Proximal Tibial Bone Graft Research Articles

The Use of Tibial Autogenous Cancellous Bone for Late Secondary Alveolar Bone Grafting in Cleft Patients: A Prospective Study.

To evaluate the management of alveolar cleft defects with proximal tibia bone grafts by late secondary alveolar bone grafting. Fifteen patients were studied, nine males and six females within age range of 21-32years. All the patients were treated with cancellous portion of the proximal tibial bone graft, harvested through the medial approach. Intraoperatively, sufficient amount of bone was harvested which ranged from 19 to 24ccs (mean 20.7 ccs). In two patients, moderate bleeding had occurred, whereas in remaining patients, mild bleeding was observed. Operative time ranged between 1.25 and 1.50h (mean 1.36h). Infection was reported in one patient (7%), which resolved by the end of one and a half months. Complete elimination of the oronasal fistula was achieved in all cases. Neurosensory disturbance (parasthesia) at the donor site was observed in two patients (13%) from the first postoperative week and subsided within 8 months. Gait disturbance was not reported in any of the cases. However, in two patients (13%), intermittent pain during daily activities remained for more than 2months, which completely resolved by the end of the third month. Tibial graft is a reliable donor site option for grafting in cleft alveolus for which the advantage being minimal donor site morbidity. The resorption rate of the graft is also minimal in the present study.

A biomechanical study of proximal tibia bone grafting through the lateral approach

BackgroundAutologous bone graft remains the gold standard source of bone graft. Iliac crest has traditionally been the most popular source for autologous bone graft. However, iliac crest bone graft harvesting is associated with high donor site morbidity. Bone graft harvesting from the proximal tibia has shown great potential with reported low complication rates. However, there is a paucity of biomechanical studies concerning the safety as well as yield of proximal bone graft harvesting. PurposeThis biomechanical study was designed to investigate (1) the stability of the harvested proximal tibial during physiological loading, and (2) the maximum size of the cortical window that can be safely created and (3) volume of accessible bone graft. MethodsBone grafts were harvested from eleven cadaveric tibiae using a circular cortical window along the lateral proximal tibia. These harvested proximal tibiae were then loaded under physiological conditions (mean 2320N, range 1650–3120N) using a customized test fixture. Strain rosettes were mounted at 7 locations in the harvested proximal tibia to record the changes in strain at the harvested proximal tibia. The change in strain with increasing cortical window size (10–25mm diameter) was also studied. Bone principal strains as well as volume of bone harvested were recorded. ResultsA repeated measures ANOVA was used to analyze the change in bone strains with the cortical window size. Statistically significant (p<0.05) increases in bone strains at the anterior and medial aspects of the tibia were observed with increasing size of osteotomies (−328.85με, SD=232.21 to −964.78με, SD=535.89 and 361.64με, SD=229.90 to −486.08με, SD=270.40 respectively), and marginally significant changes in strain at the lateral and posterior aspects. None of the tibiae failed under normal walking loads even with increasing osteotomies size of 10–25 mm diameter. A smaller osteotomy of 10mm diameter yielded an average volume of 7.15ml of compressed bone graft, while a larger osteotomy of 25mm diameter yielded on average an additional 3.64ml of bone graft. Bone grafting of the proximal tibia through the lateral approach with a circular osteotomy is a feasible option even with osteotomies of 25mm diameter. Even though increased bone strains were observed, the strains did not exceed the yield strain of cortical bone when loaded under normal walking conditions. The quantity of bone harvested from the proximal tibia is comparable to that harvested from the iliac crest. ConclusionsThis biomechanical study demonstrated the stability of the harvested proximal tibia under conditions of full weight bearing ambulation. It has also refined the technique of proximal bone graft harvesting by determining the maximum size of the cortical window. The findings of this study add to the overall understanding of proximal tibial bone graft harvesting, providing objective data regarding stability as well as yield. This information would be useful during selection of source of autologous bone graft.

Tibial Bone Grafting for Wrist Reconstruction.

Background Iliac crest bone graft harvesting is routinely performed for upper extremity orthopedic procedures despite high complication rates associated with sensory nerve injury, hematoma, chronic pain, and fracture. Description of Technique Cancellous bone graft is harvested from the proximal tibia using a medial approach, minimizing donor site morbidity. Patients and Methods A retrospective review was undertaken of 14 patients who underwent cancellous proximal tibia bone graft harvesting to augment healing of wrist reconstruction, with 2 months minimum follow-up. We report donor limb tourniquet time, time to union, visual analog scale (VAS) pain score, and complications. Patients were also contacted by phone to administer a retrospective questionnaire and record experiences with the harvesting technique. Results Average donor site VAS for the immediate postoperative period was 7.4. Average tourniquet time was 28 minutes. Average time to union of the recipient site was 45 days. One patient experienced delayed union after corrective osteotomy, attributed to osteoporosis. Two patients underwent hardware removal from the operative wrist, unrelated to bone graft harvesting. One patient with a history of chronic neuropathy and foot drop developed dysesthesia and allodynia about the ipsilateral ankle, but was asymptomatic at the proximal tibia donor site; ankle symptoms resolved 3 weeks postoperatively. No patient reported any residual donor site difficulties 24.2 months postoperatively. Conclusion In consideration of the minimal complication rate, favorable clinical parameters, and excellent patient tolerance, we advocate proximal tibia bone graft harvesting as opposed to iliac crest harvesting for wrist reconstruction when a moderate amount of autogenous cancellous graft is needed. Level of Evidence IV.

Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery

ABSTRACT Cancellous bone graft harvesting from proximal tibia is usually by a lateral approach. We describe our technique and results in harvesting proximal tibia bone graft by a medial approach in foot and ankle surgery. Our results confirm that medial proximal tibial bone graft harvesting is a relatively safe and easy procedure to obtain adequate amount of autogenous cancellous bone graft. Donor site morbidity was found to be very low and fusion rate was found to be excellent in a variety of foot and ankle surgeries. How to cite this article Dalal R, Sugathan HK, Rachha R. Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):6-9.

Proximal Tibia Bone Graft: An alternative Donor Source especially for Foot and Ankle Procedures.

Bone graft is essential in various orthopaedic procedures. Among the many donor sites for harvesting autologous bone graft, the iliac crest has been the most commonly used. However, for foot and ankle procedures the proximal tibia has gained popularity as an alternative donor site due to its anatomic proximity to the primary surgical site. In this article we evaluated the possible complications associated with harvesting proximal tibia bone graft. Our study showed the low incidence of morbidity in harvesting proximal tibia bone graft, thereby providing a good alternative donor for foot and ankle procedures.

Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery

ABSTRACT Cancellous bone graft harvesting from proximal tibia is usually by a lateral approach. We describe our technique and results in harvesting proximal tibia bone graft by a medial approach in foot and ankle surgery. Our results confirm that medial proximal tibial bone graft harvesting is a relatively safe and easy procedure to obtain adequate amount of autogenous cancellous bone graft. Donor site morbidity was found to be very low and fusion rate was found to be excellent in a variety of foot and ankle surgeries. How to cite this article Dalal R, Sugathan HK, Rachha R. Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery. J Foot Ankle Surg (Asia-Pacific) 2015;2(1):27-30.

Autogenous Cancellous Bone Graft Harvested from Proximal Tibia in Foot and Ankle Surgery

Purpose: The aim of this study was to evaluate clinical availability and advantage of autogenous cancellous bone graft from proximal tibia metaphysis. Materials and Methods: A retrospective review was conducted of 58 cases of foot and ankle surgeries using bone graft from the ipsilateral proximal tibia from August 2008 to March 2012 in Konkuk University Medical Center (Seoul, Korea). The group included patients with isolated reconstructions as well as trauma in the foot and ankle area. Results: The mean volume of cancellous bone harvested from the proximal tibia was 14 ml (range, 5 to 28 ml) and allograft was added to the autogenous bone graft in order to fill the large bone defect for six cases. The bone graft was performed for 41 arthrodesises, seven supramalleolar tibial osteotomies, eight open reduction and internal fixation procedures, and two curettage and bone grafts of bone tumor. At final follow-up, one case (1.7%) showed mild pain on the donor site and the mean visual analogue scale score for pain was 0.1 (range, 0 to 2). There was no occurrence of major post-operative complication at the donor site. Solid union at final follow-up was observed in 97% of cases. Conclusion: Proximal tibial bone graft was found to be a viable alternative to the iliac crest bone graft in the aspect of cancellous bone graft with relatively sufficient quantity and minimal donor site morbidity.

Proximal tibial bone graft: the volume of cancellous bone, and strength of decancellated tibias by the medial approach

This study aimed to assess the volume of cancellous bone harvested by the medial approach from proximal tibia and compare the maximal compressive strength of decancellated tibias with intact tibias. Twelve cadavers were studied (11 male; 1 female). Cadavers with a history of bone disease and female cadavers over 60 years of age were excluded. Cancellous bone was taken from the right proximal tibia by the medial approach. Non-compressed and compressed cancellous bone volume was measured. Maximal compressive strength of decancellated tibias and intact tibias was measured and compared. The mean volume of bone harvested was 14.58±3.30ml with the non-compress technique (range 10.5–19.5ml) and 6.62±1.60ml (range 4.0–9.2ml) with the compress technique. There was no significant difference between the maximal compressive strength of the decancellated tibias and the intact tibias (P=0.085). Sufficient volume of cancellous bone for bone grafting in the oral maxillofacial surgery region can be harvested from the proximal tibia by the medial approach. The strength of decancellated tibias and intact tibias after harvesting cancellous bone graft were not different.

Maxillary Sinus Augmentation With Autogenous Tibial Bone Graft as an In-Office Procedure

This retrospective study evaluates the efficacy of maxillary sinus grafting using autologous tibial bone in an outpatient setting. Twenty-seven patients undergoing lateral proximal tibial bone graft with subsequent sinus lifts were involved in this study. All surgeries were performed by the same surgeon in a private practice setting. A total of 28 tibial bone grafts and sinus lifts were performed on 27 patients. All subjects had minimal morbidity without any major complications. At the 1-year follow-up all implants that were placed into the grafted sites maintained stability, and no implants were lost. Two patients complained of hypertrophic scars at the site of bone harvesting (7.4%). One patient complained of leg pain for 10 weeks after the procedure, which resolved completely (2.7%). Overall complication rate was 10.1%. We conclude that the surgical harvesting of proximal tibial bone is associated with a low incidence of overall complications, mild postoperative pain, relative ease of harvest, minimal operative time, immediate ambulation, and rapid recovery, which make it an ideal office procedure when a significant amount of corticocancellous bone is required for maxillary sinus grafting.

Proximal Tibial Bone Harvesting Under Local Anesthesia Without Intravenous Sedation in the Dental Office: A Case Report

Maxillary sinus enlargement often occurs in the maxillary posterior edentulous area and reduces the available bone height for implantation. Therefore, maxillary sinus lift and bone graft procedures are necessary to provide sufficient available bone. Autogenous bone grafting is the best base for implant osseointegration. Recently, tibial bone has been recognized as an alternative extraoral donor site. We present a case in which we used a proximal tibia bone graft for maxillary sinus augmentation under local anesthesia without sedation in the dental office. During a 4-year postoperative follow-up, gait was not disturbed and the scar on the donor site remained unremarkable.

The results of utilizing proximal tibial bone graft in reconstructive procedures of the foot and ankle

The proximal tibia is becoming a popular site for harvesting autogenous bone graft. Reports on the use of the proximal tibia for bone graft have focused on donor-site morbidity. The purpose of this study is to determine the clinical rate of bony healing following the use of proximal tibial bone graft in foot and ankle procedures. This study is a retrospective review of consecutive patients who underwent proximal tibial bone grafting as an adjunct to a foot and ankle reconstructive procedure. Patients undergoing this combination of procedures at a single institution over a 2-year period were eligible for inclusion. There were no fractures of the donor site or need to prolong non-weightbearing status beyond that required for the primary operation. Twenty-three of the 25 arthrodesis procedures healed completely. Three fracture cases also healed completely. Our findings expand on prior studies by demonstrating the efficacy of proximal tibia bone graft in achieving bony healing in foot and ankle procedures with a union rate of 93%.

Covering of the Toes During Hindfoot and Ankle Surgery: A Randomized, Controlled, Clinical Study

Major advances in sterility over the last 140 years have dramatically reduced the rates of infection. The purpose of this study was to determine whether there was benefit to covering the toes during hindfoot or ankle surgery. Forty consecutive hindfoot or ankle surgery patients were randomly assigned to one of two groups based on whether the toes were covered with a sterile glove or left uncovered. Three cultures were taken of the foot in the second web space. The first sample was taken before surgical preparation. The second sample was taken immediately after draping of the patient. The third sample was taken at the conclusion of the operation before dressing placement. The culture swab was moistened before sampling with sterile saline. The operative extremity was scrubbed with chlorhexidine gluconate and sterile water solution, followed by painting with 70% isopropyl alcohol. Before surgery, the patients were assigned to one of the two groups (covered or uncovered toes) on a random basis. A sterile size 6-1/2 glove was placed over the toes of the covered group and left in place until final wound closure. All patients received the same perioperative intravenous antibiotics. Thirty-five of 40 patients (87.5%) had positive cultures before the surgical preparation. One patient had a positive culture at the conclusion of the procedure but not immediately after the surgical preparation, and the toes were covered during the operation. Cultures before and after the procedure contained coagulase negative staphylococcus species. This patient did not develop any wound infection during the followup period. A second patient had positive cultures on all three samples. The species was coagulase positive staphylococcus. This patient did not have any wound infection problems postoperatively, although he was placed on prophylactic antibiotics 8 weeks after the initial surgery for a hardware removal procedure. The toes were not covered during the initial operation in this patient. In total, 10 patients were placed on antibiotics after the initial surgery. Three patients had erythema surrounding the incision, two patients had delayed wound healing, and one patient had erythema at the knee from a proximal tibial bone graft harvest site. The other four patients who received antibiotics had a hardware removal procedure within the 90-day followup period and received prophylactic antibiotics for that procedure. The results of this study indicate no benefits in covering the toes in hindfoot or ankle surgery after skin preparation with chlorhexidine gluconate and isopropyl alcohol. There were only two positive postoperative cultures and neither patient showed any signs of postoperative wound infection during the followup period.

Donor site morbidity after harvesting of proximal tibia bone

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

Tibia Bone Graft in the Alveolar Cleft: Case Report

The congenital defects of cleft lip and palate are the most common facial deformity. This deformity usually was combined with alveolar cleft. The lack of alveolar continuity, it can affect maxillary growth, eruption of permanent teeth, and results in feeding problems or speech disorders. Autogenous bone grafts have been used to restore alveolar continuity, which is an extremely important to reconstruct the integrity of maxilla. Here we report a case of bilateral cleft lip and palate. She had received surgical repair for cleft lip and palate at her childhood. But she had not sought autogenous bone grafting for alveolar cleft. We harvested the proximal tibia bone grafts to repair the alveolar cleft. The procedure for proximal tibia bone graft is easy, has less operative risk, and result in a lower postoperative morbidity rate.

Harvesting of Autogenous Cancellous Bone Graft from the

A study was undertaken to review the results of donor site morbidity of cancellous bone grafts obtained from the proximal tibial metaphysis. Two hundred six patients who underwent 230 proximal tibial bone graft harvestings were reviewed. Patients with lower-extremity fractures or nonunions who required cancellous bone grafts and would be non-weight-bearing for at least 6 weeks were selected to undergo the procedure. Minimum length of follow-up was 4 months, with an average length of follow up of 20.4 months. The proximal tibial metaphysis was found to supply an adequate amount of graft for all procedures involved, with a complication rate related to graft donor site of 1.3%. This compares favorably to a previously published report on bone grafts taken primarily from the iliac crest. The postoperative appearance of the proximal tibia may be permanently altered by the procedure, but weight-bearing after 6 weeks appears safe. The proximal tibial metaphysis is a useful site for obtaining cancellous bone graft and is associated with a low morbidity.