Wedge Grafting Research Articles

Revision of failed bone grafting for nonunion of the scaphoid. Treatment options and results.

Failure of bone grafting in scaphoid nonunion presents the hand surgeon a perplexing set of problems. Controversy remains as to the best course of treatment in this difficult situation. The authors have retrospectively reviewed during a 5-year period the patients treated at the Mayo Clinic who have gone on to a second nonunion after a failed initial bone grafting procedure. Twenty-five patients were identified, 19 of whom had a second bone grafting procedure. Depending on the preoperative evaluation, 4 types of bone grafting procedures were performed: conventional Russe procedure, 4; Maltese cross bone graft procedure, 6; interpositional wedge graft, 5; and vascularized pedicle bone graft, 4. Twenty-two of 25 united (88%). Average followup at 57 months (range, 25-90 months), shows satisfactory results (16% very satisfied and 8% moderately satisfied), but varying degrees of pain. Results using a modification of the Mayo Wrist Score are somewhat disappointing with 3 excellent, 5 good, 10 fair, and 7 poor. It must be remembered, however, these wrists have had at least 2 surgeries, multiple long periods of immobilization, and often a delay in treatment with a prolonged period of abnormal carpal mechanics. It is thought that a second bone grafting attempt should be strongly considered. The key to success is matching the type of bone graft procedure to the specific unique features of scaphoid shortening, carpal instability, and proximal pole vascularity that each patient's wrist displays. A treatment algorithm is presented to help decision making in this difficult problem.

Bone-Graft Surgery

Bone-Graft Surgery

Translocatable leaf signal autoregulates soybean nodulation

In soybean ( Glycine max (L.) Merr.), expression of the hypernodulation phenotype appears to be controlled by the shoot. The current study attempted to localize the source of the nodulation signal in soybean cv. Wiliams 82 and its hypernodulating mutant NOD1-3. Wedge grafts (replacement of entire shoot) and approach grafts (addition of a shoot) were utilized and the shoot (scion) treatments ranged from complete shoots to various combinations of leaf, cotyledon, and apex removal from the grafted scion. Leaf-bearing wedge-grafted or approach-grafted scion types dictated the nodulation phenotype of the host plant. Scions with more leaves were clearly more effective in altering nodulation. Scions with leaves and without apices were as effective in altering nodulation as were scions with both leaves and apices. This confirmed the report by Delves et al. (Plant Cell Environ., 15 (1992) 249–254), but in neither case are results definitive as new buds continued to form which may provide stimulus for nodulation control. Leaf and shoot cuttings which were stimulated to form roots were also examined for expression of nodulation. Leaf cuttings, which were devoid of any meristematic apices, exhibited nodulation phenotypes similar to that of the shoot cuttints, i.e. leaf and shoot cutting of Williams 82 were normally nodulated while those of NOD1-3 were hypernodulated. The leaf cutting approach definitively showed that the leaf, and not the apex, was the synthesis site of a translocatable signal controlling autoregulation of nodule number.

Non-union of the scaphoid: Russe graft vs Herbert screw

The results of treatment in 50 consecutive patients with established non-union of the scaphoid are presented. All patients were treated under the care of a single consultant, for the same indications. Russe bone graft is compared with wedge bone graft plus Herbert screw fixation, in terms of union and function. Overall, a higher success rate was obtained by wedge graft plus Herbert screw, and a significantly better range of movement. However, Russe bone graft appears equally satisfactory for fibrous non-union.

Scaphoid non-union: Factors affecting the functional outcome of open reduction and wedge grafting with herbert screw fixation

50 patients with scaphoid non-union were treated by open reduction, anterior wedge bone grafting and internal fixation using the Herbert screw. Intra-operative image intensifier control enabled us to insert the screw into the scaphoid accurately. An excellent or good functional outcome was less likely when more than 5 years had elapsed since injury, the non-union was in the proximal third, when sclerosis of the proximal fragment was present, and when reduction of carpal and scaphoid deformity was unsatisfactory. These four factors are believed to be the primary determinants affecting the functional results of the surgical treatment of scaphoid non-union, even when bony union is achieved.

Illustrated Atlas of Cutaneous Surgery

Part 1 Patient preparation: informed consent antisepsis surgical facility anesthesia. Part 2 Basic skills: biopsy curettage electrosurgery cryosurgery suturing hemostasis. Part 3 Excision techniques: simple complex wedge grafts flaps healing by secondary intention dressings complications. Part 4 Other surgical techniques: Mohs nail dermabrasion and chemical peel acne scar surgery sclerotherapy collagen, fibrel, silicone, microlip injury rhinophyma co2 laser punch hair transplant surgery keloid surgery.

Studies on the root control of non-nodulation and plant growth of non-nodulating mutants and a supernodulating mutant of soybean ( Glycine max (L.) Merr.)

Ethyl methanesulphonate mutagensis of soybean cv. Bragg led to the isolation of three non-nodulating mutants: nod49, nod772 and nod139, as well as the supernodulation mutant nts382. Mutants nod49 and nod772 are allelic to naturally-occuring mutation rj 1 while nod139 is non-allelic and represents a newly found gene conditioning non-nodulation in soybean. Using the standard reciprocal wedge grafting technique it was shown earlier that non-nodulation in mutant nod49 is root controlled and supernodulation in mutant nts382 is shoot controlled. Non-nodulation in mutants nod772 and nod139 (the newly found non-nodulation gene in soybean) is also root controlled. In addition, scions of nts382 failed to alter the nodulation phenotype when grafted onto stocks of the non-nodulating lines. Lateral roots developing from the scion of nts382 and Bragg exhibited supernodulation and the wild-type pattern of nodulation, respectively, indicating that the lesion(s) conditioning non-nodulation only affect the root in a localized manner. Physiological studies conducted on the mutants indicate that they are not altered in the assimilation of nitrogen and carbon when grown on nitrate, and a study of their nitrogen contents indicate that the anomaly in the non-nodulation mutants is clearly specific for the nodulation process. This was confirmed by assaying nitrate reductase (NR) under a range of conditions; it was observed that the non-nodulation mutants expressed inducible NR and constitutive NR activity in a manner similar to the wild type.

Scaphoid non-union with D.I.S.I. deformity: A survey of clinical cases with special reference to ligamentous injury

To clarify whether or not scapho-lunate ligamentous injury is common in scaphoid non-union with D.I.S.I. deformity and whether ligamentous repair is required to treat scaphoid non-union with D.I.S.I. deformity, roentgenographic, arthrographic and arthroscopic findings were analysed and compared to those of scaphoid non-union without D.I.S.I. deformity. The carpal alignment of scaphoid non-union with D.I.S.I. deformity treated by reduction and anterior wedge grafting without ligamentous repair was also studied. No significant difference in the scapho-lunate gap was present between 26 patients with D.I.S.I. deformity and 20 without. No statistically significant difference was detected in the incidence of arthrographically-proved scapho-lunate ligamentous tears between the two groups. Arthroscopic examination carried out in 22 patients did not detect massive ligamentous injury, and carpal alignment was satisfactory in most patients who underwent anterior wedge grafting. These results show that ligamentous injury rarely causes D.I.S.I. deformity in scaphoid non-union, and anterior wedge grafting alone is sufficient to correct D.I.S.I. deformity in most cases.

MOSAIC DISEASE OF Stachytarpheta indica VAHL., A SOURCE OF VIRUS INFECTION TO CROP PLANTS

Stachytarpheta indica Vahl., a common verbenaceous weed in Kerala, was observed to be infected with a severe mosaic disease. The virus was easily transmitted by wedge grafting, sap inoculation and by the aphids, Aphis craccivora Koch.and Aphis gossypii Glov. The virus had a dilution end point (DEP) of 1: 750 1: 1000, thermal inactivation point (TIP) of 70-75°C end longevity in vitro (LIV) at room temperature (27-32°C) 48-72 h, and at refrigerated condition (5-10°C) 96-120 h. In the host range studies the virus infected seven test plants viz., Benincasa hispida, Cucumis sativus, Cucurbita maxima, Trichosanthes anguina (Cucurbitaceae), Nicotiana tabacum var. White Burley, Nicotiana tabacum var. Samsun (Solanaceae) and Stachytarpheta indica var. jamaicensis (Verbenaceae). Results of the studies on transmission, physical properties and host range of the virus indicated that this might possibly be a strain of Cucumis virus I.

Evidence for regulation following amputation and tissue grafting in the developing mouse limb.

Procedures are now available to experimentally manipulate postimplantation mouse embryos in situ and allow development to continue into postnatal life (Muneoka, K., N. Wanek, and S.V. Bryant (1986) J. Exp. Zool., 239:289-293). We have investigated the ability of the well-formed hindlimb bud to regulate following two experimental operations: amputation and wedge grafts designed to confront anterior and posterior cells. After comparing the resultant limbs with the fate maps of the relevant stages, we conclude that the developing hindlimb bud at stage 7/8 (equivalent to stage 27/28 of the chick) is capable of partial regeneration of the peripheral digits following amputation and capable of supernumerary digit tip formation after grafting of a wedge of anterior tissue to a posterior position.

Scaphoid nonunion: Role of anterior interpositional bone grafts

Twenty-one cases of unstable fractures of the scaphoid were treated by open reduction, length restoration by interpositional anterior wedge grafting, and fixation with a Herbert screw to obtain union and restore carpal stability. There was primary union in 15 (71%) of 21 patients. Two failed cases were treated with a second anterior wedge graft and Herbert screw fixation; overall rate of union was 81%. Nonunions were related to improper screw placement, failure of compression at the nonunion, bone-graft resorption, or persistent avascular necrosis. In the united scaphoids, carpal instability was corrected, with improvement in the scapholunate angle (65 degrees to 54 degrees) and capitolunate angulations (35 degrees to 15 degrees). Scaphoid malalignment associated with nonunion was improved on biplanar tomographic measurement of the scaphoid angles.

Non-union of the scaphoid: Russe graft vs Herbert screw

The results of treatment in 50 consecutive patients with established non-union of the scaphoid are presented. All patients were treated under the care of a single consultant, for the same indications. Russe bone graft is compared with wedge bone graft plus Herbert screw fixation, in terms of union and function. Overall, a higher success rate was obtained by wedge graft plus Herbert screw, and a significantly better range of movement. However, Russe bone graft appears equally satisfactory for fibrous non-union.

Non-Union of the Scaphoid: Russe Graft vs Herbert Screw

The results of treatment in 50 consecutive patients with established non-union of the scaphoid are presented. All patients were treated under the care of a single consultant, for the same indications. Russe bone graft is compared with wedge bone graft plus Herbert screw fixation, in terms of union and function. Overall, a higher success rate was obtained by wedge graft plus Herbert screw, and a significantly better range of movement. However, Russe bone graft appears equally satisfactory for fibrous non-union.

ZIELKE INSTRUMENTATION (VDS) FOR THE CORRECTION OF SPINAL CURVATURE. ANALYSIS OF RESULTS IN 66 PATIENTS

Sixty-six patients who underwent anterior spinal fusion with Zielke instrumentation for thoracolumbar and lumbar curvatures were reviewed. Results compared favorably with reported series in which the Dwyer instrumentation system was used. The best corrections were obtained in the idiopathic single-curve group (45% correction of upper curve, 87% correction of lower curve, and 95% correction of instrumented curve) as compared with the double-curve group (33% correction of upper curve, 53% correction of lower curve, and 62% correction of instrumental curve). Vertebral body lateral translation (subluxation) was completely corrected in 87% of the patients. Instrumentation kyphosis can be prevented by placement of anterior wedge grafts in the intervertebral spaces. Complications were frequent but usually insignificant. The use of the Zielke instrumentation system offers the advantage of improved ability to derotate the spine while obtaining significant curve correction in a short fusion area.

Zielke Instrumentation (VDS) for the Correction of Spinal Curvature

Sixty-six patients who underwent anterior spinal fusion with Zielke instrumentation for thoracolumbar and lumbar curvatures were reviewed. Results compared favorably with reported series in which the Dwyer instrumentation system was used. The best corrections were obtained in the idiopathic single-curve group (45% correction of upper curve, 87% correction of lower curve, and 95% correction of instrumented curve) as compared with the double-curve group (33% correction of upper curve, 53% correction of lower curve, and 62% correction of instrumental curve). Vertebral body lateral translation (subluxation) was completely corrected in 87% of the patients. Instrumentation kyphosis can be prevented by placement of anterior wedge grafts in the intervertebral spaces. Complications were frequent but usually insignificant. The use of the Zielke instrumentation system offers the advantage of improved ability to derotate the spine while obtaining significant curve correction in a short fusion area.

Does anterior (non-polarizing region) tissue signal in the developing chick limb?

The morphogenetic properties of embryonic chick limb bud tissue from anterior positions and from the posterior (polarizing) region are compared. Quail grafts, which possess the distinctive nucleolar cell marker, and γ-irradiation are used. Supernumerary limb structures induced by anterior tissue wedge grafts are found to be nearly exclusively graft, donor tissue derived. This contrasts with the duplicate limb structures formed in response to posterior (polarizing region) tissue grafts in which host cells predominate. Distinction between anterior and posterior tissue properties was also demonstrated using doses of radiation (∼ 12 Gy = 1200 rad) which inhibit cell proliferation, but have negligible effects on avian polarizing activity. These doses, however, are found to completely abolish morphogenetic activity by chick or quail anterior tissue grafts. The results of anterior (nonpolarizing) region tissue grafts are best interpreted as graft self-differentiation under the influence of a posterior signalling region, whose properties in the limb bud are demonstrably unique.

An Improved Technique for Making Wedge Grafts in Soybean Plants1

AbstractThe design and use of a grafting block for making uniform and reproducible wedge grafts in soybean (Glycine max (L.) Merr.) plants is presented. The grafting block was prepared from plexiglass measuring 14 ✕ 10 ✕ 1.2 cm. A slot to hold the scion was cut at a 2.5‐degree angle to the face of the block. The slot measured 4 cm in length, 0.3 cm in width, and varied in depth from 0.15 cm at the edge of the block to 0.0 cm at its termination point. The slot enabled a precise positioning of the scion for making the wedge cut. The block was used to successfully produce grafted plants which vary in the number of scions and roots. Six wedge grafts with different top:root ratios are described. The grafting block reduced the time required to make a graft and it gave an increase in the survival percentage of grafts. The uniformity of the wedge graft facilitated the interfacing of the scion‐root stock tissues, resulting in a more rapid recovery and uniform growth of the plant.