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Agarwal A. Nonvascularized fibular harvest in children: impact on donor limbs. J Pediatr Orthop B 2023; 32:197-205. [PMID: 35412489 DOI: 10.1097/bpb.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Nonvascularized fibular graft is commonly used in children. We investigated periosteal intactness, proportion of harvested fibula and the distal remnant for their association to regeneration and development of ankle valgus in 25 donor limbs (n = 18 patients). The fibulae were harvested from healthy legs with all possible care to preserve periosteum. Intraoperatively, periosteal breach and length of graft obtained were recorded. Follow-up radiographs at 6 months documented lateral distal tibial angle, fibular station, and longitudinal continuous regeneration of fibula in the donor limb. Limbs with and without regeneration/ankle valgus were matched for proportion of harvested length and distal remnant, respectively. Odds ratios for periosteum breach versus nonregeneration and nonregeneration versus ankle valgus were additionally calculated. The average harvest length and distal remnant were 15.1 and 4.5 cm, respectively. The periosteum intactness was maintained in 18 (72%) limbs. At 6 months follow-up, regeneration of fibula was present in 15 (60%) limbs. The postharvest-acquired ankle valgus was present in five limbs (24%). There was almost 2.5 times increased likelihood of nonregeneration, if periosteum was breached. The odds ratio for nonregeneration versus regeneration to the development of ankle valgus stood at 12 ( P = 0.0483). Periosteal breach increased the odds of nonregeneration of harvested fibula. The length of harvested segment did not appear to have significant influence on regeneration nor did distal segment on ankle valgus. The nonregeneration of fibula, however, made the limb prone to ankle valgus.
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Affiliation(s)
- Anil Agarwal
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Delhi, India
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Gupta S, Qayoom I, Gupta P, Gupta A, Singh P, Singh S, Kumar A. Exosome-Functionalized, Drug-Laden Bone Substitute along with an Antioxidant Herbal Membrane for Bone and Periosteum Regeneration in Bone Sarcoma. ACS APPLIED MATERIALS & INTERFACES 2023; 15:8824-8839. [PMID: 36749176 DOI: 10.1021/acsami.2c18308] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Developing advanced methods for effective bone reconstructive strategies in case of critical bone defects caused by tumor resection, trauma, and other implant-related complications remains a challenging problem in orthopedics. In the clinical management of bone diseases, there is a paradigm shift in using local drugs at the injury site; however, the dead space created during the surgical debridement of necrotic bone and soft tissues (periosteum and underlying muscle) leads to ineffective bone formation, thereby leading to secondary complications, and thus calls for better regenerative approaches. In this study, we have utilized an exosome-functionalized doxorubicin-loaded biodegradable nanocement (NC)-based carrier along with a Cissus quadrangularis (CQ) extract-laden antioxidant herbal membrane for simultaneously managing the periosteum as well as bone formation in the tumor resection model of osteosarcoma. We initially evaluated the efficacy of scaffolds for in vitro mineralization and bone formation. To examine the in vivo effectiveness, we developed a human osteosarcoma cell line (Saos-2)-induced tumor xenograft model with a critical-sized bone defect. The findings revealed that doxorubicin released from NC was successful in killing the tumor cells and was present even after 30 days of implantation. Additionally, the incorporation of exosomes aided the bone formation, resulting in around a 2.6-fold increase in the bone volume compared to the empty group as evaluated by micro-CT. The herbal membrane assisted in the development of periosteum and mineralizing bone callous as validated through histological and immunofluorescence analysis. Thus, our findings describe a one-step biomaterial-based cell-free approach to regenerate bone in osteosarcoma and prevent further fracture due to the complete development of periosteum and lost bone.
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Affiliation(s)
- Sneha Gupta
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, India
| | - Irfan Qayoom
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, India
| | - Purva Gupta
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, India
| | - Archita Gupta
- Department of Bioengineering and Biotechnology, Birla Institute of Technology, Mesra, Ranchi 835215, Jharkhand, India
| | - Prerna Singh
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, India
| | - Sneha Singh
- Department of Bioengineering and Biotechnology, Birla Institute of Technology, Mesra, Ranchi 835215, Jharkhand, India
| | - Ashok Kumar
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, India
- Centre for Environmental Sciences and Engineering, Indian Institute of Technology Kanpur, Kanpur 208016, India
- The Mehta Family Centre for Engineering in Medicine, Indian Institute of Technology Kanpur, Kanpur 208016, India
- Centre for Nanosciences, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India
- Centre of Excellence for Orthopedics and Prosthetics, Gangwal School of Medical Sciences and Technology, Indian Institute of Technology Kanpur, Kanpur 208016, India
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Emerged donor limb growth morbidity and malalignment after combined ipsilateral tibial and fibular cortical harvest graft in children. Early follow-up report. J Pediatr Orthop B 2023:01202412-990000000-00087. [PMID: 36662674 DOI: 10.1097/bpb.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The quantity of bone grafts required in certain pediatric conditions is sometimes substantial. This retrospective study details the radiological changes occurring in the donor leg and ankle following the simultaneous harvest of large diaphyseal cortical grafts from the tibia and fibula in 14 children (16 legs). The following preoperative and follow-up radiological parameters were measured and compared for donor legs: the longitudinal continuous regeneration of fibula, distal fibular station, medial proximal tibial angle, lateral distal tibial angle, posterior proximal tibial angle (PPTA), anterior distal tibial angle and interphyseal angle (tibia diaphyseal angulation) in both coronal and sagittal planes. Additionally, the impact of fibular regeneration in combined harvests was separately analyzed. Children were operated at the mean age of 52 months. Mean follow-up of 25.2 months was available. At follow-up, the donor tibia healed completely in all legs whereas fibular regeneration was complete only in 10 legs (62.5%). At follow-up, ankle valgus was present in 6 out of 16 legs (37%) and tibia valga increased in all legs except one (94%). Procurvatum was present in 7 legs. The fibular nonregeneration group was prone to ankle valgus deformity (P = 0.014), valgus angulation of tibial diaphysis (P = 0.0076) and lower mean PPTA (P = 0.026) when compared to the regenerate group. There was a complication of stress fracture in one donor tibia. Combined tibial and fibular harvest is a major surgical undertaking in children. The donor limbs have their share of complications postharvest, more so when the fibula remains nonregenerated. Serial monitoring of donor sites is emphasized.
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Qi BC, Gao L, Wang J, Ran J. Treatment of pediatric tibial shaft nonunion using ipsilateral free non-vascularized fibular graft. Technol Health Care 2023; 31:783-787. [PMID: 36404560 DOI: 10.3233/thc-220126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although tibial shaft fractures are the third most common long bone fractures in children after the forearm and femur, nonunion of these fractures are rare in the pediatric population. CASE REPORT Despite seldom seen, tibial nonunion is very complex and it is also a devastating complication of tibial fracture especially when infected. Numerous methods have been employed to treat pediatric tibial nonunion, but there is no consensus. Here, we present a case of a child with right tibial shaft fracture nonunion. We treated this patient with ipsilateral free non-vascularized fibular graft. RESULTS Both the nonunion site and fibular donor site united well with good function in the injured extremity and no adverse events. CONCLUSION We recommend the use of ipsilateral free non-vascularized fibular graft for the treatment of pediatric tibial shaft nonunion.
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Affiliation(s)
- Bao-Chang Qi
- Department of Orthopedic Traumatology, The First Hospital of Jilin University, Changchun, Jilin, China
- Department of Orthopedic Traumatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Long Gao
- Department of Orthopedic Traumatology, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Orthopedic Traumatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jian Wang
- Department of Orthopedic Traumatology, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jian Ran
- Department of Orthopedic Traumatology, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Complete Spontaneous Bone Regeneration following Surgical Enucleation of a Mandibular Cemento-Ossifying Fibroma. Case Rep Dent 2022; 2022:7902602. [PMID: 36034160 PMCID: PMC9411006 DOI: 10.1155/2022/7902602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Cemento-ossifying fibroma (COF) is a type of benign fibro-osseous tumor that mainly occurs in the maxillofacial region. Bone reconstruction after the surgery is often performed with bone transplantation. However, the present case report describes the accurate diagnosis and successful surgical resection of a COF with periosteum preservation, after which the defect was completely and spontaneously filled with the newly formed bone through a natural process. Case Presentation. A 32-year-old Iranian female patient presented with a history of gradual development of painful swelling, spontaneous pain, and lower lip and chin hypoesthesia in the lower third of the left side of her face. The dome-shaped swelling was tender. The patient was suffering from renal infection and urethral prolapse and was taking folic acid. She also mentioned a positive family history of similar swellings in her mother and uncle. Intraoral examination indicated a lesion in buccal and lingual vestibules extending from the first premolar to the third molar teeth. It had a firm consistency, and the covering mucosa was normal in terms of color and texture. The aspiration test was negative. The lesion had caused severe mobility of the second premolar and first and second molar teeth. Panoramic radiography revealed an extensive well-defined unilocular radiolucency. Significant knife-edge resorption of the first and second molar roots at the involved site and thinning of the alveolar crest and inferior border of the mandible were also clear. Cone-beam computed tomography showed severe expansion in the buccal and moderate expansion in the lingual aspect, causing thinning of both the buccal and lingual cortical plates. Histopathological analysis revealed neoplastic tissue mixed with fibrous connective tissue and several round and oval-shaped calcification foci. Immunohistochemical analysis confirmed the final diagnosis (COF) with the presence of SMA-8. The lesion was removed by enucleation and curettage, while the periosteum was carefully preserved. Fixation with screw and plate was also performed. Conclusions Correct diagnosis of COF and precise implementation of the periosteal osteogenesis technique, in this case, resulted in entirely and spontaneously bone regeneration, which was a rare and favorable outcome with minimum cost and complications for the patient.
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Agarwal A. Donor site changes in early months following nonvascularized fibular harvest in children: a prospective radiological analysis. J Pediatr Orthop B 2022; 31:376-381. [PMID: 35045004 DOI: 10.1097/bpb.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The exact timing of non regeneration and ankle valgus in post fibular harvest donor limbs remain elusive. The study examined the serial radiographs post harvest to better understand the transitions occurring in the ankle and leg region. We specifically focused on the noncontinuity of fibular regenerate, lateral distal tibial angle (LDTA), fibular length (fibular/tibial ratio, F/T ratio) and fibular station in the donor leg. Completeness of longitudinal fibular regeneration was documented at 6 months and accordingly two groups, with (R+) and without complete longitudinal regeneration (R-), were available for comparisons. There were 25 fibular harvests in 19 patients. The longitudinal regenerate was complete in 14 limbs (56%) (R+ group) at 6 months. The average LDTA at 6 months did not differ significantly from preoperative values. The F/T ratio decreased immediately postoperative and the trend remained sustained till 6 months. Malhotra grade corresponded inversely to F/T ratio. There was insignificant intra or intergroup affection of LDTA in R+ and R- groups over initial 6 months. The F/T ratio in R+ group recorded a downward trend till 3 months but remained static thereafter. Malhotra grades comparisons between R+ and R- revealed significant differences only at 6 months. Fibular length (F/T ratio) was found to be the critical indicator of regeneration. For the nonregenerates, ratios deteriorated significantly by 3 months. Malhotra station corresponded to changes in fibular length, although it was less quantitative. The secondary changes in lower tibia may not manifest till 6 months.
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Affiliation(s)
- Anil Agarwal
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India
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Assessment of fibular regeneration after graft harvesting in patients with benign bone tumors: A retrospective study comparing different age groups. Orthop Traumatol Surg Res 2022; 108:103108. [PMID: 34634503 DOI: 10.1016/j.otsr.2021.103108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Using non-vascularized fibula as autogenous graft has gained much success in reconstruction after tumor resection owing to its simplicity. Donor-site morbidity related to fibula deficiency includes valgus ankle, chronic pain and stress fractures of the ipsilateral tibia. HYPOTHESIS Growth potential before skeletal maturity is the most important factor promoting fibular regeneration after non- vascularized harvesting, and its decline with skeletal maturity causes failure of fibular regeneration. PATIENTS AND METHODS This is a retrospective study of the patients with benign bone tumors who required bone defect reconstruction by non-vascularized fibular graft utilizing a periosteal preserving technique. The study entailed 118 patients below the age of 12, 100 age 12-18, and 80 above the age of 18. RESULTS In children below 12, regeneration was complete in 95%, incomplete in 4.2% and partial in 0.8% of the cases. In adolescents, regeneration was complete in 72%, incomplete in 15% and partial in 13% of the cases. After skeletal maturity, no regeneration occurred in 92.5%of the patients, while partial regeneration occurred in 7.5% of the cases. Valgus ankle occurred in 2.8% of the cases before skeletal maturity, and none in older patients. DISCUSSION Complete regeneration after non-vascularized fibula graft harvesting is the rule in pediatric patients and to a lesser extent in adolescent group. This is usually associated by near normal regaining of the regenerate strength and function. Non-regeneration dominates in older age group. The length of the harvested segment has no impact on the regeneration or the remodeling process. LEVEL OF EVIDENCE IV; case series, retrospective comparative study.
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Sharma S, Dhillon MS, Singh G, Das A. Fibular Strut Arthrodesis for Salvage of Campanacci Grade III Giant Cell Tumor of the Hallucal Proximal Phalanx: A Case Report. J Foot Ankle Surg 2021; 60:861-865. [PMID: 33757685 DOI: 10.1053/j.jfas.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 07/26/2020] [Accepted: 11/02/2020] [Indexed: 02/03/2023]
Abstract
Involvement of toe phalanges by giant cell tumor (GCT) is extremely rare; tumors in these locations tend to be aggressive. Whereas aggressive GCTs of the distal phalanx may be managed successfully by en-bloc resection without reconstruction or amputation, management of these lesions, when they involve the proximal phalanx, can be challenging. We present a Campannaci grade III GCT of the hallucal proximal phalanx in a 14-year old girl that had breached into the dorsal soft tissues and the metatarso-phalangeal joint. Wide local resection of the proximal phalanx along with reconstruction arthrodesis with an autologous, non-vascularized fibular strut graft was performed. There was no recurrence at 3 years of follow-up. The patient had an excellent functional outcome. To the best of our knowledge, this is the first case reporting the outcomes of fibular strut arthrodesis for salvage of GCT of the hallucal proximal phalanx.
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Affiliation(s)
- Siddhartha Sharma
- Associate Professor, Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Mandeep S Dhillon
- Professor and Head, Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaganpreet Singh
- Assistant Professor, Department of Orthopedics, All India Institute of Medical Sciences, Bathinda, India
| | - Ashim Das
- Professor, Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Colangeli M, Spinnato P, Manfrini M. Periosteum preservation in bone regeneration. CMAJ 2020; 192:E920. [PMID: 32778605 DOI: 10.1503/cmaj.200005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Marco Colangeli
- Departments of Musculoskeletal Oncology (Colangeli, Manfrini), and Diagnostic and Interventional Radiology (Spinnato), IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Spinnato
- Departments of Musculoskeletal Oncology (Colangeli, Manfrini), and Diagnostic and Interventional Radiology (Spinnato), IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Manfrini
- Departments of Musculoskeletal Oncology (Colangeli, Manfrini), and Diagnostic and Interventional Radiology (Spinnato), IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
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Tarng YW, Lin KC. Management of bone defects due to infected non-union or chronic osteomyelitis with autologous non-vascularized free fibular grafts. Injury 2020; 51:294-300. [PMID: 31718793 DOI: 10.1016/j.injury.2019.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/07/2019] [Accepted: 10/11/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Bone defects as a result of infected non-union or chronic osteomyelitis are difficult to manage. The purpose of this study was to present the results of treatment of bone defects of < 6 cm due to a previous infected non-union or chronic osteomyelitis with autologous non-vascularized fibular grafts in a 2-stage surgery. PATIENTS AND METHODS The records of patients who were treated with autologous non-vascularized fibular grafts for bone defects of < 6 cm due to a previous infected non-union or chronic osteomyelitis between 2008 and 2013 were retrospectively reviewed. Primary complete bone union was the primary outcome. Time until fracture union, and return to normal daily activities or previous work were recorded. Radiographs were evaluated for graft hypertrophy as well as for stress fracture and other complications. RESULTS A total of 27 cases were included. The mean length of the bone defects was 4.4 cm (range 2 - 6 cm). Complete union and healing occurred in 25/27 patients (primary success rate of 92.6%). Non-union was present in two patients with suboptimal soft tissue condition 10 months after surgery, one patient was subsequently treated with a vascularized free fibular graft from the contralateral fibula, and the other patient was treated with distraction osteogenesis, bone union was achieved after the second surgery. Average time to return to normal daily activity after surgery was 7.82 months (6 ~ 11 months). Graft hypertrophy occurred in 15 cases 15/25 (60%) two years post-surgery. There were no other surgical or postoperative complications. CONCLUSIONS With careful evaluation of soft-tissue condition surrounding bone defect, management of infected bone defects with autologous non-vascularized fibular grafts technique has a high success rate with few complications.
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Affiliation(s)
- Yih-Wen Tarng
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung city, Taiwan; Department of Orthopaedics, National Defense Medical Center, Taipei city, Taiwan; Department of Physical Therapy, Shu Zen College of Medicine and Management, Taiwan.
| | - Ki-Chen Lin
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung city, Taiwan; Department of Physical Therapy, Shu Zen College of Medicine and Management, Taiwan
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Regeneration of the Fibula with Unidirectional Porous Hydroxyapatite. Case Rep Orthop 2019; 2019:9024643. [PMID: 31737394 PMCID: PMC6815582 DOI: 10.1155/2019/9024643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/13/2019] [Indexed: 12/13/2022] Open
Abstract
A fibula graft is one of the most common orthopedic procedures for reconstruction of a bone defect, and some complications related to persistent defects of the fibula have been reported previously. We believe that regeneration of the fibula may be critical for postoperative function and prevention of complications. This report describes a 9-year-old female with Ewing sarcoma of the pelvis who was treated with the double-barrel fibula grafts for pelvic bone defect following tumor resection. The defect after fibular resection was filled with unidirectional porous hydroxyapatite (UDPHAp) implants. A plain radiograph revealed new bone formation and a callus-like structure at one month after surgery and bony union between each UDPHAp implant 5 months after surgery. Resorption of implanted UDPHAp was identified, and partial remodeling of the bone marrow cavity could be seen 1 year 2 months after surgery. A radiograph at final follow-up (5 years 10 months after surgery) demonstrated almost complete absorption of the implanted UDPHAp and clear formation of the cortex and bone marrow in the resected part of the fibula. The patient is able to walk well without any walking supports and to take part in sports activities.
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Agarwal A. The regeneration at non vascularized fibular harvest site and development of ankle valgus in donor leg-investigations done over two time points. J Clin Orthop Trauma 2019; 10:999-1003. [PMID: 31528084 PMCID: PMC6739244 DOI: 10.1016/j.jcot.2019.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION We retrospectively observed the fibular regeneration in non vascularized harvest in children and development of ankle valgus at 2 time points to find any possible relationship between them. MATERIAL AND METHODS A 6 month period was chosen as the first time frame to assess regeneration and ankle valgus. Radiographs at this time and a subsequent follow up were studied for regeneration, lateral distal tibial ankle (LDTA) and fibular station. The donor sites were divided into complete and incomplete regeneration groups and compared statistically. RESULTS There were 12 patients with 18 harvested fibulae. Ten out of 18 fibulae (56%) had complete longitudinal regenerate at 6 months. Two fibulae underwent delayed union. Of 8 incomplete regenerates at 6 months, 6 (75%) were also incomplete beyond a follow up of 2.75 years. Incomplete group had radiological ankle valgus in 6 legs (75%) at 6 months increased to 7 at follow up. Further, LDTA for incomplete group was significantly lower than complete group (p = 0.025) at 6 months. CONCLUSIONS More than half of harvested legs (56%) had complete longitudinal fibular regeneration at 6 months. Of incomplete regenerates at 6 months, three fourth remained so beyond 2.5 years. Ankle valgus was found strongly related to long standing fibular non regeneration. Radiological ankle valgus developed early in the incomplete regenerate group.
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Affiliation(s)
- Anil Agarwal
- Corresponding author. 4/103, East End Apartments, MayurVihar Ph-1 Ext., 110096, Delhi, India.
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Luo S, Jiang T, Yang X, Yang Y, Zhao J. Treatment of tumor-like lesions in the femoral neck using free nonvascularized fibular autografts in pediatric patients before epiphyseal closure. J Int Med Res 2018; 47:823-835. [PMID: 30556444 PMCID: PMC6381492 DOI: 10.1177/0300060518813510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objectives Surgical resection of benign bone tumors and tumor-like lesions at the
femoral neck presents a difficult reconstructive challenge. However, the
safety and efficacy of free nonvascularized fibular autografts (FNFAs) in
the treatment of femoral neck tumor-like lesions before epiphyseal closure
in young patients remain unknown. Methods Sixteen pediatric patients who had not yet undergone epiphyseal closure were
treated with FNFAs after resection of tumor-like lesions in the femoral neck
from August 2012 to September 2016. All patients underwent supplementary
skeletal traction through the supracondylar femur for 4 to 6 weeks after
resection. Demographic data were recorded and clinical and radiological
outcomes were evaluated during the follow-up. Results All patients could walk with partial weight bearing 4 weeks postoperative,
and full weight bearing was permitted after a mean of 8 weeks. Graft union
was attained in all 16 patients at a mean of 2 months. The donor site of the
fibular cortical strut showed good regeneration in all patients. The Harris
hip score significantly improved from 65% to 95%. Conclusions Application of an FNFA is a feasible method in the treatment of tumor-like
lesions in the femoral neck before epiphyseal closure in pediatric
patients. Level of Evidence Level IV.
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Affiliation(s)
- Shanchao Luo
- Yulin Orthopedics Hospital of Chinese and Western Medicine,
Yulin, China
- Postdoctoral Innovation Practice Base, The Ninth Affiliated
Hospital of Guangxi Medical University, Beihai, China
- Guangxi Engineering Center in Biomedical Materials for Tissue
and Organ Regeneration & Guangxi Collaborative Innovation Center for
Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning,
China
- *These authors contributed equally to this
work
| | - Tongmeng Jiang
- Guangxi Engineering Center in Biomedical Materials for Tissue
and Organ Regeneration & Guangxi Collaborative Innovation Center for
Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning,
China
- Department of Orthopaedics & Guangxi Key Laboratory of
Regenerative Medicine, International Joint Laboratory on Regeneration of Bone
and Soft Tissue, The First Affiliated Hospital of Guangxi Medical University,
Nanning, China
- School of Materials Science and Engineering, Zhejiang
University, Hangzhou, China
- *These authors contributed equally to this
work
| | - Xiaoping Yang
- Yulin Orthopedics Hospital of Chinese and Western Medicine,
Yulin, China
| | - Yingnian Yang
- Yulin Orthopedics Hospital of Chinese and Western Medicine,
Yulin, China
| | - Jinmin Zhao
- Postdoctoral Innovation Practice Base, The Ninth Affiliated
Hospital of Guangxi Medical University, Beihai, China
- Guangxi Engineering Center in Biomedical Materials for Tissue
and Organ Regeneration & Guangxi Collaborative Innovation Center for
Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning,
China
- Department of Orthopaedics & Guangxi Key Laboratory of
Regenerative Medicine, International Joint Laboratory on Regeneration of Bone
and Soft Tissue, The First Affiliated Hospital of Guangxi Medical University,
Nanning, China
- Jinmin Zhao, Department of Orthopaedics
& Guangxi Key Laboratory of Regenerative Medicine, International Joint
Laboratory on Regeneration of Bone and Soft Tissue, The First Affiliated
Hospital of Guangxi Medical University, Shuangyong Road #22, Nanning 530021,
China.
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Veilleux LN, AlOtaibi M, Dahan-Oliel N, Hamdy RC. Incidence of knee height asymmetry in a paediatric population of corrected leg length discrepancy: a retrospective chart review study. INTERNATIONAL ORTHOPAEDICS 2018; 42:1979-1985. [PMID: 29387916 DOI: 10.1007/s00264-018-3794-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of the study is to provide a methodology to quantify knee height asymmetry (KHA) and to establish the incidence of knee height asymmetry in a patient population visiting the limb length discrepancy clinic in a paediatric-orthopaedic hospital centre. METHOD A retrospective chart review was performed on all patients who attended the limb length discrepancy clinic and underwent corrective surgery at the Shriners Hospital for Children-Canada from December 2009 to December 2015. Full-standing anteroposterior radiographs were used to measure pre- and post-surgery limb length discrepancy and knee height asymmetry for 52 individuals included in the study. RESULTS Sixty-seven percent of the studied population had a KHA of 20 mm or less, 25% had a KHA between 20 and 40 mm, and 8% had a KHA of over 40 mm. The average KHA preoperatively for all 52 individuals was 17 ± 14 mm (range 0-59 mm), which represents roughly 2.5% of total limb length. There was a 3-mm non-significant reduction in KHA size between pre-and post-operative states (p = 0.22). CONCLUSION The current study provides a method to quantify knee height asymmetry. Using this method, it was shown that knee height asymmetry is frequent in youth with limb length discrepancy in both pre- and post-corrective surgery states. The relatively high incidence of knee height asymmetry highlights the importance to investigate the impact of knee height asymmetry in youth living with a limb length discrepancy.
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Affiliation(s)
- Louis-Nicolas Veilleux
- Shriners Hospital for Children, 1003, Boulevard Décarie, Montréal, Quebec, H4A 0A9, Canada. .,Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montreal, Quebec, H3G 2M1, Canada.
| | - Mohammed AlOtaibi
- Shriners Hospital for Children, 1003, Boulevard Décarie, Montréal, Quebec, H4A 0A9, Canada.,Faculty of Graduate Studies, McGill University, 845 Sherbrooke Street West, Montreal, Quebec, H3A 0G4, Canada.,King Fahad Medical City, Al Mukarramah Branch Rd, As Sulimaniyah, Riyadh, Makkah, 11525, Saudi Arabia
| | - Noémi Dahan-Oliel
- Shriners Hospital for Children, 1003, Boulevard Décarie, Montréal, Quebec, H4A 0A9, Canada.,Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montreal, Quebec, H3G 2M1, Canada
| | - Reggie C Hamdy
- Shriners Hospital for Children, 1003, Boulevard Décarie, Montréal, Quebec, H4A 0A9, Canada.,Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montreal, Quebec, H3G 2M1, Canada
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Steiger CN, Journeau P, Lascombes P. The role of the periosteal sleeve in the reconstruction of bone defects using a non-vascularised fibula graft in the pediatric population. Orthop Traumatol Surg Res 2017; 103:1115-1120. [PMID: 28780005 DOI: 10.1016/j.otsr.2017.05.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 04/02/2017] [Accepted: 05/10/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Following resection of large benign bone tumors surgeons are confronted with bone defects severely affecting the stability of a limb. To restore the mechanical continuity of the bone different treatment methods using bone grafts have been described. In pediatric patients the thick periosteal sleeve is thought to contribute to bone formation. HYPOTHESIS An intact periosteal sleeve is crucial in bone remodelling around a non-vascularised fibular graft used to bridge large bone defects. METHODS We present a treatment technique applied in 6 cases comprising of subperiosteal tumor resection at the diaphyseal or metaphyseal level of long bones followed by defect bridging with a non-vascularised fibula graft inserted into the periosteal sleeve of the resection zone. Elastic intramedullary nails or plates were used for stabilisation. RESULTS Due to the intact periosteum at the resection site bone integration occurred quickly and full remodelling was seen in all but one case. Tumor location in this case was at the metaphyseal level resulting in tumor resection at the growth plate. Although bone healing at the distal resection site was seen after a few weeks proximal consolidation was only partial. Full reconstitution of the fibula in the remaining periosteal sleeve was seen in 5 cases, partial reconstitution in 1 case. DISCUSSION In the pediatric patient, the described technique is an effective and reliable treatment method for large benign bone tumors requiring resection. However, great diameter discrepancy of the donor and recipient site and a thin periosteum can be a limiting factor for its application. LEVEL OF EVIDENCE Level IV clinical study.
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Affiliation(s)
- C N Steiger
- Service d'orthopédie pédiatrique, département de l'enfant et de l'adolescent, hôpitaux universitaires de Genève, rue Willy Donzé 6, 1205 Genève, Switzerland.
| | - P Journeau
- Service d'orthopédie pédiatrique, hôpital d'enfants de Brabois, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - P Lascombes
- Service d'orthopédie pédiatrique, département de l'enfant et de l'adolescent, hôpitaux universitaires de Genève, rue Willy Donzé 6, 1205 Genève, Switzerland
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16
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Fucs PMMB, Scarlat MM. Pediatric Orthopaedics - from Kirschner wires to titanium. INTERNATIONAL ORTHOPAEDICS 2017; 41:2429-2431. [PMID: 29080040 DOI: 10.1007/s00264-017-3677-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Patricia M M B Fucs
- Orthopaedic Department - Santa Casa de São Paulo, Faculdade de Ciências Médicas da Santa Casa de Sāo Paulo, R Dr Cesário Motta Jr, 112, Sāo Paulo, 01221-020, Brazil
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17
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Lenze U, Kasal S, Hefti F, Krieg AH. Non-vascularised fibula grafts for reconstruction of segmental and hemicortical bone defects following meta- /diaphyseal tumour resection at the extremities. BMC Musculoskelet Disord 2017; 18:289. [PMID: 28679368 PMCID: PMC5499012 DOI: 10.1186/s12891-017-1640-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 06/26/2017] [Indexed: 12/23/2022] Open
Abstract
Background The reconstruction of meta−/diaphyseal bone defects following bone tumour resection is challenging, and biological treatment options should be applied whenever possible, especially in benign lesions and early stage sarcomas. We aimed to evaluate the results of segmental (SR) and hemicortical reconstructions (HR) at the extremities using non-vascularised fibula grafts. Methods We retrospectively enrolled 36 patients who were treated with non-vascularised fibula reconstructions (15 SR, 21 HR) after bone tumour resection (15 malignant, 21 benign). All cases were evaluated regarding consolidation, hypertrophy at the graft-host junctions, and complications; moreover, the functional and oncological results were assessed. The mean follow-up was 8.3 years (2.1–26.6 years). Results Primary union was achieved in 94% (SR 87%, HR 100%) of patients, and 85% (SR 81%, HR 88%) showed hypertrophy at the graft-host junction. The overall complication rate was 36% with 4 patients (11%) developing local recurrence. There was a significant correlation between the development of mechanical complications (fracture, delayed-/non-union) and a defect size of ≥12 cm (p = 0.013), segmental defects (p = 0.013) and additional required treatment (p = 0.008). The functional outcome was highly satisfactory (mean MSTS score 86%). Conclusions Due to encouraging results and advantages (such as their remodelling capacity at the donor site), non-vascularised fibula reconstructions should be considered a valuable alternative treatment option for patients with hemicortical defects or segmental reconstructions of less than 12 cm in which no additional neo-/adjuvant treatment is necessary.
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Affiliation(s)
- Ulrich Lenze
- Department of Orthopaedics, University Children's Hospital of both Basel (UKBB), Spitalstrasse 33, CH-4056, Basel, Switzerland.
| | - Stefanie Kasal
- Department of Orthopaedics, University Children's Hospital of both Basel (UKBB), Spitalstrasse 33, CH-4056, Basel, Switzerland
| | - Fritz Hefti
- Department of Orthopaedics, University Children's Hospital of both Basel (UKBB), Spitalstrasse 33, CH-4056, Basel, Switzerland
| | - Andreas Heinrich Krieg
- Department of Orthopaedics, University Children's Hospital of both Basel (UKBB), Spitalstrasse 33, CH-4056, Basel, Switzerland
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18
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Agarwal A, Kumar D, Agrawal N, Gupta N. Ankle valgus following non-vascularized fibular grafts in children—an outcome evaluation minimum two years after fibular harvest. INTERNATIONAL ORTHOPAEDICS 2017; 41:949-955. [DOI: 10.1007/s00264-017-3403-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
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