[Harvesting cancellous bone or composite corticocancellous bone grafts from the posterior iliac crest]

[Cancellous bone harvesting from the distal radius for reconstruction of bone defects in the hand]

OBJECTIVE

Extraction of cancellous bone from the distal radius for reconstructive procedures on the hand.

INDICATIONS

All reconstructive procedures on the hand for which a corticocancellous and/or vascularized bone graft or a large amount of cancellous bone is not required.

CONTRAINDICATIONS

Acute distal radius fracture, osteosynthesis material embedded in the distal radius, e.g., after palmar plate osteosynthesis of a distal radius fracture, tumor in the distal radius.

SURGICAL TECHNIQUE

Removal of cancellous bone from the distal radius radially from the dorsal radial tuberosity via a small bone window at the base of the second extensor tendon compartment.

POSTOPERATIVE MANAGEMENT

Wound dressing on the distal radius, elevation of the arm above heart level until swelling has subsided, first dressing change on postoperative day 1 or 2, depending on the primary procedure on the hand, dressing until wound healing is complete, removal of the skin sutures around postoperative day 14.

RESULTS

In 2023, cancellous bone was harvested from the distal radius of 17 patients for reconstructive procedures on the hand (6 mediocarpal partial arthrodeses, 3 acute fractures, 5 delayed bone healings, 1 pseudarthrosis, 2 bone tumors). In all cases, the available amount of radius cancellous bone was sufficient, resulting in satisfactory healing. All patients complained of short-term, slight discomfort at the donor site for the first few days after surgery, which resolved completely. There were no complications at the donor site on the distal radius.

Management of segmental defects post open distal femur fracture using a titanium cage combined with the Masquelet technique A single-centre report of 23 cases

INTRODUCTION

The segmental bone defects post open distal femur fracture presents a reconstructive challenge, which often requires extreme solutions. The present study reviewed a new treatment strategy which used a cylindrical titanium mesh cage as an adjunct to the Masquelet technique.

METHODS

We retrospectively reviewed a consecutive series of 23 patients treated for segmental bone defects post open distal femur fracture using a titanium mesh cage combined with the Masquelet technique under a 2-staged protocol in our institution from 2017 to 2021. The study group consisted of 13 men and 10 women with an average age of 44.1 years. The surgical debridement was performed with antibiotic polymethylmethacrylate (PMMA) cement spacer implanted into the bone defect combined with cement-wrapped plate stabilization, or antibiotic beads with vacuum sealing drainage (VSD) to cover the wound. The second stage of the Masquelet technique for bone defect repair began at least 4-6 weeks after the first stage, once all signs of possible infection were eliminated. After the cement spacer was removed, the definitive reconstruction was completed with exchange to a cylindrical titanium mesh cage filled with cancellous autograft within the induced membrane. The bone defect with cage was stabilized with a distal femoral Less Invasive Stabilization System (LISS). The radiological and clinical records of the enrolled patients were retrospectively analyzed.

RESULTS

The mean follow-up was 38.6 months. The average number of operations before the second stage was 1.3. The mean interval between the two stages was 12.7 weeks. The average length of the defect measured 8.3 cm (ranging from 6.1 to 12.4 cm). All the defects filled with autograft within the cage achieved bony union, with a mean healing time of 8.4 months. At the latest follow-up, the mean knee extension measured 6.2° (ranging from 0° to 20°), and the mean flexion measured 101.8° (ranging from 60° to 120°). Complications included two instances of superficial stitch abscess, which eventually healed.

CONCLUSIONS

The use of a titanium cage implanted into an induced membrane in a 2-staged Masquelet protocol could achieve satisfactory clinical outcomes in cases of segmental defects following open distal femur fractures.

Biopolymer Material from Human Spongiosa for Regenerative Medicine Application

Natural biopolymers demonstrate significant bone and connective tissue-engineering application efficiency. However, the quality of the biopolymer directly depends on microstructure and biochemical properties. This study aims to investigate the biocompatibility and microstructural properties of demineralized human spongiosa Lyoplast® (Samara, Russian Federation). The graft's microstructural and biochemical properties were analyzed by scanning electron microscopy (SEM), micro-computed tomography, Raman spectroscopy, and proteomic analysis. Furthermore, the cell adhesion property of the graft was evaluated using cell cultures and fluorescence microscopy. Microstructural analysis revealed the hierarchical porous structure of the graft with complete removal of the cellular debris and bone marrow components. Moreover, the proteomic analysis confirmed the preservation of collagen and extracellular proteins, stimulating and inhibiting cell adhesion, proliferation, and differentiation. We revealed the adhesion of chondroblast cell cultures in vitro without any evidence of cytotoxicity. According to the study results, demineralized human spongiosa Lyoplast® can be effectively used as the bioactive scaffold for articular hyaline cartilage tissue engineering.