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Functional and Radiological Outcome Analysis of Osteoperiosteal Decortication Flap in Nonunion of Tibia. Adv Orthop 2021; 2021:7980602. [PMID: 34336293 PMCID: PMC8318746 DOI: 10.1155/2021/7980602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The treatment of long bone shaft nonunions is challenging. The technique of osteoperiosteal decortications flap for approaching the nonunion site coupled with fixation modalities was first described by Judet in 1963. Despite promising clinical and radiological union, this technique is not popular among orthopaedic surgeons. Our study aimed to evaluate the radiological union and functional results of shaft tibia nonunions treated by the osteoperiosteal decortication approach. Methods This retrospective study included all the cases with established tibial shaft nonunion following stringent inclusion and exclusion criteria and operated upon by following the principle of osteoperiosteal flap technique from April 2015 to July 2019. Further subgroups were made based on nonunions complexity based on nonunion scoring system (NUSS) score. The outcome measures included radiological union scale in tibial fractures (RUST) and lower extremity functional scale (LEFS). The preoperative scores for union and function were recorded, and the subsequent scores were obtained at three, six, and nine months and one year. Appropriate statistical analysis of the data was done. Results Thirty-four cases were shortlisted for analysis, fulfilling our inclusion and exclusion criteria. There were 22 males (64.7%) and 12 females (35.3%) with a mean age of 34.17 ± 10.3 years. Subgroup analysis based on the complexity of nonunion (NUSS score) revealed 14 cases in group A, 10 cases in group B, 10 cases in group C, and 0 cases in group D. The average time from fracture to surgery in these cases was 14.6 months. The average time to achieve union was 9.6 months, with patients in groups A, B, and C, having a mean duration of 9, 10.5, and 12 months, respectively. Statistically, significant improvement was seen in both RUST scores and LEFS score. Complications included infection in seven cases, wound dehiscence in two cases, and four cases of persistent nonunion. Conclusion Osteoperiosteal decortication remains a highly effective surgical technique in the management of nonunion of long bones. NUSS scoring is an essential tool for prognosticating nonunion cases. This score is inversely related to the radiological union (RUST score) of the bone and functional recovery (LEFS score) of the patient.
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An W, Ye P, Zhu T, Li Z, Sun J. Platelet-Rich Plasma Combined With Autologous Grafting in the Treatment of Long Bone Delayed Union or Non-union: A Meta-Analysis. Front Surg 2021; 8:621559. [PMID: 34150836 PMCID: PMC8213066 DOI: 10.3389/fsurg.2021.621559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Platelet-rich plasma (PRP) has been suggested as an emerging treatment for bone defects. However, whether PRP could enhance the therapeutic efficacy of autologous bone grafting for long bone delayed union or non-union remains unknown. A meta-analysis of randomized and non-randomized controlled trials (RCT and NRCT) was performed to summarize current evidence. Methods: Relevant RCTs and NRCTs comparing the influences of autologous bone grafting on healing of long bone delayed union or non-union with and without PRP were obtained by searching PubMed, Embase, Cochrane's Library, China National Knowledge Infrastructure, and WanFang databases from inception to September 10, 2020. A random-effect model was applied to pool the results with the incorporation of the potential heterogeneity. Subgroup analysis according to study design was also performed. Results: Six RCTs and two NRCTs with 420 patients were included. Compared to patients allocated to autologous bone grafting alone, those allocated to combined treatment with PRP and autologous bone grafting were not associated with higher rates of radiographic bone healing [risk ratio (RR): 1.06, 95% confidence interval (CI): 0.99-1.13, P = 0.09; I 2 = 24%] or excellent/good posttreatment limb function (RR: 1.14, 95% CI: 0.95-1.37, P = 0.37; I 2 = 0%) but was associated with a shorter healing time (mean difference: -1.35 months, 95% CI: -1.86 to -0.84, P < 0.001; I 2 = 58%). Subgroup analysis according to study design showed similar results for the above outcomes (P-values for subgroup difference all >0.10). Conclusions: Combined treatment with PRP and autologous bone grafting may be effective to accelerate the healing of long bone delayed union or non-union compared to autologous bone grafting alone.
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Affiliation(s)
- Weijun An
- Department of Trauma Orthopedics, The General Hospital of Ningxia Medical University, Yinchuan, China
| | - Peng Ye
- Department of Trauma Orthopedics, The General Hospital of Ningxia Medical University, Yinchuan, China
| | - Tao Zhu
- Department of Trauma Orthopedics, The General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zhizhong Li
- Department of Trauma Orthopedics, The General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jianbin Sun
- Department of Trauma Orthopedics, The General Hospital of Ningxia Medical University, Yinchuan, China
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Masquelet A, Kanakaris NK, Obert L, Stafford P, Giannoudis PV. Bone Repair Using the Masquelet Technique. J Bone Joint Surg Am 2019; 101:1024-1036. [PMID: 31169581 DOI: 10.2106/jbjs.18.00842] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Alain Masquelet
- Department of Orthopaedic Surgery, Avicenne Hospital, Bobiny, France
| | - Nikolaos K Kanakaris
- Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Laurent Obert
- Traumatology, Reconstructive, and Plastic Surgery Unit, CHU Jean Minjoz, Besançon, France
| | - Paul Stafford
- Orthopedic Trauma Surgery of Oklahoma, Tulsa, Oklahoma
| | - Peter V Giannoudis
- Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom.,Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, United Kingdom
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Yan A, Mei HB, Liu K, Wu JY, Tang J, Zhu GH, Ye WH. Wrapping grafting for congenital pseudarthrosis of the tibia: A preliminary report. Medicine (Baltimore) 2017; 96:e8835. [PMID: 29310362 PMCID: PMC5728763 DOI: 10.1097/md.0000000000008835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Treatment of congenital pseudarthrosis of the tibia (CPT) remains a challenge. The autogenic iliac bone graft is important consistent of treatment for CPT. The purpose of this study was to investigate the role of wrapping autogenic iliac bone graft in improvement of the curing opportunities of CPT. METHODS We combined Ilizarov fixator with intramedullary rodding of the tibia and wrapping autogenic iliac bone graft for treatment 51 cases of CPT between 2007 and 2010. The mean age is 3.2 years at index operation, of which 31 patients (61%) were below 3 years old. According to Crawford classification, 5 tibia had type-II morphology; 3, type-III; 43, type-IV. RESULTS In the postoperative follow-up of 3.5 months (range from 3 to 4.5 months), all cases were found that the bone graft sites of pseudarthrosis of the tibia showed a significant augmentation and spindle-shaped expansion as obvious change. All cases of this series have been followed-up, average followed-up time were 1.6 years (range from 7 to 3.1 years), of which 19 cases were more than 2 years. The average time of removed the Ilizarov ring fixator was 3.5 months (range from 3 to 4.5 months). According to Johnston Clinical evaluation system, 26 cases had grade I, 21 cases, grade II, 4 cases, grade III. Following the Ohnishi X-ray evaluation criteria, union of pseudarthrosis of the tibia were 42 cases, delayed union 5 cases, nonunion 4 cases. CONCLUSION Autogenic iliac bone graft is able to offer the activity of osteoblasts and osteogenesis induced by bone morphogenetic protein (BMP) and glycoprotein, meanwhile enclosing bone graft could help keep cancellous bone fragments in close contact around pseudarthrosis of the tibia, allowing the formation of high concentration of glycoprotein and BMP induced by chemical factors because of established the sealing environment in location, all of which could enhance the healing of pseudarthrosis of the tibia.
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Zhou T, Yang HW, Tian ZW, Wang Y, Tang XS, Hu JZ. Effect of Choukroun Platelet-Rich Fibrin Combined With Autologous Micro-Morselized Bone on the Repair of Mandibular Defects in Rabbits. J Oral Maxillofac Surg 2017. [PMID: 28651068 DOI: 10.1016/j.joms.2017.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this study was to explore the effect of Choukroun platelet-rich fibrin (PRF) combined with autologous micro-morselized bone on the repair of mandibular defects in rabbits. MATERIALS AND METHODS Thirty-six healthy New Zealand rabbits were selected for the present study. After models of mandibular defects were established, rabbits were randomly divided into Choukroun PRF, autologous micro-morselized bone (autologous), Choukroun PRF combined with autologous bone (combined) and model groups. After the rabbits were sacrificed at 2, 8, and 12 weeks postoperatively, their bone formation was assessed by x-ray and scanning electron microscopy, and the histologic changes of the mandibular defect area were detected by hematoxylin and eosin staining. Cone-beam computed tomography was used to observe the size of the change of the mandibular defect area. Bone mineral density (BMD) was analyzed by dual-energy x-ray absorptiometry. RESULTS The bone defect in the combined group showed better repair, increased bone mineral content, and denser callus than the other groups, and the defect area was filled with mature trabecular bone. In the Choukroun PRF and autologous groups, the defect area was smaller and filled with osteoporotic trabecular bone. A clear mandibular defect area was still observed in the model group. Compared with the other groups, the combined group showed more bone regeneration, more fibrous tissue regeneration, and greater bone maturity at all time points. The combined group had the highest BMD, there was no relevant difference in BMD between the Choukroun PRF and autologous groups, and the model group had the lowest BMD. BMD in all 4 groups increased with time. CONCLUSION These findings indicate that Choukroun PRF combined with autologous micro-morselized bone can substantially improve the repair of mandibular defects in rabbits, and the effect is superior to Choukroun PRF or autologous micro-morselized bone alone.
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Affiliation(s)
- Tian Zhou
- Resident, Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Hua-Wei Yang
- Associate Chief Physician, Department of Stomatology, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Zhuo-Wei Tian
- Resident, Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yang Wang
- Attending Physician, Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xiao-Shan Tang
- Associate Chief Physician, Department of Stomatology, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Jing-Zhou Hu
- Associate Chief Physician, Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
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Helbig L, Guehring T, Rosenberger S, Ivanova A, Kaeppler K, Fischer CA, Moghaddam A, Schmidmaier G. A new animal model for delayed osseous union secondary to osteitis. BMC Musculoskelet Disord 2015; 16:362. [PMID: 26585516 PMCID: PMC4653915 DOI: 10.1186/s12891-015-0816-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/12/2015] [Indexed: 12/03/2022] Open
Abstract
Background The treatment of infection-related delayed bone unions is still very challenging for the orthopedic surgeon. The prevalence of such infection-related types of osteitis is high in complex fractures, particularly in open fractures with extensive soft-tissue damage. The aim of this study was to develop a new animal model for delayed union due to osteitis. Methods After randomization to infected or non-infected groups 20 Sprague–Dawley rats underwent a transverse fracture of the midshaft tibia. After intramedullary inoculation with staphylococcus aureus (103 CFU) fracture stabilization was done by intramedullary titanium K-wires. After 5 weeks all rats were euthanized and underwent biomechanical testing to evaluate bone consolidation or delayed union, respectively. Micro-CT scans were additionally used to quantitatively evaluate the callus formation by the score of Lane and Sandhu. Blood samples were taken to analyze infectious disease markers (day 1, 14 and 35). Results Biomechanical testing showed a significant higher maximum torque in the non-infected group 5 weeks postoperatively compared with the infected group (p < 0.001). According to the Lane and Sandhu score a significantly higher callus formation was found in the non-infected group (p < 0.001). Similarly, the leucocyte count in the infected group was significantly higher than in the non-infected group (p < 0.05). Conclusions Here we have established a new animal model for delayed osseous union secondary to osteitis. The animal model appears to be appropriate for future experimental studies to test new therapeutic strategies in these difficult to treat bone healing complications.
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Affiliation(s)
- Lars Helbig
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Thorsten Guehring
- Klinik für Unfallchirurgie und Orthopädie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany.
| | - Svenja Rosenberger
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Adriana Ivanova
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Kathrin Kaeppler
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Christian Alexander Fischer
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Arash Moghaddam
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Gerhard Schmidmaier
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Issa JP, Gonzaga M, Kotake BG, de Lucia C, Ervolino E, Iyomasa M. Bone repair of critical size defects treated with autogenic, allogenic, or xenogenic bone grafts alone or in combination with rhBMP-2. Clin Oral Implants Res 2015; 27:558-66. [DOI: 10.1111/clr.12622] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 12/15/2022]
Affiliation(s)
- João Paulo Issa
- Department of Morphology, Physiology and Basic Pathology; University of São Paulo; São Paulo Brazil
| | - Miliane Gonzaga
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor- School of Medicine of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | - Bruna Gabriela Kotake
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor- School of Medicine of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | - Conrado de Lucia
- Department of Morphology, Physiology and Basic Pathology; University of São Paulo; São Paulo Brazil
| | - Edilson Ervolino
- Department of Basic Science at the School of Dentistry of Araçatuba; São Paulo State University; São Paulo Brazil
| | - Mamie Iyomasa
- Department of Morphology, Physiology and Basic Pathology; Faculty of Dentistry; University of São Paulo; São Paulo Brazil
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Effect of Emdogain enamel matrix derivative and BMP-2 on the gene expression and mineralized nodule formation of alveolar bone proper-derived stem/progenitor cells. J Craniomaxillofac Surg 2013; 42:568-76. [PMID: 24080138 DOI: 10.1016/j.jcms.2013.07.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/05/2013] [Accepted: 07/31/2013] [Indexed: 11/20/2022] Open
Abstract
The objective of this study was to evaluate the effect of Emdogain (Enamel Matrix Derivative, EMD) and Bone Morphogenetic Protein-2 (BMP-2), either solely or in combination, on the gene expression and mineralized nodule formation of alveolar bone proper-derived stem/progenitor cells. Stem/progenitor cells were isolated from human alveolar bone proper, magnetically sorted using STRO-1 antibodies, characterized flowcytometrically for their surface markers' expression, and examined for colony formation and multilineage differentiation potential. Subsequently, cells were treated over three weeks with 100 μg/ml Emdogain (EMD-Group), or 100 ng/ml BMP-2 (BMP-Group), or a combination of 100 ng/ml BMP-2 and 100 μg/ml Emdogain (BMP/EMD-Group). Unstimulated stem/progenitor cells (MACS(+)-Group) and osteoblasts (OB-Group) served as controls. Osteogenic gene expression was analyzed using RTq-PCR after 1, 2 and 3 weeks (N = 3/group). Mineralized nodule formation was evaluated by Alizarin-Red staining. BMP and EMD up-regulated the osteogenic gene expression. The BMP Group showed significantly higher expression of Collagen-I, III, and V, Alkaline phosphatase and Osteonectin compared to MACS(+)- and OB-Group (p < 0.05; Two-way ANOVA/Bonferroni) with no mineralized nodule formation. Under in-vitro conditions, Emdogain and BMP-2 up-regulate the osteogenic gene expression of stem/progenitor cells. The combination of BMP-2 and Emdogain showed no additive effect and would not be recommended for a combined clinical stimulation.
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Struewer J, Crönlein M, Ziring E, Schwarting T, Kratz M, Ruchholtz S, Frangen TM. Effect of bone morphogenetic protein-2 on tendon-bone integration in an in vitro cell culture. Orthopedics 2013; 36:e200-6. [PMID: 23380015 DOI: 10.3928/01477447-20130122-23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The goal of this study was to evaluate the influence of bone morphogenetic protein-2 (BMP-2) on tendon-bone integration in a bovine in vitro cell culture. Seventy-two bovine tendons were cultivated over 3 months. The effects of BMP-2 were evaluated by generation in 4 subgroups. The groups differed in 2 parameters: the application of BMP-2 and the application of primary bovine osteoblasts. Results were analyzed biochemically by determining alkaline phosphatase activity and histologic tendon calcification, both markers for graft incorporation. Histological analysis demonstrated a positive effect of BMP-2 on the production of extracellular matrix and therefore the induction of osteogenesis. In addition, the results showed a superior cell ingrowth on the tendon in the BMP-2-stimulated groups. Calcium carbonate-like structures and organized ossification zones could only be detected in the BMP-2-stimulated tendons. The histological results matched those of the biochemical alkaline phosphatase analysis. The highest alkaline phosphatase activity was detected using BMP-2 stimulation in the first month (P<.001). High alkaline phosphatase values suggest high osteoblast activity and a high potential for mineralization. Furthermore, a positive effect of BMP-2 on fibroblasts existed with regard to the overall integration process. These results confirm the positive influence and triggering effect of BMP-2 on the mineralization process. Bone morphogenetic protein-2 seems to accelerate and optimize tendon-bone integration in the early process of graft incorporation. Besides the influence of BMP-2 on bovine osteoblasts, an additional positive effect of BMP-2 on bovine fibroblasts was detected; therefore, graft incorporation may be carried out by osteoblasts and fibroblasts.
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Affiliation(s)
- Johannes Struewer
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043 Marburg, Germany.
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Hacking SA, Vrahas MS. Toward a new standard in autogenous bone graft?: commentary on an article by H. Claude Sagi, MD, et al.: "qualitative and quantitative differences between bone graft obtained from the medullary canal (with a Reamer/Irrigator/Aspirator) and the iliac crest of the same patient". J Bone Joint Surg Am 2012; 94:e1801-2. [PMID: 23224398 DOI: 10.2106/jbjs.l.01232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- S Adam Hacking
- Massachusetts General Hospital, Boston, Massachusetts, USA
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Herscovici, Jr D, Scaduto JM. Use of the reamer–irrigator–aspirator technique to obtain autograft for ankle and hindfoot arthrodesis. ACTA ACUST UNITED AC 2012; 94:75-9. [DOI: 10.1302/0301-620x.94b1.27690] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The use of autograft bone is the best option when undertaking a procedure that requires bone graft because it is osteogenic, osteoconductive and osseo-inductive. Pain, morbidity and complications associated with harvesting iliac or non-iliac sites occur in between 6% and 30% of cases. An alternative source of graft with possibly a lower morbidity is the intramedullary canal. In this study, 28 patients undergoing 30 arthrodesis procedures on the hindfoot had a mean of 48 cm3 (43 to 50) of bone harvested locally from the hindfoot or the tibial shaft by antegrade or retrograde reaming. No patient sustained a fracture of the calcaneum, talus or tibia. There was no morbidity except for one complication when the reamer breached the medial tibial cortex. This healed uneventfully. This method of using the reamer–irrigator–aspirator system is an extension of the standard technique of intramedullary reaming of the lower limb: it produces good-quality bone graft with viable growth factors consistent with that of the iliac crest, and donor site morbidity is low. This is an efficient method of obtaining autologous bone for use in arthrodesis of the ankle or hindfoot.
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Affiliation(s)
- D. Herscovici, Jr
- Florida Orthopaedic Institute, Foot
and Ankle Service, 13020 Telecom Parkway, Temple
Terrace, Florida 33637, USA
| | - J. M. Scaduto
- Florida Orthopaedic Institute, Foot
and Ankle Service, 13020 Telecom Parkway, Temple
Terrace, Florida 33637, USA
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Abstract
The evolution of contemporary intramedullary reaming systems has recently generated the Reamer Irrigator Aspirator system (RIA-Synthes®), which has progressively gained in popularity as well as in indications. The preliminary results of its use over the initial period of 18 months ata single tertiary referral centre were prospectively collected and are presented. The wide spectrum of RIA's indications have been exploited, including 7 patients with polytrauma that underwent acute femoral nailing, 8 with femoral intramedullary osteomyelitis, 9 with pathological lesions of the femoral shaft, as well as 18 patients where the RIA system has been used to harvest morselised autologous bone graft in the presence of recalcitrant atrophie non-unions and bone defects. Overall its use was proven safe and efficient, achieving aggressive medullary canal debridement, collection of adequate samples for further analysis in the infected and oncology cases, as well as impressive volumes of the osteoinductive and osteogenic reaming debris for grafting purposes. No pulmonary complications or evidence of the second hit sequelae were recorded in the polytrauma patient subgroup despite the presence of a high ISS Further controlled clinical studies should follow focused in all different applications of this reliable, user-friendly and impressively versatile system, to validate these preliminary results.
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Nauth A, Ristevski B, Li R, Schemitsch EH. Growth factors and bone regeneration: how much bone can we expect? Injury 2011; 42:574-9. [PMID: 21489530 DOI: 10.1016/j.injury.2011.03.034] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 03/17/2011] [Indexed: 02/02/2023]
Abstract
A large body of research has investigated the use of growth factors for bone regeneration, as a potential alternative to autogenous bone grafting. The bone morphogenetic proteins (BMPs) represent the most extensively investigated growth factors to date, as potential therapeutic agents for bone regeneration. Despite decades of research, the ideal growth factor or combination of growth factors for bone regeneration remains undefined. This article reviews the current available evidence for the application of growth factors for bone regeneration, with a focus on the clinical evidence for BMP use. Emerging pre-clinical and clinical evidence for growth factors other than the BMPs is also discussed.
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Affiliation(s)
- Aaron Nauth
- Department of Surgery, Division of Orthopaeadics, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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Rodríguez-Vegas J, Delgado-Serrano P. Corticoperiosteal flap in the treatment of nonunions and small bone gaps: Technical details and expanding possibilities. J Plast Reconstr Aesthet Surg 2011; 64:515-27. [DOI: 10.1016/j.bjps.2010.06.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 05/21/2010] [Accepted: 06/18/2010] [Indexed: 10/19/2022]
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