Strip Of Bone Research Articles

Viability and osteogenicity of bone graft coated with methylmethacrylate cement.

The idea of utilizing bone grafts during hip arthroplasty has been discussed in the literature and clinical successes have been indicated. These communications, however, did not relate to long-term results. Thus, to date, we still lack sufficient understanding as to the fate of bone grafts when they are coated with methylmethacrylate. In order to elucidate the above issue further an experimental study has recently been initiated in an attempt to provide answers to the following questions: a) do bone grafts remain viable when they are held in place with methylmethacrylate bone cement? and b) do such grafts retain their osteogenic potential? In the present study osteotomies were made in the femora of dogs and cortico-cancellous strips of autogenous bone were placed around the osteotomy site. The grafts were then surrounded by polymethylmethacrylate bone cement. Mechanical examination and morphological studies, performed 3, 6 and 10 months following surgery, revealed the elaboration of fibro-osseous union. Our present findings tend to indicate that bone grafts, even if they are covered with methylmethacrylate bone cement, still retain their viability as well as their osteogenic potential.

Experimental use of adhesives in the repair of transverse fractures of the rat and rabbit.

In this preliminary study, the feasibility of fixing fractured bones was explored using the ethyl and isobutyl 2-cyano-acrylates, prepolymerized barnacle cement, and fibrin glue. Adequate cohesive strength cannot be obtained when lipids are present on the surface to be joined by alkyl 2-cyanoacrylates. Oxidized regenerated cellulose gauze soaked in a highly concentrated fibrinogen solution was inserted into the partially hollowed fracture ends to arrest the flow of oozing blood from the medullary canal. Anhydrous ether was used to sponge off any residual lipid from the bone surfaces. The displaced fracture ends were aligned and narrow strips of bone were secured around the fracture line resulting in a barrel stave arrangement. Roentgenograms indicated successful reduction of transverse (midshaft) fractures in eight rat (femur) and seven rabbit (tibia) models. In some cases, casts were used as supplementary fixation. Using the ethyl and isobutyl 2-cyanoacrylates, reduced fractures were maintained in a stable position for up to five and six days, respectively. Further study of the 2-cyanoacrylates is recommended. By using a standardized surgical method for testing the usefulness of future adhesives in vivo, consistent interpretation of results will be facilitated.

Step Osteotomy

A scissoring deformity of the fingers frequently results from malunion of a phalangeal or metacarpal fracture. If union occurs with rotation, the injured digit will scissor with an adjacent digit on flexion of the hand. Malrotation can be corrected by a technique of step osteotomy of the metacarpal with removal of a longitudinal strip of bone. The placement of the transverse cuts of the osteotomy determines the direction of rotational correction and the width of dorsal strut determines the amount of rotational correction. Firm fixation with two interosseous wires ensures good bony union and allows early mobilization.

The effect of prolonged physical training on the properties of long bone

Five one-year-old immature swine were subjected to twelve months of exercise training. Four matched swine with no training served as controls. After they were killed, four-millimeter-wide strips of bone taken from the anterior, medial, posterior, and lateral quadrants of the central femoral diaphysis were subjected to four-point bending tests to failure. It was found that although exercise did not change the mechanical properties of the cortical bone, it resulted in significant increases in the averaged femoral cross-sectional properties: 17 per cent in cortical thickness, 23 per cent in cortical cross-sectional area, and 21 per cent and 27 per cent in maximum and minimum area moments of inertia, respectively. These changes were due primarily to reduction in the diameter of the medullary canal. The analyses of bone composition showed that the bone density and biochemical contents of the control and exercised animals were similar, but the total volume and the dry, ash, and calcium weights of the exercised bone were significantly higher. These combined results suggest that prolonged exercise has a significant effect on the quantity of the bone, but not on its quality. It has long been recognized that stress deprivation from immobilization in plaster casts results in profound bone atrophy, and it is generally accepted that a minimum level of activity is necessary for homeostasis of bone. These results show that exercise at a level comparable to that prescribed in running fitness programs for humans (65 to 80 per cent of maximum heart rate) can not only maintain homeostasis, but produce actual hypertrophy of bone. This work further suggests the importance of graduated, prolonged, supervised rehabilitation programs in overcoming osteoporotic states.

Intertransverse Process Fusion with the Aid of Chemosterilized Autolyzed Antigen-Extracted Allogeneic (AAA) Bone

Forty intertransverse process spinal fusions were performed across two to three vertebrae in four cases of fracture-dislocations of the dorsolumbar region and 36 cases of degenerative joint and disk disease, including spinal stenosis and spondylolisthesis of lumbosacral segments. In all cases, arthrodesis was performed with a composite of AAA cortical bone strips and local autologous spongiosa, including lamellar bone chips. The iliac crest was not used as a donor site in any case. The apophyseal joints were erased, packed with autologous bone slivers, and transfixed with AAA bone pegs. In selected cases, AAA cortical bone "H-blocks" were also placed between the spinous process as in a routine posterior lateral arthrodesis. In cases of bilateral total laminectomy for fractures or spinal stenosis, the excised cancellous bone chips were cleaned of soft parts and transplanted across the transverse processes beneath and around the AAA cortical bone implants. In the above-described operations, graded by the Anatomic-Functional Economic (AEF) system, the long-term excellent and good results were: 4/4 in fracture dislocations; 23/28 in degenerative arthritis and spinal stenosis; 5/8 in spondylolisthesis. Overall, there were over 80% excellent and good results; the pseudarthrosis rate was 12%. In a comparable surgical procedure with autologous iliac bone in 58 control cases, reported in the foregoing article in this volume, the minimum pseudarthrosis rate was 8%. Raw band bone, either frozen or freeze-dried, is now either so infrequently considered or unavailable for lumbar spinal operations or unavailable for lumbar spinal operations that further investigations of AAA bone grafts are warranted in a statistically significant number of patients. Although autologous bone is the ideal bone for a graft, the most important incentive for further investigations of AAA bone is the avoidance of complications of excision of massive bone grafts from iliac crests.

Maxillary Growth after Palatal Surgery: An Experimental Study on Dogs

Maxillary growth after unilateral closure of surgically induced defects in the hard palate in 6- to 8-week old Beagle puppies was studied. The hard palate except for a 4 mm wide strip of bone in the midline and with its overlaying oral mucoperiosteum was removed. On one side the nasal mucoperiosteum was covered with an autogenous full-thickness skin graft (side SGS) and, on the other side the raw surface (side RS) was left for secondary epithelialization. The animals were killed at 47 to 52 weeks of age. Measurements on the dried skulls of the experimental dogs showed no difference in total maxillary length between the two sides of the maxilla. However, the posterior half of the maxilla was longer in 8 dogs on side SGS and the anterior half of the maxilla was in 7 dogs long on side RS. The palatine suture was displaced towards side RS on all dogs, and the height of the nose was in all dogs greater on side SGS. There was a small consistent tendency that the overall growth was more pronounced on the side with the full-thickness skin graft. It is concluded that reducing the amount of scar tissue by covering raw surfaces with an autogenous full-thickness skin graft is one way to reduce maxillary growth impairment after palatal surgery.

A new cranial suture appearing in the site of craniectomy for synostosis.

Abstract The formation of a radiologically normal suture following craniectomy for congenital craniosynostosis is described. In the cases discussed, craniectomy consisted of removal of a strip of skull bone 1 cm wide to separate the congenitally fused membranous bones of the skull. Polyethylene film is wrapped around the bone edges to retard sealing of the surgical defect by new bone growth. In 1966, a suture radiographically identical to a normal suture was seen on a follow-up study. Since that time 26 such cases have been described. A discussion of the mechanisms of suture formation is presented.

TREATMENT OF FOREARM FRACTURES IN ADULTS WITH PARTICULAR REFERENCE TO PLATE FIXATION

1. A simple method of internal fixation of adult forearm fractures which gives consistent good results is necessary because the closed method of treatment is of limited application. 2. Open reduction of fractures without rigid internal fixation gives a high proportion of non-union and poor results. 3. Rigid internal fixation with standard plates and screws has been shown to give a low incidence of non-union in this series. 4. A three and a half inch long plate with six screws is suitable for most fractures, but if there is moderate or severe comminution, or if there is a segmental fracture, longer plates and more screws should be used to provide sound fixation. 5. Severely comminuted fractures with large avascular bone fragments should have the addition of a bone graft at the time of the plating operation in order that union may be assured. Thin strips of iliac bone are preferred. 6. Rigid plating is considered to be the most satisfactory treatment for open fractures. 7. Immobilisation of the limb after operation is not necessary and is undesirable if the fixation is rigid. 8. The functional results of this treatment are good and seemingly better than those achieved by other methods. 9. Serious complications of the plating operation are few and avoidable.

Premature synostosis of the sagittal suture, and its treatment. A modification of the linear craniectomy and the use of synthetic fabrics.

Craniostenosis, a term introduced by Virchow in 1851, TM applied to the premature closure of one or several cranial sutures. Of the 37 sutures of the cranium, the 4 long ones, sagittal, coronal, lambdoidal and squamosal, in order of sequence, are the most frequently involved. The premature ossification of the sagittal suture creates scaphocephaly. For the correction of this deformity, many surgical procedures have been described. Faber and Towne 3'4 removed a strip of bone about cm. wide adjacent to the prematurely closed suture. Because of the fact that the linear craniectomy tends to close in a short time of 4 to 8 months, various materials designed to prevent fusion have been reported. 5'6's'9'14 Among these, polyethylene sheet, introduced by Ingraham et al. 7's and McLaurin and Matson, 12 is the most commonly used. Tim above authors advocated a bilateral parasagittal craniectomy instead of a unilateral one. For the prevention of new-bone formation from the endosteum, Anderson and Johnson ~ painted the outer surface of the dura mater with iodine or Zenker's solution. In older children with scaphocephaly, extensive procedures such as bilateral large craniotomy bone flap, moulding flap, four-flap technic, football-field pattern of craniectomy, and top-lifting circular craniotomy have been developed. 2'n'13'15 King recommended morccllation for severe types of craniostenosis.l~ The present communication concerns a modification of the unilateral parasagittal craniectomy performed in 8 cases of scaphocephaly. For the prevention of early fusion of the craniectomy, synthetic cloth, Vinyon N ''16'1s and Teflon, 17 have been used. The advantages of using this modified simple technic and the results, with a follow-up of ~ to 6 years, are presented in the following.

HEREDITARY DEFORMING CHONDRODYSPLASIA—MULTIPLE CARTILAGINOUS EXOSTOSES

In the fall of 1914 a case of multiple cartilaginous exostoses, so called, appeared during my service at the Children's Hospital. With the permission of Dr. Lovett I investigated the case clinically and roentgenologically, and removed a strip of bone from across an affected epiphysis for pathologic study. The results of this investigation were presented in an article¹published in May, 1915. In reviewing the literature, I found that although the disease is generally considered rare, and textbooks in English give little or no place to it, more than 600 cases had been reported from all over the world, and about 350 articles had been written on the subject. The American literature I found to be very scanty. As a logical sequence to my previous article, I proposed to discover if possible how frequent the condition really was in this country, and what its clinical and roentgenologic manifestations were.

The Surgical Treatment of Idiocy

The fact that considerable attention has been drawn of late years, both in the medical and lay press, to the subject of operations undertaken for the relief of idiocy and other mental deficiencies of child-life, must be my excuse for taking up the time of this section with observations resting, not alone upon my own limited experience, but largely on that of others. The operation of craniectomy, or as some prefer to call it linear craniotomy (that is the cutting out of strips of bone from the skull), has, indeed, almost passed from the domain of science to the region of romance, and articles have appeared in several of our popular magazines under such sensational titles as “Creating a Mind,” which have led parents of mentally-deficient children to form extravagant conceptions of the powers of surgery in this direction. It may not, therefore, be inappropriate for medical men to weigh and measure the evidence which has accumulated during the last five years as to the possibilities and impossibilities of operative interference in these cases.