Type Of Bone Graft Research Articles

Current concepts of bone grafting in trauma surgery

Bone graft in trauma surgery is commonly used in managing bone defects, non-union, fracture related infections, arthrodesis or to provide structural support in fractures. A variety of bone grafts are made available to the treating physician, which includes autograft, allograft and bone graft substitutes. The future of bone grafting in trauma surgery is exciting with the incorporation of technological advancement such as gene therapy, 3D-printing and tissue engineering. Regardless, there are still limitations to what we understand regarding current bone grafting techniques with conflicting literature on their clinical utility and indication. The aim of this review article therefore is to take a step back and critically evaluate the current concepts of bone grafting in trauma surgery, with special emphasis made on reviewing the types of bone graft, biology of bone graft incorporation and indication for its use in various clinical scenarios.

The impact of bone graft type used to fill bone defects in patients undergoing ACL reconstruction with bone–patellar tendon–bone (BPTB) autograft on kneeling, anterior knee pain and knee functional outcomes

PurposeMultiple different materials are used for filling bone defects following bone–patellar tendon–bone (BPTB) graft ACL reconstruction surgery. The theoretical objective being to minimize kneeling pain, improve clinical outcomes and reduce anterior knee pain following surgery. The impact of these materials is assessed in this study.MethodsA prospective monocentric cohort study was conducted from January 2018 to March 2020. There were 128 skeletally mature athletic patients who underwent ACL reconstruction using the same arthroscopic-assisted BPTB technique, with a minimum follow-up of two years identified in our database. After obtaining approval from the local ethics committee, 102 patients were included in the study. Patients were divided into three groups based on type of bone substitute. The Bioactive glass 45S5 ceramic Glassbone™ (GB), collagen and hydroxyapatite bone void filler in sponge form Collapat® II (CP), and treated human bone graft Osteopure®(OP) bone substitutes were used according to availability. Clinical evaluation of patients at follow-up was performed using the WebSurvey software. A questionnaire completed in the 2nd post-operative year included three items: The ability to kneel, the presence of donor site pain, and the palpation of a defect. Another assessment tool included the IKDC subjective score and Lysholm score. These two tools were completed by patients preoperatively, and postoperatively on three occasions (6 months, 1 year, and 2 years).ResultsA total of 102 patients were included in this study. In terms of Kneeling pain, the percentage of GB and CP patients’ who kneel with ease were much higher than that of OP patients (77.78%, 76.5% vs 65.6%, respectively). All three groups experienced an important increase in IKDC and Lysholm scores. There was no difference in anterior knee pain between the groups.ConclusionThe use of Glassbone® and Collapat II® bone substitutes reduced the incidence of kneeling pain compared to Osteopure®. There was no influence of the bone substitute type on the functional outcome of the knee or on the anterior knee pain at two years of follow.

A systematic review of sinus floor augmentation complications. Does graft type influence the complications rate?

Background. Sinus floor elevation is considered a safe procedure to properly augment the height of the edentulous crest. Often, complications may arise due to multiple causes and can lead to a poor outcome of the graft and implant’s osseointegration. A careful surgical approach, a good knowledge of possible obstacles, and careful treatment planning can reduce the risks of complications, as well as their impact on the surgical outcome. This study aims to make a literature review of 40 articles, analyzing the incidence and type of complications related to maxillary sinus graft surgeries and graft materials. Material and methods. A total of 40 articles published between 2015 and 2021 were selected for a systematic literature review on maxillary sinus floor complications. The studies were selected from 2 different internet databases: PubMed and Science Direct. The sinus lift complications were counted and their incidence was organized upon the surgical technique and the timing of occurrence (intraoperative, postoperative). It was also analyzed if the graft material influences the complication rate. Results. In a group of 1757 sinus augmentation surgeries performed on 1605 patients, 363 complications were found. Sinus membrane perforation occurred in 242 cases, 29 procedures resulted in partial or total graft loss, there were 26 postoperative cases of sinusitis, 24 sinus infections, 16 wound dehiscence, 6 bleeding complications, 5 lost implants, and 2 oro-antral fistulas. Conclusion. Sinus lift complications are sometimes inherent circumstances of the procedures, but they can also be prevented through an accurate technique and preoperative plan. The type of bone graft does not influence the incidence of surgical complications.

Toxicity test of bioceramic biphasic calcium phospate (BCP) Sr-Ag doping as bone graft in BHK-21 fibroblast cells

Background: Bone graft is a substitute material that is used to assist reconstruction, stabilize the structure and bonds in bone, stimulate the osteogenesis process and as a healing bone defect. One type of bone graft that has good osteoinductive and bicompatibility is alloplast which is a synthetic calcium phosphate compound. The most frequently used Calcium Phosphate groups are Hydroxyapatite (HA), β-Tricalcium Phosphate (β-TCP), and Biphasic Calcium Phosphate (BCP). In this study the material used was BCP doping Sr2+ and Ag+. Strontium ions (Sr2+) can increase osteoblast activity, reduce osteoclast activity and cytokine production, improve osteointegration, and minimize fractures. Ag+ ion has the ability as an antibacterial agent. Purpose: To explain and prove the toxicity of bioceramic Biphasic Calcium Phosphate (BCP) doped Sr-Ag as bone graft on BHK-21 fibroblast cells. Methods: This type of research is a laboratory experiment with a post-test only control group design. Treatment with Biphasic Calcium Phosphate (BCP) doped Sr-Ag with concentrations of 200 ppm, 180 ppm, 160 ppm, 140 ppm, 120 ppm, 80 ppm, 40 ppm, 20 ppm, 10 ppm, 5 pmm, 2.5 ppm, 1.25 ppm, 0.625 ppm in BHK-21 fibroblast cell culture. Results: The percentage of fibroblast cell life at concentrations of 200 ppm, 180 ppm, 160 ppm, 140 ppm, 120 ppm, 80 ppm, 40 ppm, 20 ppm, 10 ppm, 5 pmm, 2.5 ppm, 1.25 ppm, 0.625 ppm, respectively, the percentage of live cells was 38% 44%, 46%, 50%, 52%, 65%, 69%, 71%, 72%, 75%, 77%, 81%, and 87%. The parameter used in this toxicity test is CD50. Conclusion: The results of the toxicity test of bioceramic Biphasic Calcium Phosphate (BCP) doped Sr-Ag as a bone graft showed a toxic and non-toxic effect on BHK-21 fibroblast cells at certain concentrations.

Selection of bone graft type for the surgical treatment of thoracolumbar spinal tuberculosis based on the spinal instability neoplastic score: a retrospective single-center cohort study

ObjectivesThis study aimed to establish a standard for selecting bone graft type for thoracolumbar spinal tuberculosis surgery based on the spinal instability neoplastic score (SINS).MethodsPatients with thoracolumbar tuberculosis who underwent one-stage debridement posteriorly and instrumentation were divided into a structural bone graft group (SBG) (51 cases) and a non-structural bone graft group (NSBG) (54 cases) according to their SINS. SBG was performed when the SINS was ≥ 13 and NSBG was performed when it was 7 ≤ SINS ≤ 12. Baseline data, clinical outcomes, and imaging outcomes were collected and statistically analyzed between the two groups.ResultsSignificant improvements in clinical and imaging outcomes were achieved in both groups. Compared to the SBG group, the operation time of the NSBG group was shorter, the intraoperative blood loss of the NSBG group was less, the bone fusion time of the NSBG group was faster.ConclusionNon-structural and structural bone grafting can achieve comparable therapeutic effects in patients with spinal tuberculosis, and a suitable selection of bone grafts based on quantitative SINS will make full use of the advantages of different bone grafts.

Decline in Separate Incision Autograft for Spine Surgery Over the Past Decade: A Fading "gold standard".

Spinal fusion is a common procedure for which bone grafting is a critical component. Although iliac crest (separate incision autograft) is typically referred to as the "gold standard" grafting material, it seems to be used less and less frequently. The 2010 to Q3 2020 MSpine PearlDiver data set was used to identify patients receiving separate incision autograft versus local autograft/allograft/graft supplement for spinal fusion. Grafting trends over the decade were determined. Patient age, sex, Elixhauser Comorbidity Index, smoking status, insurance plan, region of the country where the surgery was conducted, and surgeon specialty were characterized and compared by the type of bone graft using univariate and multivariate analyses. Of 373,569 spinal bone grafting procedures, separate incision autografts were used for 32,401 (8.67%). A gradual decline was observed from 2010 (10.57% of spinal grafting procedures) to 2020 (4.69%, P -value < 0.00001). Independent predictors of having had a separate incision autograft in order of decreasing odds included surgeon specialty (relative to neurosurgery, orthopaedic odds ratio [OR], 2.45), smoking status (relative to nonsmokers, smokers OR, 1.45), region of the country (relative to Midwest, Northeast OR, 1.11; West OR, 1.42; and South OR, 1.48), insurance (relative to commercial, Medicare OR, 1.14), younger age (OR, 1.04 per decade increase), and lower Elixhauser Comorbidity Index (OR, 0.95 per two-point increase) ( P < 0.0001 for each). Iliac crest autograft continues to be referred to as the gold standard grafting material for spine fusions. However, the use of this has faded over the past decade to only 4.69% of spinal fusions in 2020. While some patient factors had an effect on when separate incision autograft was used, nonsurgical factors, including surgeon specialty, geographic region where the surgery was conducted, and insurance factors, suggested that external factors/physician training influence this choice.

Sterility and bioactivity evaluation of two types of bone graft substitutes after removing the original packaging.

Xenograft and allograft bone substitutes are widely used to replace the missing bone in defects. Since removing the packaging of these grafts can nullify their sterilization, this study aimed to evaluate the sterility and bioactivity changes of an allograft and a xenograft following uncapping/recap. Two types of commercial allograft and xenograft vials were unpacked and further exposed to operating room air, where implant surgery was performed for one second, ten minutes, and one hour. After three repetitions, samples were analyzed using microbiological tests and scanning electron microscopy (SEM) with energy dispersive x-ray analysis (EDX) for sterility and bioactivity evaluation. None of the bone graft samples showed microbial growth or bioactivity-negative changes after seven days of unpacking the vials. Despite the positive results of this study, future studies and more analysis considering influential factors are required. Also, disinfection and air exchange must still be observed during biomaterial application and bone grafting procedures.

Preliminary Assessment of In Vivo Raman Spectroscopy Technique for Bone Quality Evaluation of Augmented Maxillary Sinus Floor

(1) Background: In oral surgery, bone regeneration is achieved through various types of bone grafts or bone substitutes and its success is usually analyzed by micro-computed tomography and histomorphometry. The aim of this study was to evaluate the usefulness of Raman spectroscopy as an alternative to other techniques for bone quality evaluation during a standard oral surgery procedure. (2) Methods: The preliminary evaluation of bone augmentation during maxillary sinus floor elevation oral surgery was performed by Raman spectroscopy for several (five) patients during and after the surgery and the results were compared with postoperative data from histomorphometry, EDX and SEM analysis. (3) Results: After analyzing all the results for the bone samples according to the four methods (Raman, EDX, SEM and Histology) that were used in our study, the obtained result of the investigation provided a good augmentation process for three of the patients and partly successful augmentation process for two of the patients. The primary evaluation using Raman spectroscopy (in vivo and ex vivo investigation) was confirmed by histological results, thus having a first step for validation of Raman as a new method of imaging for dentistry. (4) Conclusions: Our results show that Raman spectroscopy could provide fast and reliable insight on bone condition during augmentation of the maxillary sinus floor. We emphasize the advantages and drawbacks of the proposed techniques as its accuracy could increase by performing larger size clinical trials. Using the Raman mapping, the method can serve as an alternative to histology.

Evaluation of Radiological and Neurological Outcomes after Anterior Cervical Corpectomy with Fusion using Expandable Cage Alone and Expandable Cage with Anterior Cervical Plating.

Objective After anterior cervical corpectomy expandable cage were used with or without using anterior cervical plate for structural support are being preferred over autologous bone graft and other types of cages. Nowadays, the preferable type of cages and application of anterior cervical plate remain a debatable topic with studies giving divergent results. The purpose of this study is to evaluate the outcomes of expandable cages used alone or expandable cage used with anterior cervical plate following anterior cervical corpectomy. Materials and Methods This study was conducted on 100 patients from January 2019 to December 2021 and all patients were undergone anterior cervical corpectomy and fusion and divided in two groups with expandable cage only (Group A) and expandable cage with anterior cervical plate (Group B). Various long-term benefits and radiological outcomes were studied in both groups. Statistical Analysis and Results In this study, 100 patients were included and all patients underwent corpectomy followed by insertion of expandable cage alone or with anterior cervical plate. There was an improvement in C2-C7 Cobb's angle in group B was significantly higher than group A ( p < 0.05) and decrease in Nurick's scale score in group B was significantly higher than group A ( p < 0.05). The outcomes were measured with fusion rate (94%), subsidence rate (15%) and change in C2-C7 Cobb's angle was 4 degrees in this study. Conclusion Expandable cage with or without anterior cervical plate was used after anterior cervical corpectomy for various cervical pathological conditions. In this study, we conclude the long-term benefits and radiological outcomes of two groups as expandable cage was used alone or with additional application of anterior cervical plate. In this study, the results were more in favor of additional application of anterior cervical plate as compared with expandable cage alone and more studies were required in future for more established long-term benefits and drawbacks.

Characteristics and risk factors of instrumentation failure following total en bloc spondylectomy.

The aim of this study was to investigate the incidence and characteristics of instrumentation failure (IF) after total en bloc spondylectomy (TES), and to analyze risk factors for IF. The medical records from 136 patients (65 male, 71 female) with a mean age of 52.7 years (14 to 80) who underwent TES were retrospectively reviewed. The mean follow-up period was 101 months (36 to 232). Analyzed factors included incidence of IF, age, sex, BMI, history of chemotherapy or radiotherapy, tumour histology (primary or metastasis; benign or malignant), surgical approach (posterior or combined), tumour location (thoracic or lumbar; junctional or non-junctional), number of resected vertebrae (single or multilevel), anterior resection line (disc-to-disc or intravertebra), type of bone graft (autograft or frozen autograft), cage subsidence (CS), and local alignment (LA). A survival analysis of the instrumentation was performed, and relationships between IF and other factors were investigated using the Cox regression model. A total of 44 patients (32.4%) developed IF at a median of 31 months (interquartile range 23 to 74) following TES. Most IFs were rod fractures preceded by a mean CS of 6.1 mm (2 to 18) and LA kyphotic enhancement of 10.8° (-1 to 36). IF-free survival rates were 75.8% at five years and 56.9% at ten years. The interval from TES to IF peaked at two to three years postoperatively and continued to occur over a period of time thereafter; the early IF-developing group had greater CS at one month postoperatively (CS1M) and more lumbar TES. CS1M ≥ 3 mm and sole use of frozen autografts were identified as independent risk factors for IF. IF is a common complication following TES. We have demonstrated that robust spinal reconstruction preventing CS, and high-quality bone grafting are necessary for successful reconstruction.Cite this article: Bone Joint J2023;105-B(2):172-179.

Fusion rates based on type of bone graft substitute using minimally invasive scoliosis surgery for adolescent idiopathic scoliosis

BackgroundMinimally invasive scoliosis surgery (MISS) is currently introduced on novel technique for surgical treatment of adolescent idiopathic scoliosis (AIS). This study is aimed to evaluate the efficacy of facet fusion in MISS compared to posterior fusion in conventional open scoliosis surgery (COSS) and compare facet fusion rates based on three bone graft substitutes in MISS for adolescent idiopathic scoliosis (AIS).MethodsEighty six AIS patients who underwent scoliosis surgery were divided into two groups: the COSS group and the MISS group. COSS was performed through posterior fusion with allograft. MISS was applied via facet fusion with three bone graft substitutes. The MISS group was further divided into three subgroups based on graft substitute: Group A (allograft), Group B (demineralized bone matrix [DBM]), and group C (demineralized cancellous bone chips). Fusion rate was measured using conventional radiographs to visualize loss of correction > 10°, presence of lysis around implants, breaks in fusion mass, and abnormal mobility of the fused segment.ResultsThe fusion rates showed no significant difference in COSS and MISS groups (p = 0.070). In the MISS group, the fusion rates were 85, 100, and 100% in groups A, B, and C, respectively, with no significant difference (p = 0.221). There were no statistical differences between groups A, B, and C in terms of correction rate, fusion rate, and SRS-22 scores (p > 0.05).ConclusionsThe facet fusion in MISS showed comparable to posterior fusion in COSS with regard to radiological and clinical outcomes. Furthermore, the type of graft substitute among allograft, DBM, and demineralized cancellous bone chips did not affect facet fusion rate or clinical outcomes in MISS. Therefore, MISS showed comparable fusion rate (with no influences on the type of graft substitute) and clinical outcomes to those of COSS in the surgical treatment of AIS.

Komparativna analiza dve metode prezervacije postekstrakcione alveole - pilot-studija

Objective. Volumetric changes of the residual alveolar ridge begin after tooth extraction. They are more pronounced in the vestibule-oral aspect than in the coronary-apical aspect. In order to preserve the volume of hard and soft tissues, several types of bone grafts, bone substitutes and biomaterials have been used. PRF (Platelet Rich Fibrin) as an autologous blood derivative has been used in recent years as a solo graft material or in combination with other graft materials. The aim of this study was clinical and radiological evaluation of two different methods of socket preservation. Methods. Two study groups of 10 subjects each, one with socket preservation with solo PRF and the other with PRF+xenograft. Dimensional changes after 4 and 6 months, density of the newly formed bone after 4 months with CBCT 3D (cone beam computed tomography) imaging technique, postoperative morbidity during the first 7 days after intervention were evaluated. Results. Statistical analysis confirmed lower bone resorption in the PRF+GRAFT test group compared to the PRF group. Better density of the newly formed bone was found in the PRF+GRAFT group and better ratio between the density in the socket and the density in the periapical region. Postoperative morbidity decreased in both groups. Conclusion. Recommendation for the use of PRF as an adjuvant with other grafts and substitutes, as well as a solo graft material.

Micro-computed tomography analysis of mineral attachment to the implants augmented by three types of bone grafts: An experimental study in dogs

Micro-computed tomography analysis of mineral attachment to the implants augmented by three types of bone grafts: An experimental study in dogs

Impact of Harvesting Method and Donor Age on the Behavior of Human Osteoblast-Like Cells.

Autogenous particulate bone grafts are being utilized in oral implantology for minor grafting procedures. This study aimed to investigate the influence of the bone-harvesting technique, donor age, and donor site on proliferation and differentiation of human primary osteoblast-like cells in the cell culture. Autogenous bone particles (20 samples) were harvested from the maxilla and mandible during surgery using two different protocols, and two types of particulate bone grafts were collected: bone chips and bone sludge. Bone samples were cultured in growth medium and, after 2 to 3 weeks, the cells that grew from bone grafts were cultured in the normal and osteogenic medium for 0, 4, 7, and 20 days. DNA, alkaline-phosphatase (ALP), calcium-content measurements, and Alizarin red/toluidine blue staining were performed. Data were analyzed by repeated-measures analysis of variance with Bonferroni test. The level of statistical significance was set at 5% (P < .05). Total DNA, ALP, and calcium content were significantly higher for the bone chip samples compared to the bone sludge samples. Total DNA and ALP content were significantly higher for the patients in age group 1 (≤ 60 years) compared to age group 2 (> 60 years) and was significantly higher for mandibular samples than maxillary samples on day 20. However, the calcium measurement showed no significant difference concerning donor age and donor site. Data analysis revealed that harvesting technique (bone chips vs bone sludge), donor age (≤ 60 years vs > 60 years), and donor site (maxilla vs mandible) influenced the osteogenic potential of the collected particulate bone graft. The bone chips were superior in terms of osteogenic efficacy and should be considered a suitable option for particulate bone graft collection.

Endosteal plating for the treatment of malunions and nonunions of distal femur fractures.

To describe the surgical technique and the outcome of a case series of nonunion and malunion of distal femur fractures treated with an endosteal medial plate combined with a lateral locking plate and with autogenous bone grafting. We retrospectively analyzed a series of patients with malunion or nonunion of the distal femur treated with a medial endosteal plate in combination with a lateral locking plate, in a period between January 2011 and December 2019, Database from chart review was obtained including all the clinical relevant available baseline data (demographics, type of fracture, mechanism of injury, time from injury to surgery, number of previous surgical procedures, type of bone graft, and type of lateral plate). Time to bone healing, limb alignment at follow-up and complications were documented. Ten patients were included into the study: 7 male and 3 female with mean age of 48.3years (range 21-67). The mechanism of trauma was in 8 cases a road traffic accident and in 2 cases a fall from height. According to AO/OTA classification 5 fractures were 33 A3, 3 were 33 C1, 1 was 33 C2 and 1 was 33 C3. The average follow up was 13.5months. In all cases but one bony union was achieved. Bone healing was observed in average 3.3months after surgery. No intraoperative or postoperative complications were reported. A medial endosteal plate is a useful augmentation for lateral plate fixation in nonunion or malunion following distal femur fractures, particularly in cases of medial bone loss, severe comminution, or poor bone quality. Level IV (retrospective case series).

Recombinant human bone morphogenetic protein-2 in spine surgery: recommendations for use and alternative bone substitutes-a narrative review.

Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been extensively studied in preclinical, animal, and human studies and has been used widely in spine fusion surgery. Evidence demonstrates that fusion rates with rhBMP-2 are similar to or higher than those achieved with autologous bone graft. However, there have been concerns regarding the cost, optimal dosage, and potential complications of rhBMP-2 use in spine surgery. The objective of this paper is to provide a current review of the available evidence regarding rhBMP-2 and other bone graft substitutes used for spinal surgery. We searched Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, and Database of Abstracts of Review of Effectiveness for 2 studies regarding physiology of bone fusion in spine surgery, formulations and indications of rhBMP-2, cancer risk of rhBMP-2, and alternatives to rhBMP-2 published from 1965 to 2022 in English. The debate regarding indications and cost effectiveness of rhBMP-2 is presented based on increasing data and use criteria. Here, we focus on the effectiveness and economic costs (both direct and indirect) of rhBMP-2 and alternative bone graft substitutes. Based on the cumulative literature, we provide recommendations for rhBMP-2 use in spine surgery. Based on our review of the literature, we recommend the following: (I) clear informed consent processes between surgeons and patients regarding current evidence of the benefits and risks of using rhBMP-2 and available alternative bone graft substitutes. (II) Consideration of rhBMP-2 for spinal fusion surgery (excluding anterior cervical procedures), especially adult spinal deformity (ASD) surgery, lumbar surgery for multilevel degenerative disease, revision surgery for pseudoarthrosis, and surgery in patients with a low-quantity or low-quality autograft. (III) Regulatory oversight of the type, volume, and dose of bone graft substitute (both per level and per procedure) to ensure appropriate indications, prevent excessive usage, and thereby enhance cost containment.

Investigation of Different Types of Micro- and Nanostructured Materials for Bone Grafting Application.

The insufficient volume of dental ridges is one of the most severe problems regarding an oral cavity. An inadequate amount can cause problems during various types of dental treatment. Its complexity originates from the etiopathogenesis of this problem. In this study, the representatives of auto-, allo-, and xenografts are compared. The physic-chemical differences between each of them were evaluated using XRD (X-ray Powder Diffraction), a SEM (Scanning Electron Microscopy), FT-IR (Fourier transformed infrared spectroscopy), and TGA (thermogravimetric analysis). Based on the SEM images, it was observed that the origin of the material has an influence on collagen fiber compact level and porosity. Following a comparison of FT-IR spectra and XRD, the crystal and chemical structures were described. Based on TGA, different water concentrations of the investigated materials, their high thermal stability, and concentration of inorganic phase, hydroxyapatite was determined. The presented study is important because it delivers information about chemical structure and its impact on bone regeneration. This knowledge should be taken into consideration by dental clinicians, because different types of bone grafts can accommodate the achievement of various goals.

The Efficiency of Highly Porous β-Tricalcium Phosphate (β-TCP) with Bone Marrow Aspirate Concentrate (BMAC) in Midfoot Joint Arthrodesis

Category: Midfoot/Forefoot Introduction/Purpose: Nonunion is one of the most common and devastating complications following midfoot joint arthrodesis. Many different types of bone grafts and bone substitutes have been used to promote osseous fusion. However, there is no consensus on the gold standard bone grafting material and whether biologic materials should be used alone or in combination. The purpose of this study is to investigate the efficiency of highly porous β-tricalcium phosphate (β-TCP) with Bone Marrow Aspirate Concentrate (BMAC) in midfoot joint arthrodesis. Methods: This retrospective comparative study included patients who underwent midfoot joint arthrodesis using compression screws from January 2014 to May 2019. A total of 44 patients (46 feet) including 89 joints were included in this study. The cohort was then stratified into two groups: 25 patients (26 feet) in arthrodesis with highly porous β-TCP and BMAC (group A) and 19 patients (20 feet) in arthrodesis without highly porous β-TCP and BMAC (group B). The osseous union rate was compared between the two groups. Demographic and operative data including age, sex, body mass index (BMI), smoking, etiology of arthritis, comorbidities such as diabetes mellitus and rheumatoid arthritis, number of joints fixed, use of bone graft or bone substitute, and postoperative midfoot anatomic alignment in the two groups were compared. Results: There was a significant difference in the union rate between the two groups: 91.5 % (43 out of 47 joints) in arthrodesis with highly porous β-TCP and BMAC (group A) and 76.2 % (32 out of 42 joints) in arthrodesis without highly porous β-TCP and BMAC (group B) (P = 0.048). During the follow-up period, a total of four postoperative complications were reported in this study. In group A, two patients developed hardware irritation, and all of them underwent removal of hardware procedure. In group B, one patient had a superficial wound infection, which was resolved completely without further treatment. The other patient in group B developed a deep wound infection with dehiscence, and it was managed with irrigation and debridement followed by vacuum assisted wound closure therapy. Conclusion: This study investigated the efficiency of highly porous β-TCP and BMAC to promote bony healing in midfoot joint arthrodesis. A significantly higher union rate was shown when arthrodesis was performed with highly porous β-TCP and BMAC compared to arthrodesis without them, suggesting that highly porous β-TCP and BMAC can be a viable and effective adjunct to the fixation in midfoot joint arthrodesis.

The experience of cranioplasty outcome, management and its complication in neurosurgery

Background: Head trauma is the most common case encountered in neurosurgery, and it is on the rise daily; head trauma sometimes requires the removal of skull bone which leads to another set of complications and associated issues related to cranioplasty. The study's objective was to share the single-center tertiary care hospital experience of cranioplasty, including outcomes, management, and associated complications.&#x0D; Methodology: Patients who underwent reconstructive cranioplasty at the study site from 2015-2020 were examined in this retrospective descriptive study conducted at the department of neurosurgery, Jinnah postgraduate medical center, Karachi. Patients aged 18 to 60 years were considered for cranioplasty procedures, preceded by the decompressive post-craniotomy for brain trauma, skull fracture, intractable intracranial hypertension, brain tumor, and infected post-craniotomy bone flaps were included in the study.&#x0D; Results: A total of 68 patients who presented to the study center with cranial defects were included in this study. The frequent cause of cranioplasty was the traumatic injury to the brain in 38(55.88%), followed by brain tumors in 321(0.4%) and cerebrovascular injury in 9(13.23%) cases. In our study, no patient required more than one cranial procedure. The anatomical regional wise division of defects was temporal 29(42.64%), frontal 15(22%), and parietal 24(35.39%).&#x0D; Conclusion: Indications for cranioplasty, type of bone graft, associated comorbidities, and complications have been addressed that are potentially preventable.

Fusion Revision Surgery With Reamer-Irrigator-Aspirator to Harvest Autograft After Spinal Pseudarthrosis.

Background and purposeSpinal pseudarthrosis (SPA) is a common complication after attempted cervical or lumbosacral spinal fusion surgery. Revision surgeries usually necessitate bone graft implementation as an adjunct to hardware revision. Iliac crest bone graft is the gold standard but availability can be limited and usage often leads to persistent postoperative pain at the donor site. There is scant literature regarding the use of reamer-irrigator-aspirator (RIA)-harvested bone graft in lumbar spinal fusion. This is a collaborative study between orthopedic surgery and neurosurgery departments to utilize femur intramedullary autograft harvested using the RIA system as an adjunct graft in SPA revision surgeries.Materials and methodsA retrospective review was conducted at a single center between August 2014 and December 2017 of patients aged ≥ 18 years and diagnosed with cervical, thoracic, or lumbar SPA who underwent revision fusion surgery using femur intramedullary autograft harvested using the RIA system. Plain radiographs and CT scans were utilized to confirm successful fusion.ResultsEleven patients underwent 12 SPA revision surgeries using the RIA system as a source for bone graft in addition to bone morphogenetic protein 2 (BMP-2) and allograft. The mean amount of graft harvested was 51.3 mL (range: 20-70 mL). Nine patients achieved successful fusion (81.8%). The average time to fusion was 9.1 months. Four patients (36.4%) had postoperative knee pain. Regarding patient position and approach for harvesting, 66.7% (n = 8) of cases were positioned prone and a retrograde approach was utilized in 91.7% (n = 11) of cases.InterpretationThis is the first case series in known literature to report the RIA system as a reliably considerable source of autologous bone graft for SPA revision surgeries. It provides a useful adjunct to the known types of bone grafts. Patient positioning and the approach choice for graft harvesting can be adjusted according to the fusion approach and the surgeon’s preference.