Stripping Of Periosteum Research Articles

Tantalum and magnesium nanoparticles enhance the biomimetic properties and osteo-angiogenic effects of PCL membranes.

Segmental bone defects, accompanied by periosteum stripping or injury, usually lead to delayed bone union or nonunion, which have challenged orthopedic surgeons. The periosteum, which provides essential blood supply and initial stem cells for bone tissue, plays an important role in the repair of bone defects. The reconstruction of the destroyed periosteum has attracted the attention of researchers exploring more satisfactory therapies to repair bone defects. However, periosteum-like biomaterials have yet to meet the clinical requirements and resolve this challenging problem. In this study, we manufactured a nanofiber periosteum replacement based on poly-ε-caprolactone (PCL), in which tantalum nanoparticles (TaNPs) and nanoscale magnesium oxide (MgO) were introduced to enhance its osteogenic and angiogenic ability. The results of in vitro experiments indicated that the PCL/Ta/MgO periosteum replacement, with excellent cytocompatibility, promoted the proliferation of both bone marrow mesenchymal stem cells (BMSCs) and endothelial progenitor cells (EPCs). Furthermore, the incorporation of TaNPs and nano-MgO synergistically enhanced the osteogenic differentiation of BMSCs and the angiogenic properties of EPCs. Similarly, the results of in vivo experiments from subcutaneous implantation and critical-sized calvarial defect models showed that the PCL/Ta/MgO periosteum replacement combined the osteogenesis and angiogenesis abilities, promoting vascularized bone formation to repair critical-sized calvarial defects. The results of our study suggest that the strategy of stimulating repairing bone defects can be achieved with the periosteum repaired in situ and that the proposed periosteum replacement can act as a bioactive medium to accelerate bone healing.

Clinical analysis of external micro-locking plate in the treatment of fifth metatarsal comminuted fractures

To explore the clinical efficacy of external micro-locking plate combined with closed reduction in the treatment of fifth metatarsal comminuted fracture with severe soft tissue injury. From January 2018 to December 2019, 13 patients received micro-locking plate combined with closed reduction treatment due to the fifth metatarsal comminuted fracture with severe soft tissue injury. There were 11 males and 2 females patients, ranging in age from 21 to 69 years. According to the fracture AO fracture classification, 9 cases belonged to type 87(S)-C2.2 and 4 cases belonged to type 87(S)-C2.1. The fifth metatarsal cuneiform articular surface was not involved, and all of them were comminuted fractures of the fifth metatarsal shaft. All soft tissues were damaged to varying degrees. Three patients got small defect of skin and soft tissue, and they were treated with debridement and suture after one-stage emergency surgery. The fracture healing and complications were observed, and the clinical efficacy was evaluated according to the midfoot function score of American Orthopaedic Foot & Ankle Society (AOFAS) at the latest follow-up. All patients were followed up, and the duration ranged from 3 to 12 months. One patient had delayed union. One patient had local skin necrosis and was treated with second-stage skin grafting to repair the wound surface. No external screw breakage or infection was reported, the skin soft tissue healed satisfactorily and reached bony union, with the union time ranging from 8 to 19 weeks. The postoperative functional recovery was rated according to the midfoot score of AOFAS, the score ranged from 49 to 98, and 7 patients got an excellent result, 4 good, 1 fair and 1 poor. The external micro-locking plate combined with closed reduction in the treatment of fifth metatarsal comminuted fracture with severe soft tissue injury has the advantages of simple operation, good stability and low infection rate, which is helpful to the repair of soft issue injury, and the fixation can be removed early in outpatient clinic. To sum up, this surgical procedure is suitable for patients with severe soft tissue injury and comminuted fracture to avoid periosteum stripping. The space occupying is smaller than the micro-external fixator, which is convenient for patients with early functional exercise.

Reconstruction of Bone Defect Combined with Massive Loss of Periosteum Using Injectable Human Mesenchymal Stem Cells in Biocompatible Ceramic Scaffolds in a Porcine Animal Model.

Clinically, in patients who sustain severe open fractures, there is not only a segmental bone defect needed to be reconstructed but also insufficient healing capacity due to concomitant damages to the periosteum and surrounding soft tissues. For studying the reconstruction of bone defects associated with massive loss of periosteum and surrounding soft tissues, there are no well-established preclinical models in large animals in the literature. The purpose of the study was to generate a large animal model of bone defect with massive periosteum loss and to adopt a tissue engineering approach to achieve rapid bony union with stem cells and biomaterials. In this study, a bone defect with massive periosteum stripping was generated in pigs, which was followed by emptying nearby canal marrow including fat and cancellous bone. The stripped periosteum was a mimic to the situation in the Gustilo type 3 open fractures. Bone defects were then reconstructed by impacting the biocompatible ceramic scaffold, morselized tricalcium phosphate (TCP) loaded with human adipose tissue-derived mesenchymal stem cells (hMSCs). Radiological and pathological assessments indicated that TCP and hMSCs synergistically promoted bone healing with increased lamination and ingrowth of vessels. Both bridging periosteum formation and gap filling were induced rapidly. In conclusion, a porcine model of segmental bone loss with damage of surrounding periosteum was created. Reconstruction of such defects with hMSCs and TCP achieved rapid union of bone defects associated with massive periosteal stripping.

Prospective study of functional outcome of Arthroscopic ACL reconstruction using semitendinosus tendon graft with a periosteal strip from anteromedial tibia

Background: Semitendinosus tendon is considered one of the best grafts for ACL reconstruction. Only if the semitendinosus graft is inadequate in length or diameter the need for gracilis tendon occurs. Harvesting the semitendinosus tendon along with a 1.5 to 2 cm periosteal strip from anteromedial tibia will increase the graft dimensions. The purpose of this study is to assess the functional outcome of ACL reconstruction with this modified form of semitendinosus graft. Materials and methods: Twenty patients with symptomatic ACL tear underwent arthroscopic ACL reconstruction using quadrupled semitendinosus tendon along with a strip of periosteum from the anteromedial tibia. No patient required gracilis tendon and all had a graft diameter of 8mm and above with a length greater than 7.5cm. Seventeen patients completed a period of one year follow up. Results: The average preoperative score was 61.24 (S.D.=5.8). After surgery, the average Tegner Lysholm score at one year was 87.76 (S.D.=4.1). This shows a significant improvement in the score (p value <0.01). Fourteen of the 17 patients had the entire range of knee motion restored. Two of them had 20 degrees loss of flexion and one had a fixed flexion deformity of 5 degrees. Two patients had superficial infection which subsided with antibiotics. One patient had graft impingement which was noticed intraoperatively and notchplasty was done. There was no graft failure for any of them. Conclusion: Harvesting semitendinosus tendon along with a strip of periosteum from the anteromedial tibia will improve the dimensions of the graft making it sufficient for ACL reconstruction. This will decrease the need for gracilis tendon and the morbidity associated with its harvest Keywords: ACL; Hamstring tendon; Semitendinosus; Gracilis

A method of production of boneless chicken wings (drumettes and winglets) by separation of periosteum from bone without cutting skin and muscles

The deboning of broiler chicken wings, including drumettes and winglets, is not common in the poultry processing industry. However, consumers who like convenient foods may be interested in boneless products. Samples of broiler wings were deboned by articular cartilage dislocation and periosteum stripping without cutting skin and muscles to obtain boneless drumettes and winglets, with each having inner space formed by bone removal. The average weight of bone-in winglets (30.7 g) was less (P < 0.05) than that of bone-in drumettes (39.9 g), whereas the average percentage of boneless product was less (P < 0.05) in the drumettes (74.9) than in the winglets (80.1). There was a smaller number of muscles in the drumettes than in the winglets, but major muscles in the drumettes were larger than any muscles in the winglets. The average weight of muscle was greater (P < 0.05) and that of skin was less (P < 0.05) in the drumettes than in the winglets, and thus the muscle/skin ratio was approximately twice as high (P < 0.05) in the drumettes. The size and shape were different between the bone-in and boneless products, as expected. When a cooked product was examined, no appreciable inner space (resulting from bone removal) was seen on its transverse section. The advantages of boneless wing products over bone-in wing products were discussed. It was concluded that the method described in the present study is useful for the production of high-quality boneless wing products.

Anterior minimally invasive bridge-plate technique for treatment of humeral shaft nonunion

BackgroundThe present study introduces a new surgical technique and the results of a case series of patients with humeral shaft nonunion.Materials and methodsFifteen patients with diagnosis of diaphyseal nonunion of humerus were operated by a bridge-plate technique. A 4.5-mm plate is slid on the anterior surface of the humerus, submuscular to the brachial muscle. With the plate over the anterior surface of the humerus, screws are inserted from anterior to posterior on the ends of the plate. When there is a small bone gap, an iliac autologous graft is inserted. Minimum follow-up was 1 year.ResultsBone healing was obtained in all patients: 1.5 months postoperatively in 11 patients, 2 months in 3 patients, and 3 months in 1 patient. There were no postoperative infections, there was one case with loosening of the screws and plate, and there were no nerve injuries.ConclusionsThe present technique avoids wide dissection, radial nerve isolation, and periosteum stripping. The anterior minimally invasive bridge-plate technique for treatment of humeral shaft nonunion is a safe procedure and obtained bone healing in all patients in this series.

Evaluation Of Postoperative Facial Swelling Following The Surgical Removal Of Impacted Third Molars Using The Tape Measuring Technique.

Context: The complications associated with the removal of impacted third molars should not be underestimated. The surgery entails incision, stripping of periosteum, bone and tooth removal, and suturing. Swelling is almost universal after this procedure which, affect patients daily life activities. Objectives: To assess the use of tape measuring technique in the clinical evaluation of facial swelling following lower third molar surgery. Patients and Methods: Clinical evaluation of facial swelling after the surgical removal of impacted mandibular third molars using a tape measuring technique was carried out among 50 patients of both genders at the oral and maxillofacial surgery clinic of the University of Nigeria Teaching Hospital and Ntasiobi Specialist Hospital both in Enugu. Postoperative facial swelling was evaluated at 24 hours, 72 hours and five days. The measurements obtained were recorded and converted to relative values, which provided numerical data for comparative analysis Results: The result of our study shows that swelling usually reaches its maximum within 48 – 72 hours after surgery and begins to subside from the day after. We equally observed that there was an increase in the duration of surgical procedure in different molar positions with corresponding increase in amount of facial swelling. Conclusion: Patients are hampered by the level of physical discomfort within 2 – 3 days after surgery, which include perception of their appearance and oral function. Treatment for minimizing this postoperative sequalae should commence immediately after surgery to achieve desired and maximum effect. The tape measuring method is simple, non-invasive, cost effective and time-saving method, which provides numerical data for determination of facial contour changes. Keywords: Third molar surgery, Swelling, Clinical evaluation, Tape measuring Technique

Epiphysiolysis with separation of the capital femoral epiphysis after reduction of traumatic dislocation of the hip–a case report

Correspondence: Dr. Deepak Jain, 133, New Lajpat Nagar, Opp. Hotel Imperial, Pakhowal Road, Ludhiana, Punjab, India. E-mail: deepakjainorth@rediffmail.com posterior dislocation of the left hip. The hip was reduced in the emergency ward, 4 hours after the injury under conscious sedation without the need of any undue force. The post-reduction radiograph revealed separation of the capital femoral epiphysis that was laying dislocated (Figure 2). Open reduction and internal fixation with posterior approach using two 7 mm cancellous cannulated screws, was done within 6 hours of the injury (Figure 3). The epiphysis was found attached to the neck by a thin strip of periosteum, which was preserved. It was difficult to assess the exact reduction of the capital epiphysis on the neck, as there were no inter-digitating edges and due to the circular profile of the neck and the separated portion. It was also difficult to assess the exact alignment of the reduced fragment and the position of the cannulated screws in antero-posterior and lateral planes. This was because the patient was in a lateral position and proper positioning of the image intensifier was not possible before the reduction of the hip joint. The patient was discharged with skin traction for 2 weeks and non-weight bearing walking for next 4 weeks after which partial weight bearing was commenced. The patient had good hip function in the first 10 months post surgery. Epiphysiolysis with separation of the capital femoral epiphysis after reduction of traumatic dislocation of the hip—a case report

Periosteal nociceptors induced hypotension and bradycardia under spinal anesthesia -A report of two cases-

The sudden hemodynamic disturbance in the perioperative period can occur because of various surgical and anesthetic reasons but hemodynamic collapse due to noxious stimulus of periosteum stripping has not been described. We report two cases of severe hypotension and bradycardia during periosteum stripping in orthopedic surgery under subarachnoid block even though the block level was adequate. In our patients, hemodynamic collapse occurred specifically at a moment when surgeons manipulated periosteum and fall in blood pressure and heart rate was sudden in onset. The hemodynamic disturbance did not appear to be related to vagally mediated or due to blockade of sympathetic fibers but appeared to be related to periosteal nociceptors.

Fracture of the clavicle following the island type of pectoralis major myocutaneous flap for reconstruction of head and neck defect

Fractures of the clavicle following radical neck dissection (RND) and/or radiation therapy have been previously noted in the literature. Interestingly, we experienced three cases of clavicular fracture, which were considered to have resulted from pectoralis major myocutaneous flap (PMMCF). All of these three cases had received the combined treatment of RND, PMMCF and postoperative radiotherapy on the side of fracture. In all three cases, ipsilateral lower neck received 4,500 cGy and island type of PMMCF was used for reconstruction of surgical defect in head and neck area. All fractures noted between 1 and 3 years postoperatively occurred on the medial portion of the clavicle. Devascularization after stripping of periosteum and altered mechanics of the clavicle following resection of clavicular head of pectoralis major muscle may contribute to develop this rare complication in addition to the effect of radiotherapy and RND. We present three cases of the clavicle fracture following the island type PMMCF with a review of literature.

Treatment of femoral shaft comminuted fractures with interlocking intramedullary nail

目的 探讨使用交锁髓内钉治疗股骨干粉碎性骨折的手术方式选择、疗效.方法对1998年1月～2002年10月使用交锁髓内钉治疗67例(76肢)股骨干粉碎性骨折的疗效进行回顾性分析.手术采用闭合、小切口或有限切开复位,用三维瞄准器锁定骨折远近端.结果平均随访14.1个月,肢体、关节功能恢复优良率92.5%(62/67),一期骨折愈合率90.8%(69/76).平均骨临床愈合时间6.7个月.2例软组织感染,感染率2.6%,2例髓内钉断裂.结论交锁髓内钉治疗股骨干粉碎性骨折应常规静力固定,不剥离或少剥离骨膜,不强求解剖复位,尽量闭合复位、有限扩髓,是目前治疗股骨干粉碎性或多节段骨折的有效方法。

Nonunion using a canine model.

The investigation involved a search for a model of atrophic nonunion. Fifty-two mature, adult, mongrel dogs were used to study the repair after creating a 0.5-cm bone defect in the mid-diaphysis of the radius. In addition, a 2-cm wide strip of periosteum was circumferentially resected from each osteotomy extremity. No immobilization was used thereafter. The reparative process was assessed by X-rays, histology, vascular injection, and scintigraphy. The dogs we distributed into three groups according to the time of follow-up (1, 3, and 6 months). Two kinds of repair were recognized after 3 months and were well-established after 6 months: disturbed healing with much callus (54%) and disturbed healing with absent or scanty callus (46%). In the first instance, the periosteum had regenerated and produced the external callus. The bone ends were capped with fibrocartilage; the vascularization around the defect was increased and displayed a well-defined vascular picture. In the healing pattern with absent external callus (atrophic nonunion), the bone defect was enlarged and filled with fibrous tissue, but there was no deficient vascularization in and around the osteotomy. Radioactivity counting showed an increased uptake around the osteotomy site in both types of repair, which persisted over time but was higher in the 1-month group. It was concluded that the present model yields a consistent pattern of a disturbed reparative process that mimics human cases of atrophic or hypertrophic nonunion. The differences between the two kinds of repair seemed to be related to the periosteal capacity of regeneration.

Close Comminuted Fracture in the Shaft of Femur: Managed by Open Reduction and Internal Fixation with Broad Dynamic Compression Plate (DCP) Without Stripping of Periosteum

Management of close comminuted fracture in the shaft of femur in adult is a difficult task. Herewe report a case who was managed by open reduction and internal fixation with broad dynamiccompression plate without stripping of Periosteum.doi: 10.3329/taj.v15i2.3919TAJ December 2002; Vol.15(2): 96-97

INFANTILE PSEUDARTHROSIS OF THE TIBIA

1. Three cases of infantile pseudarthrosis of the tibia treated successfully by delayed autogenous by-pass graft are reported. 2. The delayed autogenous graft is stouter, stronger and more easily handled and has enhanced osteogenic properties than a graft transferred immediately. 3. The by-pass graft commends itself, firstly, because it does not disturb the pseudarthrosis, which in consequence helps the immobilisation of the graft; secondly, because it is well embedded in healthy bone above and below, well away from the abnormal bone; thirdly, because it lies under compression and, ideally, is vertically disposed between the knee and the ankle; and fourthly, because there is no devitalising stripping of periosteum or introduction of foreign bodies. 4. Support to the grafted leg is needed for at least five years, but only by a polythene splint after four to six months. 5. With early grafting the deformity straightens out and shortening is overcome, as there is early return to normal use of the limb. 6. Prolonged follow-up is called for lest the basic lesion in the tibia should extend. 7. Fibrous dysplasia and similar fibrous lesions of bone account for many cases of infantile pseudarthrosis of the tibia. Many of these lesions are congenital and subsequently lead to fracture. 8. Postponement of surgery should not be countenanced.