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Yu X, Wu H, Li J, Xie Z. Antibiotic cement-coated locking plate as a temporary internal fixator for femoral osteomyelitis defects. INTERNATIONAL ORTHOPAEDICS 2016; 41:1851-1857. [PMID: 27520738 DOI: 10.1007/s00264-016-3258-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/22/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE Recently we modified the Masquelet technique by using an antibiotic cement-coated locking plate as a temporary internal fixator when treating septic bone defects. This modification is in order to prevent the complications related to external fixator use and provides the involved limb with a greater stability to undergo earlier and more vigorous physical therapy for recovery of joint function. The purpose of this study was to assess the outcomes of large femoral osteomyelitis defects managed by Masquelet technique combined with the antibiotic cement-coated locking plate used as a temporary internal fixator. METHODS Between November 2013 to November 2014, 13 cases of large femoral osteomyelitis defects were treated by Masquelet technique and the antibiotic cement-coated locking plate was used as a temporary internal fixator in the first stage surgery. All the patients' clinical and imaging results were retrospectively analyzed. RESULTS After debridement, there was a femoral bone defect with a mean of 9.8 cm (range, 5-16 cm). The mean follow-up was 17.8 months (range 12 to 24 months). One patient developed infection in nine months after second stage surgery. Radiographic bony union was achieved within a mean 20.3 weeks (range, 18-30 weeks) in all patients. The mean time period to full weight bearing after the second step procedure was 5.8 months (range, 5-8.5 months). The mean knee range of motion for the patients at the last follow up was 122° (range 100-135°). CONCLUSION Based on our experience, we believe that antibiotic cement-coated locking plate is a viable fixation method in the first stage of Masquelet technique for the management of large femoral osteomyelitis defects. It may offer a better chance of infection eradication as well as improved recovery of joint function without increasing the infection recurrence rate and without compromising bone graft union.
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Affiliation(s)
- Xin Yu
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Hongri Wu
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Jianhua Li
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Zhao Xie
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
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Felden A, Aurégan JC, Badina A, Glorion C, Pannier S. The Induced Membrane Technique for Bone Defects of Critical Size After Infection in Children: A Report of 3 Consecutive Cases. JBJS Case Connect 2016; 6:e65. [PMID: 29252642 DOI: 10.2106/jbjs.cc.15.00252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report 3 consecutive cases of bone defects of critical size after chronic osteomyelitis in children that were treated with the induced membrane technique, in 2 girls and a boy 7 months to 7 years old. All defects were diaphyseal. The length of resection was from 4 to 12 cm (35% to 55% of the total bone length). Resection of the infected bone, filling of the defect with a cement spacer, and intramedullary fixation were followed by autologous bone-grafting 60 to 90 days later. All defects healed. At the latest follow-up, which ranged from 21 months to 6 years, no recurrence or complication had occurred. CONCLUSION The induced membrane technique is an attractive option for bone defects of critical size after chronic osteomyelitis in children.
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Affiliation(s)
- Arnaud Felden
- Department of Orthopedic Pediatrics, Necker-Enfants-Malades Hospital, University Paris-Descartes, Paris, France
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Abstract
UNLABELLED Osteomyelitis of the hand is uncommon, but if not adequately and promptly treated the detrimental effects on hand function can be devastating. The majority of literature on osteomyelitis relates to the lower limb, but the principles of management are applicable to the hand, with good surgical debridement and culture-guided antimicrobial therapy. For osteomyelitis in general, antibiotic therapy of 4-6 weeks' duration (intravenous and/or oral) is typically recommended. In the hand, length and mode of antibiotic administration are still under study. LEVEL OF EVIDENCE V.
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Affiliation(s)
- R Pinder
- Department of Plastic, Hand and Reconstructive Surgery, Castle Hill Hospital, Cottingham, UK
| | - G Barlow
- Department of Infection & Tropical Medicine, Castle Hill Hospital, Cottingham, UK
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Tarchala M, Harvey EJ, Barralet J. Biomaterial-Stabilized Soft Tissue Healing for Healing of Critical-Sized Bone Defects: the Masquelet Technique. Adv Healthc Mater 2016; 5:630-40. [PMID: 26855349 DOI: 10.1002/adhm.201500793] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/10/2015] [Indexed: 12/23/2022]
Abstract
Critical-sized bone defects present a significant burden to the medical community due to their challenging treatment. However, a successful limb-salvaging technique, the Masquelet Technique (MT), has significantly improved the prognosis of many segmental bone defects in helping to restore form and function. Although the Masquelet Technique has proven to be clinically effective, the physiology of the healing it induces is not well understood. Multiple modifiable factors have been implicated by various surgical and research teams, but no single factor has been proven to be critical to the success of the Masquelet Technique. In this review the most recent clinical and experimental evidence that supports and helps to decipher the traditional Masquelet, as well as the modifiable factors and their effect on the success of the technique are discussed. In addition, future developments for the integration of the traditional Masquelet Technique with the use of alternative biomaterials to increase the effectiveness and expand the clinical applicability of the Masquelet Technique are reviewed.
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Affiliation(s)
- Magdalena Tarchala
- Division of Orthopaedic Surgery; McGill University Health Centre; Montreal H3g 1A4 Quebec Canada
| | - Edward J. Harvey
- Division of Orthopaedic Surgery; McGill University Health Centre; Montreal H3g 1A4 Quebec Canada
| | - Jake Barralet
- Faculty of Dentistry; McGill University; Montreal H3A 0G4 Quebec Canada
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Wei X, Zhao D, Wang B, Wang W, Kang K, Xie H, Liu B, Zhang X, Zhang J, Yang Z. Tantalum coating of porous carbon scaffold supplemented with autologous bone marrow stromal stem cells for bone regeneration in vitro and in vivo. Exp Biol Med (Maywood) 2016; 241:592-602. [PMID: 26843518 DOI: 10.1177/1535370216629578] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/04/2016] [Indexed: 01/23/2023] Open
Abstract
Porous tantalum metal with low elastic modulus is similar to cancellous bone. Reticulated vitreous carbon (RVC) can provide three-dimensional pore structure and serves as the ideal scaffold of tantalum coating. In this study, the biocompatibility of domestic porous tantalum was first successfully tested with bone marrow stromal stem cells (BMSCs) in vitro and for bone tissue repair in vivo. We evaluated cytotoxicity of RVC scaffold and tantalum coating using BMSCs. The morphology, adhesion, and proliferation of BMSCs were observed via laser scanning confocal microscope and scanning electron microscopy. In addition, porous tantalum rods with or without autologous BMSCs were implanted on hind legs in dogs, respectively. The osteogenic potential was observed by hard tissue slice examination. At three weeks and six weeks following implantation, new osteoblasts and new bone were observed at the tantalum-host bone interface and pores. At 12 weeks postporous tantalum with autologous BMSCs implantation, regenerated trabecular equivalent to mature bone was found in the pore of tantalum rods. Our results suggested that domestic porous tantalum had excellent biocompatibility and could promote new bone formation in vivo. Meanwhile, the osteogenesis of porous tantalum associated with autologous BMSCs was more excellent than only tantalum implantation. Future clinical studies are warranted to verify the clinical efficacy of combined implantation of this domestic porous tantalum associated with autologous BMSCs implantation and compare their efficacy with conventional autologous bone grafting carrying blood vessel in patients needing bone repairing.
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Affiliation(s)
- Xiaowei Wei
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Dewei Zhao
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Benjie Wang
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Wei Wang
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Kai Kang
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Hui Xie
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Baoyi Liu
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Xiuzhi Zhang
- Department of Orthopaedic Laboratory, Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Jinsong Zhang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
| | - Zhenming Yang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China
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Dai Z, Li Y, Lu W, Jiang D, Li H, Yan Y, Lv G, Yang A. In vivo biocompatibility of new nano-calcium-deficient hydroxyapatite/poly-amino acid complex biomaterials. Int J Nanomedicine 2015; 10:6303-16. [PMID: 26504382 PMCID: PMC4605249 DOI: 10.2147/ijn.s90273] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the compatibility of novel nano-calcium-deficient hydroxyapatite/poly-amino acid (n-CDHA/PAA) complex biomaterials with muscle and bone tissue in an in vivo model. Methods Thirty-two New Zealand white rabbits were used in this study. Biomaterials were surgically implanted into each rabbit in the back erector spinae and in tibia with induced defect. Polyethylene was implanted into rabbits in the control group and n-CDHA/PAA into those of the experimental group. Animals were examined at four different points in time: 2 weeks, 4 weeks, 12 weeks, and 24 weeks after surgery. They were euthanized after embolization. Back erector spinae muscles with the surgical implants were examined after hematoxylin and eosin (HE) staining at these points in time. Tibia bones with the surgical implants were examined by X-ray and scanning electron microscopy (SEM) at these points in time to evaluate the interface of the bone with the implanted biomaterials. Bone tissues were sectioned and subjected to HE, Masson, and toluidine blue staining. Results HE staining of back erector spinae muscles at 4 weeks, 12 weeks, and 24 weeks after implantation of either n-CDHA/PAA or polyethylene showed disappearance of inflammation and normal arrangement in the peripheral tissue of implant biomaterials; no abnormal staining was observed. At 2 weeks after implantation, X-ray imaging of bone tissue samples in both experimental and control groups showed that the peripheral tissues of the implanted biomaterials were continuous and lacked bone osteolysis, absorption, necrosis, or osteomyelitis. The connection between implanted biomaterials and bone tissue was tight. The results of HE, Masson, toluidine blue staining and SEM confirmed that the implanted biomaterials were closely connected to the bone defect and that no rejection had taken place. The n-CDHA/PAA biomaterials induced differentiation of a large number of chondrocytes. New bone trabecula began to form at 4 weeks after implanting n-CDHA/PAA biomaterials, and lamellar bone gradually formed at 12 weeks and 24 weeks after implantation. Routine blood and kidney function tests showed no significant changes at 2 weeks and 24 weeks after implantation of both biomaterials. Conclusion n-CDHA/PAA composites showed good compatibility in in vivo model. In this study, n-CDHA/PAA were found to be safe, nontoxic, and biologically active in bone repair.
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Affiliation(s)
- Zhenyu Dai
- College of Physical Science and Technology, Sichuan University, Chengdu, People's Republic of China ; Department of Orthopedics, Chongqing Hospital of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yue Li
- Department of Clinical Laboratory, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Weizhong Lu
- Department of Orthopedics, Chongqing Hospital of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, People's Republic of China
| | - Dianming Jiang
- Department of Orthopedics, the First Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Hong Li
- College of Physical Science and Technology, Sichuan University, Chengdu, People's Republic of China
| | - Yonggang Yan
- College of Physical Science and Technology, Sichuan University, Chengdu, People's Republic of China
| | - Guoyu Lv
- College of Physical Science and Technology, Sichuan University, Chengdu, People's Republic of China
| | - Aiping Yang
- College of Physical Science and Technology, Sichuan University, Chengdu, People's Republic of China
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Sabharwal S, Nelson SC, Sontich JK. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am 2015; 97:1375-84. [PMID: 26290092 DOI: 10.2106/jbjs.o.00298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
| | - Scott C Nelson
- Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 214A, Loma Linda, CA 92354
| | - John K Sontich
- MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109
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Dumic-Cule I, Pecina M, Jelic M, Jankolija M, Popek I, Grgurevic L, Vukicevic S. Biological aspects of segmental bone defects management. INTERNATIONAL ORTHOPAEDICS 2015; 39:1005-11. [DOI: 10.1007/s00264-015-2728-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
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Pećina M, Vukičević S. Tissue engineering and regenerative orthopaedics (TERO). INTERNATIONAL ORTHOPAEDICS 2014; 38:1757-60. [PMID: 25109479 DOI: 10.1007/s00264-014-2477-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 07/18/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Marko Pećina
- Department of Orthopaedic Surgery, University of Zagreb School of Medicine, Zagreb, Croatia,
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