Search

Objective: Comparison between bovine-derived demineralized bone matrix (DMBM) and iliac crest graft over long term for secondary alveolar bone grafting (SABG) in patients with unilateral cleft lip and palate (UCLP) in terms of radiological and clinical outcomes. Design: Prospective, randomized, parallel groups, double-blind, controlled trial. Setting: Unit of Oral and Maxillofacial Surgery, Oral Health Science Centre, Postgraduate Institute of Medical Education & Research, Chandigarh. Participants: Twenty patients with UCLP. Interventions: Patients were allocated into group I (Iliac crest bone graft) and group II (DMBM) for SABG. Outcomes were assessed at 2 weeks, 6 months, and then after mean follow-up period of 63 months. Outcomes Measures: Volumetric analysis of the grafted bone in the alveolar cleft site was done through cone beam computed tomography using Cavalieri principle and modified assessment tool. Clinical assessment was performed in terms of pain, swelling, duration of hospital stay, cost of surgery, alar base symmetry, and donor site morbidity associated with iliac crest harvesting. Results: Volumetric analysis through Cavalieri principle revealed comparable bone uptake at follow-up of 6 months between group I (70%) and group II (69%). Modified assessment tool showed no significant difference between horizontal and vertical bone scores over short- and long-term follow-up. In group II, there was higher cost of surgery, but no donor site morbidity unlike group I. Conclusions: Demineralized bone matrix proved analogous to iliac crest bone graft as per volumetric analysis over shorter period. However, although statistically insignificant, net bone volume achieved was lower than the iliac crest graft at longer follow-up.

Large bone defects or complex pseudarthrosis represent an interdisciplinary challenge. Established surgical procedures include autogenous cancellous bone graft, the Masquelet technique or bone transfer via segment transport as well as free microvascular bone transplantation. However, the successful use of all these techniques requires a specialized center with great interdisciplinary expertise. In the following case series we describe the technique of free fibula transplantation and additional allograft. In both cases a good functional result with full mechanical strength of the affected extremity and satisfactory patient comfort has been achieved. In the second case, implant failure with the necessity of revision endoprosthetics occurred during the procedure.Höhergradige größere Knochendefekte oder komplexe Pseudarthrosen stellen eine interdisziplinäre Herausforderung dar. Als etablierte Operationsverfahren stehen die autologe Spongiosaplastik, die Masquelet-Technik oder der Knochentransfer über einen Segmenttransport, aber auch die freie Knochentransplantation zur Verfügung. Prinzipiell erfordert der erfolgreiche Einsatz aller genannten Techniken ein spezialisiertes Zentrum mit großen interdisziplinären Kompetenzen. In 2 Kasuistiken wird die Technik der freien Fibulatransplantation mit additivem Allograft dargestellt. In beiden Fällen konnte letztendlich ein gutes funktionelles Ergebnis mit voller Belastbarkeit der betroffenen Extremität und zufriedenstellendem Patientenkomfort erzielt werden. Im 2. Fall kam es im Verlauf zu einem Implantatversagen mit der Notwendigkeit der revisionsendoprothetischen Versorgung.

Background: Autogenous cancellous bone graft and bone marrow aspirate are commonly used in lower extremity fusion procedures to enhance fusion potential, and frequently in revision situations where bone loss and osteolysis may be a feature. The tibial metaphysis is a common donor site for bone graft, with the procedure typically performed using a curette or trephine to harvest the cancellous bone. Some limitations of this technique include suboptimal harvest of the marrow portion in particular, incomplete graft harvest, and loss of graft material during the harvest process. We describe a novel vacuum-assisted bone harvesting device to acquire cancellous bone and marrow from the proximal tibia. Methods: This is a retrospective study of a single surgeon’s consecutive patients who underwent foot and ankle arthrodesis procedures using proximal tibia autograft obtained using a vacuum-assisted bone harvesting device. Descriptive statistics were used to summarize patient and operative characteristics and outcomes. We identified 9 patients with a mean age of 51 years, 4 of whom were female. Results: On average, the skin incision was slightly more than 2 cm, and 27 mL of solid graft and 16 mL of liquid phase aspirate were collected. At 6 weeks after the procedure, there was minimal to no pain at the donor site, and we did not observe any fractures or other complications. Conclusions: We report the use of a novel vacuum-assisted curette device to harvest bone graft from the proximal tibial metaphysis for use in foot and ankle fusions. This device has been reliable and efficient in clinical practice. Level of Evidence: Level IV, retrospective case series.

Background The objective of this study is to assess prospectively the effectiveness of double-plate fixation combined with autogenous cancellous bone graft in the treatment for the atrophic clavicular nonunion. Methods Between February 2013 and November 2017, a total of 12 patients with atrophic clavicular nonunion (mean age, 40.4 ± 9.0 years, range, 27–60 years) were treated by double-plate fixation with autogenous cancellous bone graft in our institute. The Constant Score System was used to evaluate the preoperative and final outcomes. The Short Form-36 (SF-36) outcome questionnaire was used to assess the final clinical results. Results All patients were followed-up, with the average follow-up of 34.7 ± 6.7 months (range, 24–48 months). The healing rate was 100% in our study. The mean time of bony union was 9 weeks (range, 8–10 weeks). One patient had a postoperative superficial infection, and the patient was cured by oral antibiotics and wound dressing. No implant-related complications (plate-screw loosening or breakage) were observed postoperatively. No vascular injury, neural impairment, or thoracic outlet syndrome was discovered preoperatively or postoperatively. There is a statistical significance between the preoperative and the postoperative constant scores (P < 0.05). All the patients were satisfied with their final clinical results by SF-36 outcome questionnaire. Average scores of the physical function and bodily pain components of the SF-36 were 94.2 ± 7.3 and 92.5 ± 5.8, respectively. Conclusion Our results presented that double-plate fixation with autogenous cancellous bone graft is an effective treatment for atrophic clavicular nonunion, especially for those with a significant bone defect.

Objective To retrospectively investigate a novel surgical technique using the Fitz Intervertebral Traction Screw (FITS) combined with string-of-pearl (SOP™) locking plates for the treatment of Disc Associated Wobbler Syndrome (DAWS). Study design Case series (n = 16). Methods Ventral approach and fenestration of the affected disc(s), nuclear extirpation, and insertion of the FITS device to the level of the dorsal annulus was followed by application of one or two 3.5 mm SOP™ plates. Autogenous cancellous bone graft was placed between adjacent vertebrae. Long-term followup (>12months) via telephone or examination was attempted for all dogs. Results Case records of 16 dogs were reviewed. All dogs had Type II disc disease with a single site in 13 dogs and multiple sites in 3 dogs. Mean ± SD age was 75 ± 38 months and body weight was 34 ± 7 kg. Fifteen of the 16 dogs had significantly improved neurologic status (P =.01) at 6 weeks. Seven of the 16 dogs were examined at 24–36 months with 6 considered normal and 1 had mild ataxia. Postoperative radiographic intervertebral distraction was significant (P = .01). Radiographic bridging was recorded in 10/16 dogs at 6 weeks and in 7 dogs available for follow-up at 5–36 months. Computed tomography in 3 dogs at 24–36 months and postmortem with histology in 1 dog confirmed bone-bridging. Complications were not considered clinically significant and included implant loosening (2 dogs, both single plates) and minor end-plate subsidence (8 dogs). Conclusion Application of the FITS device in combination with 2 ventral SOP™ locking plates and autogenous cancellous bone graft was associated with excellent outcomes in dogs treated for DAWS in this small case series.

Icariin (Ica), the main active component of Herba Epimedii, has been identified as an osteogenic and angiogenic phytomolecule. To develop a bioactive scaffold for enhancing bone repair, Ica was loaded into porous tricalcium phosphate (TCP) scaffolds, and the obtained porous Ica/TCP composites were investigated for treating osteonecrosis of the femoral head (ONFH) in a rabbit model. ONFH was histopathologically confirmed at two weeks after methylprednisolone acetate injection, and the rabbits were treated with porous Ica/TCP scaffolds (group A), porous TCP scaffolds (group B), and autogenous cancellous bone graft (group C). At 12 weeks, the amount of newly formed bone in group A increased significantly compared with that in group B ( P = 0.003). The mean histological and radiological scores for repaired defects in group A were significantly higher than those in group B ( P = 0.007, P = 0.029, respectively), but were lower than those in group C ( P = 0.032, P = 0.046, respectively). In addition, the expression of vascular endothelial growth factor by immunohistochemical testing and real-time polymerase chain reaction in group A was significantly higher than that in group B ( P = 0.002, P = 0.001, respectively), but was lower than that in group C ( P = 0.034, P = 0.005, respectively). Therefore, Ica can be a promising osteogenic and angiogenic compound for repairing bone defects and preventing the collapse of the femoral head in ONFH.

Objective To compare radiographic healing and clinical outcome of a frontal-opening wedge osteotomy of canine tibiae when the osteotomy site is packed with either a novel bovine xenograft or standard autogenous cancellous bone graft (ACBG). Study Design Cohort study. Animals Dogs (n = 82) with partial or complete rupture of the cranial cruciate ligament that had tibial tuberosity advancement (TTA). Methods In 48 dogs, the osteotomy was packed with a novel bovine xenograft and in 34 dogs, ACBG was used. Eight week postoperative radiographs from both groups were graded for osteotomy healing using a 0–4-point scale. Data were analyzed using a Mann–Whitney test with significance set at P < .05. Results Thirty-four dogs (39 stifles) with xenoimplants had complete records and radiographic follow-up at 8 weeks. No significant differences between xenografting and autografting were identified in grading of osteotomy fill, osteointegration, or healing of the distal osteotomy. Significant differences were noted in grading of osteotomy healing proximally (autograft > xenoimplant) and of opacity in the osteotomy site (xenoimplant > autograft). Conclusions Radiographic evidence of healing of the xenoimplanted portion of the TTA osteotomy was equivalent to results with ACBG. Healing of the proximal osteotomy site (above the cage) was improved when ACBG was used as the graft.

Objective: To assess the effect of autogenous cancellous bone graft (autograft) and novel plate use on radiographic healing and complications in tibial tuberosity advancement (TTA) for treatment of cranial cruciate ligament (CrCL)-deficient stifles in dogs. Study Design: Prospective clinical study. Animals: Consecutive dogs (n=125) with unilateral CrCL-deficient stifles. Methods: Four treatment groups: CPG, conventional plate with autograft; CPNG, conventional plate without autograft; NPG, novel plate with autograft; NPNG, novel plate without autograft were studied. Radiographs from 60 dogs were scored for healing at 6 and 10 weeks postoperatively; all 125 dogs were assessed for radiographic complications. Variables evaluated for relationship with healing scores and radiographic complications were age, weight, sex, cage and plate size, implant type, and graft use. Results: Dogs with autograft had overall higher healing scores at 6 and 10 weeks. Radiographic complications occurred in 13 dogs (12 minor, 1 major), and were not influenced by graft or novel plate use. Conclusion: Autograft increases healing scores, but was not found to have a significant impact on the rate of complications in TTA. The novel plate was not found to have healing scores or radiographic complication rates significantly different from the conventional plate design.

Objective: To evaluate and compare healing, with and without the use of bone graft, of the gap created during tibial tuberosity advancement (TTA). Study Design: Prospective study and case series. Animals: Dogs treated with TTA (n=67). Methods: Prospective study: Mediolateral radiographic projections (6 weeks and 4 months) after TTA without use of bone graft (group I, n=14) were compared with radiographs of consecutive TTA in which the gap was filled with autologous cancellous bone graft (group II, n=14). Two scoring techniques (A, B) were used. Score A was used to grade the overall osteotomy healing (0=no healing, 4=healed osteotomy). Score B evaluated, independently of each other, healing in 3 sites: proximal to the cage (B1), between cage and plate (B2), and distal to the plate (B3). Case series: nongrafted TTA (4-25 weeks, n=39) were evaluated for healing (Score A). Data was analyzed using t-tests and ANOVA. Significance was set at P≤.05. Results: Prospective study: Score A, B2, and B3 showed no difference in healing between groups at 6.8 weeks and 4.2 months. Score B1 revealed, in both rechecks, a significantly higher density in group II. Case series: Radiographs at 11.59±5.99 weeks scored 3.3 (2-4). No healing related complications were observed. Conclusion: The osteotomy gap created during TTA healed within expected time regardless of bone graft use.

Bone grafting is the transplantation or implantation of bone or a bone substitute into a site to replace missing bone or to enhance bone healing. This chapter looks at autografts; allografts; grow factors; mesenchymal stem cells and tissue engineering; alloplastic grafts; ideal bone graft properties. Operative technique: Harvesting of an autogenous cancellous bone graft.

Objectives: To compare optical values in the osteotomy gap created after a Tibial Tuberosity Advancement (TTA) treated with autogenous cancellous bone graft (ACBG), extracorporeal shock wave therapy (ESWT), a combination of ACBG and ESWT, and absence of both ACBG and ESWT using densitometry. Methods: Dogs presenting for surgical repair of a cranial cruciate ligament rupture were randomly assigned to one of four groups; TTA with ACBG (TTA-G), TTA with ACBG and ESWT (TTA-GS), TTA with ESWT (TTA-S), and TTA with no additional therapy (TTA-O). Mediolateral radiographs at 0, 4 and 8 weeks after surgery were evaluated to compare healing of the osteotomy gap via densitometry. An analysis of variance (ANOVA) statistical analysis was used to compare the densitometric values between groups. Results: At 4 weeks after surgery, a significant difference in osteotomy gap density was noted between TTA-GS (8.4 millimeters of Aluminum equivalent [mmAleq]) and TTA-S (6.1mmAleq), and between TTA-GS (8.4 mmAleq) and TTA-O (6.4 mmAleq). There were no significant differences noted between groups at the 8 week recheck. Clinical Significance: There were no significant differences in the osteotomy gap density at 8 weeks after surgery regardless of the treatment modality used. The combination of ACBG and ESWT may lead to increased density of the osteotomy gap in the first 4 weeks after surgery. Densitometry using an aluminum step wedge is a feasible method for comparison of bone healing after TTA in dogs. Master of Science

Trapezium fractures comprise approximately 3% to 5% of all hand fractures. Although operative management of intra-articular trapezium fractures can result in good functional outcomes, there is very little literature addressing specific operative techniques. We describe a technique for open reduction and internal fixation of severely comminuted, intra-articular trapezium fractures, utilizing autogenous cancellous bone graft from the distal radius.

Background:Fresh autogenous cancellous bone graft is the material of choice in reconstruction and fusion procedures in foot and ankle surgery. There are many potential donor sites for graft harvest, all with recognized minor and major complications. The proximal tibia is one such potential site and is particularly suited to foot and ankle surgery, because it is within the operative field and under tourniquet control.Methods:A retrospective review was performed of 148 procedures using bone graft from the proximal tibia performed over a period of 5 years. Minimum followup was 3 months. Data were obtained from operative notes and patient interviews to establish pain, morbidity, and overall satisfaction.Results:Most patients had no pain (78%) or very mild pain (20%) at the site of graft harvest immediately after surgery. At followup, 96% had no pain and 4% had very mild pain with certain activities such as kneeling. There were no major complications. Four patients (2.7%) had persisting areas of paresthesia at followup, but none were troubled by it. One patient had a superficial wound infection that resolved. The period of nonweightbearing, usually 2 to 3 weeks, was dictated by the primary procedure. There were no complications related to early weightbearingConclusions:The proximal tibia is a suitable and safe site for bone graft harvest for foot and ankle surgery. There is no need for additional restrictions in weightbearing after this procedure.

Many approaches are used to repair skeletal defects in reconstructive orthopaedic surgery, and bone grafting is involved in virtually every procedure. The type of bone graft used depends on the clinical scenario and the anticipated final outcome. Autogenous cancellous bone graft, with its osteogenic, osteoinductive, and osteoconductive properties, remains the standard for grafting. However, the high incidence of morbidity during autogenous graft harvest may make the acquisition of grafts from other sources desirable. The clinical applications for each type of bone graft are dictated by the structure and biochemical properties of the graft. An elegant cellular and molecular cascade follows bone transplantation. Bone graft incorporation within the host, whether autogenous or allogeneic, depends on many factors: type of graft (autogenous versus allogeneic, vascular versus nonvascular), site of transplant, quality of transplanted bone and host bone, host bed preparation, preservation techniques, systemic and local disease, and mechanical properties of the graft.

Introduction: The harvesting of autogenous cancellous bone graft has many uses in foot and ankle surgery. The most common referenced donor sites are the iliac crest, distal tibia, and calcaneus. These all have demonstrated limitations, the high morbidity rate associated with the iliac crest and the poor quantity of graft from distal sources. Materials and Methods: Between April 1995 and February 2000, 155 patients were retrospectively indentified who had undergone a foot or ankle procedure utilizing the ipsilateral, proximal tibia as the donor site for autogenous cancellous graft. The patients were 18 years or older with no history of previous bony surgery to the tibia used and no history of previous injury or pain in the knee. The group included patients with isolated reconstructions as well as multiextremity trauma patients. All were kept nonweightbearing on the involved extremity for a minimum of 6 weeks postoperatively. Results: There were 90 male and 65 female patients. The average age was 41 years and 5 months. There were 51 smokers averaging 17.6 pack years (range, 1-50 pack years). Twenty-six patients were admitted alcoholics, and 12 admitted to prior intravenous drug use. Cancellous graft was utilized in both traumatic and reconstructive settings. Eighty-nine fractures in 86 patients received grafting. Sixty-nine reconstructions or fusions of the hindfoot or midfoot were done using this technique. There were no reported major complications due to this procedure. No fractures, infections, or wound breakdowns occurred during this study. There were no reported long-term problems with knee pain or function. There was one postoperative hematoma that resolved over time. There were three incidents of sensory changes at the incision site. Conclusion: The use of the ipsilateral proximal tibia as a source for autogenous cancellous bone graft is a procedure with low added morbidity and a source of adequate graft material.

SummaryThe incorporation of autogenous cortico-cancellous bone graft (CCBG) harvested from the wing of ilium using a powered acetabular reamer and autogenous cancellous bone graft (CBG), harvested from the proximal humerus by curettage, were compared in four young adult mixed breed female dogs. Five milliliters of CCBG or CBG were placed in bilateral, stable, 3.0 cm proximal diaphyseal ulnar defects. Humeral donor sites, and subsequent assignment of graft types of ulnar recipient sites, were alternated between dogs. Craniocaudal and lateral view radiographs were obtained immediately (day 0) and on days 16 and 35 after the operation. Photodensitometric and bone graft area measurements were made from these radiographs and the specific radiographic characteristics of the bone grafts were described at each time interval. Each dog received a series of intravenous fluorochrome label injections on days 23, 28 and 33. The dogs were humanely euthanatized on day 35. The bone graft recipient sites were harvested, processed and the descriptive histological and histomorphometric parameters were evaluated.A statistically significant difference in photodensitometric measurements was not seen between the CCBG and CBG. However, there was a statistically significant increase in the graft area of the CCBG from day 0-16. Mineral apposition rate was significantly greater, (P = 0.005) for the CCBG (mean = 4.8) than for the CBG (mean = 3.7), suggesting that the CCBG appears to be in an earlier more osteogenic phase of incorporation than the CBG. There was a trend which suggested that the percentage of trabecular bone volume was greater (P = 0.11) for the CBG (mean = 43.0) than for the CCBG (mean = 32.0). Other significant differences were not found, with respect to the other morphometric parameters measured. The descriptive histology and subjective radiographic evaluation were the most effective ways of readily distinguishing between the two types of bone graft and they demonstrated that the CBG had incorporated more completely than the CCBG by day 35.Presented at the 30th Annual Meeting of the American College of Veterinary Surgeons, Chicago, Illinois 1995 and at the 23rd Annual Meeting of the Veterinary Orthopaedic Society, Telluride, Colorado 1996

Summary The indication for open reduction and internal fixation of comminuted fractures of the calcaneum is still controversial. The authors examined 36 comminuted intra-articular fractures clinically and radiologically in 35 patients with a mean age of 36 years (6–64 years) at a mean follow-up of 38 months (18–72 months). The results were classified according to Sanders using conventional radiograms, computed tomography (CT) data and operative findings: six Type II, 22 Type III and eight Type IV. All cases underwent open reduction and internal fixation (ORIF) using an extended postero-lateral approach and, in four cases, an additional medial approach. In all Type III and IV fractures an autogenous cancellous bone graft was used. Clinical evaluation was performed using the functional score according to Kitaoka. Type II fractures averaged 92/100 (65–100), Type III 79/100 (64–97) and Type IV 69/100 (48–87). One Type III and three Type IV fractures required subsequent subtalar fusion. At follow-up, bone axes about the hindfoot were radiologically normal in all Type II, in 17/22 of Type III (77%) and in 5/8 of Type IV (63%) fractures. Severe arthrosis developed in 1/6 of Type II (17%), 5/22 of Type III (23%) and in 4/8 of Type IV (50%) fractures. These results suggest that anatomical reconstruction of fractures of the calcaneum is indicated even in highly comminuted fractures with an acceptable rate of subsequently needed subtalar fusion. In the latter cases, subtalar fusion is much easier and safer to perform.

The results of 12 dogs with antebrachial deformity treated by ulnar ostectomy, radial osteotomy and external skeletal fixation are presented. Postoperative complications were seen in only one dog; a delayed union requiring placement of autogenous cancellous bone graft at a second surgery to achieve healing. Postoperatively, owners reported limb function was good in almost all cases, although they were less pleased with the cosmetic appearance.

The distal interphalangeal joint was successfully arthrodesed in two horses using three parallel 5.5-mm cortical screws and an autogenous cancellous bone graft. The screws were directed from the palmar proximal border of the second phalanx dorso-distally across the joint space and into the third phalanx. The technique was first developed on a normal horse. The second horse, a clinical case, ruptured its deep digital flexor tendon with complete luxation of the distal interphalangeal joint. Bony fusion of the distal interphalangeal joint occurred in both horses, but both also had residual lameness at a walk. Twenty-one months after the arthrodesis procedure, the clinical patient died from complications related to a subsolar abscess in the operated limb.

SummaryA two-and-half-year-old cow was presented with a defect nonunion of the right metatarsal III/IV bone following a severely comminuted open fracture two months previously. The animal underwent open fixation using a 4.5 mm, broad, 10-hole, dynamic compression plate and autogenous cancellous bone graft collected from the contralateral iliac shaft. The animal started partial weight bearing after the third postoperative day and resumed complete weight bearing after the 10th day. Fracture healing was complete and the implants were removed after the 120th postoperative day. Stable fixation by means of a bone plate in conjunction with a cancellous bone graft facilitated complete healing and restoration of the bone column of the defect and the metatarsal fracture. The animal made a complete recovery.

Nonunion after intramedullary nailing of femoral and tibial fractures, although infrequent, remains a challenge for orthopedic surgeons. Augmentation plate fixation can be a reasonable choice in this situation. From 2003 to 2005, 38 patients (25 femoral nonunions and 13 tibial nonunions) were treated after intramedullary nailing with augmentation plate fixation, leaving the nail in situ, with or without autogenous cancellous bone graft. Patients were followed for at least 1 year postoperatively. All 25 femoral nonunions healed with solid union (100% union rate), but 2 of 13 tibial nonunions remained symptomatic and did not achieve union (84.6% union rate) at a mean 4.78 months postoperatively (range, 1-6 months). No serious complications were encountered at 1-year follow-up. We suggest augmentation plate fixation for femoral and tibial nonunion after intramedullary nailing.

SummaryA 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 wh

Autogenous cancellous bone was procured from the proximal ends of one humerus and the contralateral tibia of eight adult mixed-breed dogs. Greater weights of bone were consistently harvested from the humerus than from the tibia. Restoration of cancellous bone was more rapid and complete in the humerus than in the tibia. The tibial harvest site filled primarily with fibrous tissue rather than with cancellous bone.

The case of a 25-year-old man with osteonecrosis of the hamate is reported. He had pain and swelling in his right wrist. The diagnosis was accomplished with plain radiographs as well as with MRI. The case was treated surgically that included resection of the necrotic bone. The occured cavity was filled with autogenous cancellous bone graft. In addition, capito-hamate arthrodesis was performed. Histopathological examination following the operation demonstrated avascular necrosis of the hamate. The arthrodesis was obtained four months after the operation.

A mature mixed breed dog was evaluated for acute onset of non-weight-bearing lameness involving the right hind limb. The dog had, reportedly, walked normally for the previous three years. A diagnosis of acute displacement of a functional femoral pseudoarthrosis was made. The pseudoarthrosis was stabilized using a dynamic compression bone plate and an autogenous cancellous bone graft. The dog was walking normally five months after the operation.

While gap defect models provide greater graft stability and are more representative of many clinical situations than segmental defect models, the healing in these models has not been well documented. To study the histologic course of cancellous bone graft healing in a long bone gap defect, 12 adult mongrel dogs were killed in groups of two at 1, 2, 3, 4, 6, and 12 weeks. Graft incorporation in these dogs was studied using macro- and microradiography, histologic sections, and computer-assisted digital surface analysis ; results are described. Unlike that seen in segmental defect models, the pattern of repair in a cancellous bone grafted gap defect provides consistent healing at 12 weeks and follows the same healing process seen with stable defects.

Frontal sinus fractures make up about 2-15% of all facial fractures.This is relatively low frequency of occurrence, but it has a large potential of complication and may involve not only the frontal sinuse but more importantly the brain and the eyes. The management depends of the complexity. If anterior wall is fractured with grossly involved nasofrontal duct (NFD) in the injury it is paramount to occlude NFD. Very often, sinus obliteration is done at the same time. In our expirience autogenous cancellous bone graft is considered to be the best grafting material. It has the less short - or long-term complications and the donor site morbidity is insignificant.

목 적: 상완골 간부 골절의 불유합율은 저자에 따라 5%에서 15%까지 비교적 높은 불유합율을 보고하고 있으며 그 치료법에 있어서도 다양 한 의견들이 보고되고 있는 바, 본 저자들은 상완골 불유합에 대하여 금속판 고정술 및 자가 해면골 이식술을 통한 수술적 치료 결과를 평가 하고자 하였다. 대상 및 방법: 1998년 3월부터 2002년 3월까지 본원 정형외과에서 상완골 간부 골절 불유합에 대하여 수술적 치료를 받은 20명의 환자를 대 상으로 하였으며, 평균 추시 기간은 33개월이었고 남자 9예, 여자 11예로 평균 연령은 45세였으며 유병 기간은 평균 23개월이었다. 수술은 전 예에서 불유합 부위의 기존 삽입물을 제거한 후 골절 부위의 섬유 조직 및 골절면의 괴사 골 조직을 제거하여 혈액 순환이 좋은 골 부위를 노출시켰으며 이 과정에서 일부 상완골의 단축술이 병행되었다. 이 후 금속판을 이용하여 내고정을 시행하였고 자가 해면골 이식술을 시행하 였다. 추시상 검사한 단순 방사선 결과로 골유합을 확인하였다. 결 과: 전 예에서 완전한 골유합을 얻었으나 이 중 1예에서는 1차 수술 후 합병증으로 감염이 발생하여 내고정물 제거 후 염증이 사라진 다 음 골수강내 금속정 삽입술을 2차로 시행한 후 완전한 골유합을 얻을 수 있었고 다른 1예에서는 본원 내원 당시 감염성 불유합 소견을 보여 2 차례에 걸쳐 염증 제거술을 시행한 후에야 금속판 내고정술을 이용하여 골유합을 얻을 수 있었다. 결 론: 상완골 간부 골절 불유합 치료시 다양한 방법들이 보고되고 있으나 저자들의 경우 금속판 내고정술 및 자가 해면 골 이식술을 이용하 여 만족스러운 결과를 얻을 수 있었다.

Patients requiring cancellous bone grafting of an extensive deficit or multiple bone grafting procedures often lack a sufficient quantity of autogenous cancellous bone. Canine studies have indicated that a potential exists for reharvesting autogenous cancellous bone from an iliac crest donor site using a trapdoor harvesting technique. However, significant human experience with this procedure has been lacking. This report describes four patients who underwent successful reharvesting of an iliac crest donor site that provided clinically sufficient autogenous cancellous bone graft material to treat an ongoing or a new skeletal problem. These patients all met specific criteria regarding use of the trapdoor method of bone graft harvest and a minimum 24-month interval between bone grafting procedures. Preoperative computed tomography scanning of the iliac crest was useful in documenting that sufficient cancellous bone was available for reharvest. It appears that iliac crest donor site reharvesting is a specific advantage of the trapdoor technique and is a possible alternative to multiple site grafting or the use of allograft or bone substitute materials.

ummary The clinical features, diagnosis and radiological findings of eight cases of a subchondral bone cyst involving the medial condyle of the femur are described. Surgical treatment, which comprised performing an arthrotomy of the femorotibial joint, curetting and packing the cystic cavity with an autogenous cancellous bone graft, is described. Resume On decrit les carateres cliniques, le diagnostic et les observations radiographiques de huit cas de kystes sous chondraux du condyl medial (interne) du femur. Le traitement chirurgical est decrit: il implique une arthrotomie femoro tibiale, le curettage puis le remplissage de la cavite kystique avec un greffon osseux autogene. Zusammenfassung Die klinischen Erscheinungen, die Diagnose und die radiologischen Befunde von acht Fallen mit subchondralen Knochenzysten am medialen Condylus des Femurs werden beschrieben. Die chirurgische Behandlung bestand in einer Arthrotomie des Femoro-Tibialgelenks, Curettage und Auffullen dur Zystenhohle mit autogenem Spongiosamaterial.

A commercially available collagen sponge acting as a cylindrical retainer containing autogenous cancellous bone graft was proposed for treatment of full thickness cortical defects in dogs. Three groups of three dogs each were subjected to removal of at least 1.5 cm of the tibial diaphyses. All tibias were stabilized with bilateral external fixators. Group 1 received collagen surrounding an autogenous cancellous bone graft. Group 2 received collagen and group 3 received no treatment of the ostectomy site. The collagen sponge appeared to allow vascularization of the bone graft as evidenced by new bone formation and was resorbed by 3 months after implantation. Radiographic, histomor-phologic, and histomorphometric evaluation at 3 months after surgery showed a greater per cent of bone in the ostectomy site in group 1.

The use of autogenous bone graft to repair major defects is most feasible biologically. When the bone could not be shaped or carved to fit a given defect, the use of solid alloplastic biomaterial implants gained wide popularity. We are describing a new method wherein a “combination” graft is used. It possesses the advantage of the dependence on autogenous cancellous bone graft, and the added bone inducing capability of a recently developing biomaterial implant (Polyurethane-Terephthalate). The results obtained in the repair of major defects in patients after ablative surgery, or as sequelae of trauma, document the advantages of this new mode of treatment. In selected patients with major defects due to deficiency or absence of the osseous framework of the face, the use of “combination” grafts has proven to be the most appropriate form of repair.

Summary The results of surgical treatment of 10 subchondral bone cysts, all located in the medial femoral condyle, are presented. A cancellous bone graft was used in nine cases and a two component acrylic bone cement was used in the case of an extremely large cyst. Eight out of the 10 cases made a satisfactory clinical recovery.

During a ten-year period 37 femoral diaphyseal fractures were treated by a solitary AO (Arbeitsgemeinschaft fur Osteosynthesefragen [Association for the Study of Problems of Internal Fixation]) plate. Thirty fractures united following the internal stabilization. The seven that received an autogenous cancellous bone graft with the plate united. Twenty nongrafted fractures that stabilized in the first week resulted in one nonunion and four delayed unions. Ten nongrafted fractures were stabilized more than one week following injury resulting in one delayed union and one nonunion. Two femurs united after the addition of a bone graft without disturbing the previously applied plate in the fifth month after initial stabilization. A new plate and bone graft produced union in the remaining five. Higher union rates have been reported with the intramedullary nail. A plate rather than an intramedullary nail is the preferred implant in fractures that are either comminuted or infraisthmal or in the presence of a femoral prosthetic stem.

Summary The incorporation of autogenous cancellous bone graft was studied in eight yearling ponies. The site for the defect to be grafted was chosen so that the effect on the graft, of both the host cortical and trabecular bone, could be assessed. To obtain information concerning the vitality of the graft and the dynamic aspects of the modelling and remodelling processes of graft incorporation, a double and treble tetracycline intravital labelling technique was used. Radiographs of the graft and host tissues of all ponies were obtained regularly, but were of little assistance in assessing graft incorporation. The ponies were destroyed humanely at regular intervals between nine and 241 days after installation of the graft, followed by histological examination of undecalcified sections. The study revealed that all installed graft trabeculae showed signs of non-vitality at nine days after installation and gradually disintegrated. Two processes of new bone formation were observed. First, finger-like projections of immature new trabeculae were found to originate from the graft/host interfaces. Second, a gradual process of accretion of osteoid and woven bone upon disintegrating graft trabeculae occurred uniformly throughout the graft. The graft adapted to the structure of opposing host bone by corticalisation and trabecularisation. The present study confirmed clinical observations relating to convalescence time following grafting of large osseous defects in horses and indicated that equine bone reacts to autogenous bone grafts in a similar manner to other mammals.

Autogenous cancellous bone graft alone or in combination with electrical stimulation is commonly employed yet there exists no conclusive data that the strength of the healing defect is actually modified. The authors examined three groups of paired canine femurs that were torsion tested to failure. Group I (in vitro): an intact femur was compared to a standard defect; Group II (in vivo): a defect alone was compared to a defect plus graft killed at eight weeks; Group III (in vivo): a defect plus graft was compared to a defect graft plus Osteostim (BGS Medical Corp., Milwaukee, Wisconsin) implantable stimulator killed at eight weeks. In Group I the defect decreased the average strength 45% (p = 0.005); in Group II the grafted defect decreased the strength 20% (p = 0.121); in Group III the defect graft plus electrical stimulation increased strength 4% (p = 0.669). At eight weeks, bone grafting, alone or with electrical stimulation did not statistically increase the torsional strength of the healing bony defect.