ‘Downsliding’ Osteotomy

Vertical ‘down grafting’ of the maxilla is routinely performed using orthotopic bone graft or heterotopic donor bone products. It is well documented that with this approach, bone grafting does not always result in a favorable stable outcome as relapse commences before complete integration of the graft.1 We wish to highlight the ‘down sliding’ osteotomy, first described by Reyneke in 1985,2 which allows anterior and inferior movement of the maxilla after a ‘z’ shaped Le Fort 1 osteotomy is performed. Bony contact is preserved at the medial pyriform and lateral maxillary buttresses as the maxilla displaces down a sloping plane, thereby obviating the need for bone grafting. We demonstrate how to decide whether a patient is suitable for this technique by utilizing Visual Treatment Objective Schematics prior to the commencement of pre-surgical orthodontics. The ‘down sliding’ osteotomy is straightforward and reliable technique. It avoids the necessity of a donor surgical site, thereby minimizing operating time and hospital stay. We believe that the ‘down sliding’ osteotomy is a highly cost-effective yet under-used surgical technique which should be contemplated for suitable cases.

Management of fractures of the distal third tibia by minimally invasive plate osteosynthesis - A prospective series of 50 patients.

Minimally invasive plate osteosynthesis (MIPO) is an established technique for fixation of fractures of the distal third tibia. Our study aimed to manage intra articular and extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications & efficacy of the procedure reviewed. Though many studies on the subject have been done previously, these have been retrospective reviews or small series. From May 2010 to May 2013, 50 patients of closed distal tibial fractures were operated by MIPO technique with a distal tibial anatomical locking plate having 4.5/5 proximal and 3.5/4 distal screw holes. The follow up duration was for 3 years. The mean fracture healing time was 21.4 weeks (range 16-32 weeks) and average AOFAS score 95.06 was out of a total possible 100 points. At last follow up, superficial infection occurred in 5 patients (10%); deep infection, implant failure and malunion in 1-patient each (2%). MIPO technique provides good, though slightly delayed bone healing and decreases incidence of nonunion and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminuted fractures and in fractures with intra-articular extension.

Fracturas de radio distal: ¿es necesario el aporte de injerto o sustitutivo óseo en los casos con osteoporosis o conminución severa?

ObjectivesThe purpose of this study was to assess the need of bone graft or bone substitutes in unstable distal radius fractures (DRF) treated with locking compression plates (LCP) Patients and MethodsAn observational and prospective study was conducted on 60 patients with DRF AO-type A3 and AO-type C3, treated surgically by LCP plates without bone grafts or substitutes. Ranges of motion in flexion (F), extension (E), pronation (P), and supination (S) were measured in the injured wrist and compared with the healthy contralateral wrist. X-ray parameters: palmar tilt (PT), radial inclination (RI), ulnar variance (UV), and radial height (RH) were calculated in the injured wrist one year after surgery and then compared, with those parameters in the healthy contralateral wrist and in the follow-up postoperative x-ray of the injured wrist. PRWE and DASH scores were used to evaluate patient satisfaction. ResultsThe range of motion loss was F 12°±16.1°, E 9°±13.1°, P 2.5°±7.5°, and S 5°±10°, but they remained within functional parameters. Good results were also obtained in the PRWE and DASH scores (DASH 12.6±14.16 and PRWE 9.5±9.5). All the fractures were healed without significant collapse (IP 0.55±1.7°, IR 0.31±1.5°, VC 0.25±0.8mm, and AR 0.1±0.9mm). ConclusionsAll fractures healed without problems or with significant loss of reduction. Bone graft and bone substitutes are not mandatory for treatment of unstable DRF with LCP plates. Their use increases the cost and is not exempt of morbidities. This study also reinforces the role of LCP plates in surgical treatment of unstable DRF.

Blade-plate fixation for distal femoral fractures: A case-control study

BackgroundThe blade-plate is the earliest of the contemporary internal fixation devices introduced for distal femoral fractures. The recent development of dedicated, fixation devices has considerably limited its use. The objective of this study was to evaluate outcomes after blade-plate fixation and after fixation using other devices. HypothesisOutcomes after blade-plate fixation are similar to those after condylar screw-plate, distal femoral nail, or locking condylar plate fixation. Material and methodsWe reviewed outcomes after 62 patients managed with blade-plate fixation and included in a multicentre retrospective study (n=57) or a multicentre prospective study (n=5) and we compared them to outcomes after fixation using condylar screw-plates (n=82), distal femoral nail (n=219), or locking condylar plates (n=301). The four groups were comparable for age, gender distribution, occupational status, prevalence of skin wounds, patient-related factors, type of accident, and type of fracture. The evaluation relied on the clinical International Knee Society (IKS) score and on radiographs. ResultsNo significant differences existed across the four groups for operative time, blood transfusion use, complications, need for bone grafting, non-union rate, or IKS score values. The early surgical revision rate for removal of the fixation material was 4% with the blade-plate and 16% with the other three fixation devices (P=0.02). Post-operative fracture deformity was similar in the four groups with, however, a higher proportion of residual malalignment in the screw-fixation group. The final anatomic axis was 3.3±1.4° with the blade-plate versus 2.3±3.7° with the other three fixation devices. The blade-plate group had few patients with axial malalignment, and the degree of malalignment was limited to 3° of varus and 10° of valgus at the most, compared to 10° and 18° respectively, with the other three fixation devices. ConclusionDespite the now extremely limited use and teaching of blade-plate fixation, as well as the undeniable technical challenges raised by the implantation of this device, the blade-plate is a simple, strong, and inexpensive fixation method. It remains reliable for the fixation of distal femoral fractures. The disfavour into which the blade-plate is currently falling is not warranted. Level of evidenceIII, case-control study.

The ‘Downsliding’ Osteotomy; Highlighting an Underused Surgical Technique to Manage Vertical Maxillary Deficiency

Vertical ‘down grafting’ of the maxilla is routinely performed using orthotopic bone graft or heterotopic donor bone products. It is well documented that with this approach, bone grafting does not always result in a favorable stable outcome as relapse commences before complete integration of the graft. We wish to highlight the ‘down sliding’ osteotomy, first described by Reyneke in 1985, which allows anterior and inferior movement of the maxilla after a ‘z’ shaped Le Fort 1 osteotomy is performed. Bony contact is preserved at the medial pyriform and lateral maxillary buttresses as the maxilla displaces down a sloping plane, thereby obviating the need for bone grafting. We demonstrate how to decide whether a patient is suitable for this technique by utilizing Visual Treatment Objective Schematics prior to the commencement of pre-surgical orthodontics.

Narrow-Diameter versus Standard-Diameter Implants and Their Effect on the Need for Guided Bone Regeneration: A Virtual Three-Dimensional Study.

Narrow-diameter implants (NDIs) are proven treatment options for completely edentulous patients with severely resorbed alveolar ridges. The aim of this study was to evaluate virtually whether or not the implant diameter affects the need for ridge augmentation in edentulous patients, using a 3D planning software program. Existing cone beam CT scans of 200 outpatients (100 maxillae, 100 mandibles) were selected, and treatment was planned in a virtual 3D planning software program with either 3.3 mm-diameter implants (test group) or 4.1 mm-diameter implants (control group). Statistical analysis was performed. A total of 1,760 implants were virtually planned (880 implants each for test and control groups). Overall, significantly associated with the absence or need for ridge augmentation as compared with need for ridge augmentation (p < .0001). Use of the 3.3 mm-diameter implants increased the odds ratio for ridge augmentation being unnecessary by 2.2 (95% confidence interval) relative to the 4.1 mm-diameter implants. Use of NDIs was able to provide a statistically significant reduction in need for bone grafting among completely edentulous patients. More clinical longitudinal studies are necessary to confirm the long-term success of their use.

Managing Spondylotic Cervical Myeloradiculopathy Using Oblique Cervical Corpectomy

IntroductionThe technique of oblique cervical corpectomy describes preservation of significant portion of the anterior and lateral aspects of the vertebral body.1 In 1999, Ozer et al described a te...

Revision of unicompartmental knee arthroplasty: implants used and causes of failure

Objectiveto determine the causes of unicondylar knee arthroplasty failures, as well as identify the implants used and the need of bone grafting in patients undergoing revision UKA in Center of Knee Surgery at the Instituto Nacional de Traumatologia e Ortopedia (INTO) in the period between January 1990 and January 2013. Methodsa retrospective analysis of the medical documentation and imaging, determining the cause of failure of UKA and the time of its occurrence, as well as prosthetic components implanted during the review and the need for bone grafting. Resultsin this study, 27 UKA failures in 26 patients were included. Collapse of one or more components was the main cause of failure, occurring in 33% of patients. Aseptic failure was identified in 30% of cases, progression of osteoarthrosis in 15%, infection and pain 7% each, and osteolysis and polyethylene failure in 4% each. Early failure occurred in 41% of all revisions of UKA and late failure in 59%. 23 patients have undergone revision of UK. Conclusionin 35% of revisions the use of bone grafting was needed in tibial area; in 3 cases we needed allograft from Tissue Bank. We did not use metal increase in any of the revision. In one patient we used implant constraint for instability.

Posterior Minimally Invasive Plate Osteosynthesis for Humeral Shaft Fractures

Fractures of the humeral shaft are common. Most of them can be successfully treated without surgery. In some cases, an operative intervention may offer faster and better functional results. One of the major problems with the open plating osteosynthesis is the extensive soft tissue stripping and disruption of periosteal circulation, caused by extensive surgical exposure, resulting in a relatively high rate of nonunion. Minimally invasive plate osteosynthesis (MIPO) techniques were developed to achieve a biologic fixation, although minimizing the complications of an open reduction. The incisions are small and remote from the fracture site to avoid direct fracture exposure. Thereby, MIPO technique obtains, theoretically, higher rates of union, lower infection risk, and decreases the need for bone graft. In the last years, MIPO has gained popularity with satisfactory clinical outcomes in the treatment of long bone fractures, especially in lower extremity. MIPO for humeral shaft fractures, however, could be a surgically dangerous procedure because of the risk of radial nerve injury. It was described by anterior and lateral approach. Humeral middle shaft fractures are possible to treat with a MIPO technique through an anterior, lateral, or a posterior approach. However, when the fracture is near the olecranon fossa, anterior approach is not possible as there is not enough space in the distal fragment to insert the amount of screws required to achieve stability. In this case, the posterior approach may be a good option for treatment. This article describes the MIPO technique through a posterior approach for the treatment of humeral shaft fractures.