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Gui S, Xu W, Ouyang Z, Guo X, Shen Y, Tao H, Chen X, Peng D. Endoprosthetic replacement with preservation of the epiphysis for proximal tibial reconstruction after osteosarcoma resection in children: a case report. BMC Musculoskelet Disord 2024; 25:567. [PMID: 39033278 PMCID: PMC11264714 DOI: 10.1186/s12891-024-07651-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 07/01/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Limb salvage surgery is an important method for treating malignant tumors of the bone involving the adjacent parts of the major joints in children. This technique allows for preservation of limb function, especially in the lower limb. However, the reconstruction of the proximal end of the tibia after removing the tumor mass with a rational scale to preserve the total knee joint and reduce limb length discrepancy presents a challenge. CASE PRESENTATION We present a case of osteosarcoma of the proximal tibia. After being treated with an extended tumor resection, the proximal tibia of the child was restructured using endoprosthetic replacement with epiphyseal preservation. This procedure preserves the entire articular surface and growth plate of the knee joint of the affected limb and provides a feasible alternative protocol for retaining the function and growth potential of the affected limb. The patient remained disease-free and normal limb motor function was observed during the 3.5 year follow-up since the initial surgery. CONCLUSIONS Preservation of the epiphysis enabled our patient to perform better limb function after limb-saving surgery as a result of his undamaged knee joint and minimized limb-length discrepancy. We believe that endoprosthetic replacement with preservation of the epiphysis can provide the best strategy for reconstruction after resection of focal malignant tumors in long bones without epiphytic involvement.
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Affiliation(s)
- Sijie Gui
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Wantong Xu
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Zhengxiao Ouyang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Xiaoning Guo
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Yi Shen
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Huai Tao
- Department of Biochemistry and Molecular Biology, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, China
| | - Xia Chen
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
| | - Dan Peng
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
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Aydın A, Baydar M, Ünkar EA, Erbaş A, Üçpunar H, Yapıcı F, Gür V, Öztürk K. Evaluation of the effect of vascularized fibula graft harvesting on coronal plane alignment and functional outcomes of the lower limb. Sci Rep 2024; 14:15820. [PMID: 38982162 PMCID: PMC11233678 DOI: 10.1038/s41598-024-66847-8] [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] [Received: 07/26/2023] [Accepted: 07/04/2024] [Indexed: 07/11/2024] Open
Abstract
Recent studies on fibular osteotomy for varus gonarthrosis and possible subsequent biomechanical changes have attracted increasing attention to the topic. Existing studies have focused mainly on proximal fibular osteotomy with short follow-up periods. The aim of this study was to investigate changes in the alignment of the coronal plane of the ankle and knee joints in patients who underwent vascularized fibula graft harvest (VFGH). The evaluation was based on functional outcomes and radiological measurements.In the comparison between the VFGH side and the contralateral side, no significant differences in the knee inclination (KI) or talar inclination (TI) angle, knee medial clear space (K-MCS) or ankle medial clear space (A-MCS) distance were noted. However, a significant difference in the hip knee (HKA) angle was observed between the operated and nonoperated sides (0.3° ± 1.8° and 1.5° ± 1.9°, respectively [p = 0.019]). Statistically significant differences in both the knee society score (KSS) and the AOFAS scores were found between the ipsilateral donor limb and the contralateral healthy limb. Although the contralateral healthy side had better clinical scores than the VFGH side, the outcomes of the VFGH side were still satisfactory or excellent.
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Affiliation(s)
- Abdurrahman Aydın
- Department of Orthopedics and Traumatology, Düzce Akçakoca State Hospital, Cumhuriyet Mh, Park Cd. No: 20, 81650, Akçakoca, Düzce, Turkey.
| | - Mehmet Baydar
- Hand Surgery Clinic, University of Health Sciences Turkey MS Baltalimani Bone Diseases Teaching and Research Hospital, Istanbul, Turkey
| | - Ethem Ayhan Ünkar
- Hand Surgery Clinic, University of Health Sciences Turkey MS Baltalimani Bone Diseases Teaching and Research Hospital, Istanbul, Turkey
| | - Anıl Erbaş
- Department of Orthopedics and Traumatology, University of Health Sciences Turkey MS Baltalimani Bone Diseases Teaching and Research Hospital, Istanbul, Turkey
| | - Hanifi Üçpunar
- Department of Orthopedics and Traumatology, University of Health Sciences Turkey MS Baltalimani Bone Diseases Teaching and Research Hospital, Istanbul, Turkey
| | - Furkan Yapıcı
- Department of Orthopedics and Traumatology, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Volkan Gür
- Department of Orthopedics and Traumatology, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Kahraman Öztürk
- Hand Surgery Clinic, University of Health Sciences Turkey MS Baltalimani Bone Diseases Teaching and Research Hospital, Istanbul, Turkey
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Bernstein M, Little MTM, Marecek G. Current Management of Acute and Posttraumatic Critical Bone Defects. J Orthop Trauma 2024; 38:S1-S8. [PMID: 38502596 DOI: 10.1097/bot.0000000000002762] [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] [Accepted: 01/04/2024] [Indexed: 03/21/2024]
Abstract
SUMMARY Limb reconstruction in patients with critical-sized bone defects remains a challenge due to the availability of various technically demanding treatment options and a lack of standardized decision algorithms. Although no consensus exists, it is apparent from the literature that the combination of patient, surgeon, and institutional collaborations is effective in providing the most efficient care pathway for these patients. Success relies on choosing a particular surgical approach that manages infection, soft tissue defects, stability, and alignment. Recent systematic reviews demonstrate high success rates with the following management options: Ilizarov bone transport, Masquelet (induced membrane) technique, cancellous bone grafting, and vascularized bone grafts.
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Affiliation(s)
- Mitchell Bernstein
- Department of Surgery, McGill University Health Center, Montreal QC, Canada
- Department of Pediatric Surgery, McGill University Health Center, Montreal QC, Canada; and
| | - Milton T M Little
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Beverly Hills, CA
| | - Geoffrey Marecek
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Beverly Hills, CA
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Büyüktopçu Ö, Baysal Ö, Ağırdil Y, Şahbat Y, Shammadli Z, Şirin E, Erol B. Midterm Donor Site Morbidity After Vascularized Free Fibula Flap Harvesting. Foot Ankle Int 2024; 45:364-372. [PMID: 38361397 DOI: 10.1177/10711007241226620] [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] [Indexed: 02/17/2024]
Abstract
BACKGROUND Vascularized fibula grafts (VFGs) have become one of the most preferred grafts for the reconstruction of bone defects. However, despite the many advantages over other graft options, recipient and donor site morbidities are also common. Donor site morbidity has been reported at rates ranging from 5% to 67%. The aim of this study was to present a single-center series examining the clinical, functional, and radiologic aspects of donor site morbidity following VFG harvesting. METHODS The study included 69 patients who underwent biological reconstruction with VFG for bone tumors, avascular necrosis of the femoral head, or bone defects after trauma. Patients were evaluated functionally, clinically, and radiologically for donor site morbidity. RESULTS Donor site morbidity was observed in 33 of 69 patients (48%). The most complications were sensation deficits around the feet and ankles (20 of 69; 29%). Knee laxity was more common in patients who underwent osteoarticular fibular resection (P = .006). CONCLUSION We found VFG to be an effective method for the reconstruction of large bone defects, but associated with a relatively high rate of complications. Complications requiring surgical intervention were rare and the majority of patients did not have long-term functional limitations. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ömer Büyüktopçu
- Marmara University School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Özgür Baysal
- Marmara University School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Yücel Ağırdil
- Marmara University School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Yavuz Şahbat
- Erzurum Regional Training and Research Hospital, Department of Orthopaedics and Traumatology, Erzurum, Turkey
| | - Ziya Shammadli
- Marmara University School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Evrim Şirin
- Marmara University School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Bülent Erol
- Marmara University School of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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Schutz JF, Iorio ML, Marshall CB, Clay MR, Gimarc DC, Park A. Adamantinoma of the Ulnar Shaft Reconstructed With a Vascularized Free Fibula. Orthopedics 2024; 47:e102-e105. [PMID: 37921530 DOI: 10.3928/01477447-20231027-02] [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: 11/04/2023]
Abstract
We describe a 36-year-old man with a long-standing diagnosis of ulnar fibrous dysplasia with associated fracture of the ulna. He presented with a growing and increasingly tender forearm mass and was diagnosed with adamantinoma of the ulna, for which he underwent wide resection of the ulnar diaphysis followed by reconstruction with a vascularized fibula autograft. This case serves to emphasize the importance of performing a stepwise workup for the diagnosis of osseous neoplasms even in cases with long-standing diagnoses. [Orthopedics. 2024;47(2):e102-e105.].
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Varagur K, Sullivan J, Chiang SN, Skolnick GB, Sacks JM, Christensen JM. Investigating Weekend Effect in the Management of Upper and Lower Extremity Degloving Injuries. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5345. [PMID: 37850199 PMCID: PMC10578671 DOI: 10.1097/gox.0000000000005345] [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: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 10/19/2023]
Abstract
Background Weekend presentation has been associated with adverse outcomes in emergent conditions, including stroke, myocardial infarction, and critical limb ischemia. We examine whether a weekend effect exists in the management of and outcomes after extremity degloving injuries. Methods The cohort included adults presenting with open extremity degloving injuries to a tertiary level one trauma center between June 2018 and May 2022. We collected demographics, comorbidities, injury information, interventions, and complications. Propensity score weighting was used to minimize confounding differences between those presenting on weekends (Sat-Sun) versus weekdays (Mon-Fri). Weighted regressions were used to examine differences in interventions by day of presentation. Multivariable weighted regressions accounting for differences in interventions received were used to examine whether weekend presentation was associated with amputation risk, complications, or functional deficits. Results Ninety-five patients with 100 open extremity degloving injuries were included. In total, 39% of injuries were weekend-presenting. There was a higher rate of noninsulin-dependent diabetes among patients presenting on weekends (P = 0.03). Weekend-presenting injuries had higher median Injury Severity Scores (P = 0.04). Propensity-weighted regression analysis revealed differences in interventions received on weekends, including lower rates of pedicled and free flaps and bone graft, and increased rates of negative-pressure wound therapy (P ≤ 0.02). Multivariable regression analysis revealed weekend presentation was a significant independent risk factor for amputation of the affected extremity [odds ratio 2.27, 95% CI (1.01-5.33), P = 0.05]. Conclusion Weekend presentation may impact interventions received and amputation risk in patients presenting with open extremity degloving injuries.
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Affiliation(s)
- Kaamya Varagur
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Janessa Sullivan
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Sarah N. Chiang
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Gary B. Skolnick
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Justin M. Sacks
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Joani M. Christensen
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
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Das SS, Choudhary C, Mishra M. Sexual Dimorphism of the Nutrient Foramen of the Fibula and Its Importance in Vascularised Bone Grafting: A Descriptive Cross-Sectional Study. Indian J Orthop 2023; 57:1276-1282. [PMID: 37525724 PMCID: PMC10387001 DOI: 10.1007/s43465-023-00938-y] [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: 02/24/2023] [Accepted: 06/20/2023] [Indexed: 08/02/2023]
Abstract
Background Vascularised fibular bone grafting is widely used in many reconstructive surgeries to repair bony defects. It is very essential for the nutrient blood supply to be conserved in the vascular bone graft. Understanding the sexual differences of the fibular nutrient foramen can help operating surgeons make appropriate changes in their clinical methodologies according to the sex. The present study was done to evaluate the sexual dimorphism of fibular nutrient foramen and its clinical importance in the adult central Indian population. Methods This descriptive cross-sectional study was done on 136 dry adult central Indian human fibula bones of known sex (male: 68 and female: 68). The presence of nutrient foramen, their numbers, relation with fibular surfaces, and distance from the styloid process were assessed and were then clinically correlated. Results In males, single-nutrient foramen and double-nutrient foramina were seen in 92.65% and 7.35% of fibula, respectively. Whereas in females, single-nutrient foramen and double-nutrient foramina were seen in 95.59% and 4.41% of fibula, respectively. The position of the nutrient foramen and the fibular length showed significant sexual variation. Conclusions This study concludes that among both sexes, the single fibular nutrient foramen in the middle third segment was the most prevalent. Compared to the female population, the male population demonstrated a broader location of the nutrient foramen.
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Affiliation(s)
- Sushant Swaroop Das
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh India
| | | | - Meghana Mishra
- Department of Anatomy, Shyam Shah Medical College, Rewa, Madhya Pradesh India
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8
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Wu P, Xiao Y, Qing L, Tang J, Huang C, Cao Z. Comparison of retrograde anatomy iliac bone flap grafting versus anterograde anatomy iliac bone flap grafting for treatment of osteonecrosis of the femoral head. J Orthop Surg Res 2023; 18:130. [PMID: 36814279 PMCID: PMC9945694 DOI: 10.1186/s13018-023-03617-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Iliac bone flap with deep circumflex iliac artery is a common option in the treatment of Osteonecrosis of the femoral head (ONFH), and dissection of iliac bone flap is the key step for successful operation. This paper aims to introduce a new operative technique for dissecting iliac bone flap with deep circumflex iliac artery based on analysis of its advantages. METHODS A total of 49 patients treated by retrograde anatomy and 52 patients treated by anterograde anatomy from January 2010 to December 2020 were recruited. The two groups were then compared in terms of the preoperative baseline conditions, intraoperative data, and postoperative Harris hip score (HHS). RESULTS Compared with the retrograde anatomy group, the anterograde anatomy group had a significantly longer operating time, a significantly heavier intraoperative blood loss, a significantly higher rate of donor complication morbidity, a significantly higher rate of donor-recipient delayed healing, a significantly higher failure rate of iliac bone flap resection, a significantly higher rate of lateral femoral cutaneous nerve (LFCN) injury, and a significantly higher rate of ectopic ossification. No difference was found in postoperative HHS score between the two groups. CONCLUSION As a new operative technique that can accurately locate the nutrient vessels of the iliac bone flap and quickly dissect the iliac bone flap with deep circumflex iliac artery while maintaining a comparable clinical effect, retrograde anatomy exhibited distinct advantages over anterograde anatomy in terms of simpler intraoperative operation, safer dissection, shorter operation time, lower blood loss, and fewer donor complications. LEVEL OF EVIDENCE III, Retrospective.
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Affiliation(s)
- Panfeng Wu
- grid.216417.70000 0001 0379 7164Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan China
| | - Yu Xiao
- grid.216417.70000 0001 0379 7164Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan China
| | - Liming Qing
- grid.216417.70000 0001 0379 7164Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan China
| | - Juyu Tang
- grid.216417.70000 0001 0379 7164Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan China
| | - Chengxiong Huang
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
| | - Zheming Cao
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
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Chappell AG, Ramsey MD, Dabestani PJ, Ko JH. Vascularized Bone Graft Reconstruction for Upper Extremity Defects: A Review. Arch Plast Surg 2023; 50:82-95. [PMID: 36755653 PMCID: PMC9902088 DOI: 10.1055/s-0042-1758639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 08/04/2022] [Indexed: 02/09/2023] Open
Abstract
Upper extremity reconstruction may pose clinical challenges for surgeons due to the often-critical, complex functional demands of the damaged and/or missing structures. The advent of vascularized bone grafts (VBGs) has aided in reconstruction of upper extremity (UE) defects due to their superior regenerative properties compared with nonvascularized bone grafts, ability to reconstruct large bony defects, and multiple donor site options. VBGs may be pedicled or free transfers and have the potential for composite tissue transfers when bone and soft tissue are needed. This article provides a comprehensive up-to-date review of VBGs, the commonly reported donor sites, and their indications for the treatment of specific UE defects.
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Affiliation(s)
- Ava G. Chappell
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew D. Ramsey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Parinaz J. Dabestani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Jason H. Ko
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Address for correspondence Jason H. Ko, MD, MBA, Associate Professor, Program Director Plastic Surgery Residency, Division of Plastic and Reconstructive SurgeryDepartment of Orthopedic Surgery, Northwestern University Feinberg School of MedicineChicago, IL 60611
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Outcomes of free vascularised fibular graft reconstruction in upper limb trauma-a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:207-223. [PMID: 35083566 DOI: 10.1007/s00590-021-03185-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate existing literature describing the use of free fibular flaps in upper extremity trauma and summarise flap outcomes. Secondary objectives are to evaluate patient demographics and flap characteristics. METHODS EMBASE, PubMed, MEDLINE and the Cochrane Database were searched for eligible studies published from 1975 to January 2019. Primary outcome measures collected were rate of union, graft survival rate, and complication rates. Patient demographics and flap characteristics were also collected. Statistical analysis was performed using SPSS software (SPSS version 25; IBM, Chicago, USA). Pooled data were presented as mean and standard deviation or median and range. Categorical variables were assessed by chi-squared test. Quality of studies were assessed using the National Institutes of Health (NIH) Quality Assessment Tool for case series studies. RESULTS Initial search yielded 1070 articles. A total of 25 studies (151 cases) met the inclusion criteria. Flap survival was 97% (147/151) at time of follow-up, with first union rate of 95% (142/151) and second union rate of 97% (147/151) following bone graft or further procedure. Overall complication rate was 33% (47/140). There was a statistically significant association between recipient flap site and rates of flap fracture (p = 0.049). There was no statistically significant association between flap type, evidence of infection at donor or defect site, or method of flap fixation on outcomes. CONCLUSIONS Vascularised fibular flaps are a safe and efficacious reconstructive option for upper limb trauma. Further research is required to enable better understanding of the impact of patient and clinical factors on flap outcome measures.
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Feltri P, Solaro L, Errani C, Schiavon G, Candrian C, Filardo G. Vascularized fibular grafts for the treatment of long bone defects: pros and cons. A systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:29-48. [PMID: 34110477 DOI: 10.1007/s00402-021-03962-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/16/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify union rate, complication rate, reintervention rate, as well as functional outcome after vascularized fibular bone grafts (VFGs) for the treatment of long-bone defects. METHODS A comprehensive search was performed in the PubMed, Web of Science, and Cochrane databases up to August 18, 2020. Randomized controlled trials, comparative studies, and case series describing the various techniques available involving VFGs for the reconstruction of segmental long-bone defects were included. A meta-analysis was performed on union results, complications, and reinterventions. Assessment of risk of bias and quality of evidence was performed with the Downs and Black's "Checklist for Measuring Quality". RESULTS After full-text assessment, 110 articles on 2226 patients were included. Among the retrieved studies, 4 were classified as poor, 83 as fair, and 23 as good. Overall, good functional results were documented and a union rate of 80.1% (CI 74.1-86.2%) was found, with a 39.4% (CI 34.4-44.4%) complication rate, the most common being fractures, non-unions and delayed unions, infections, and thrombosis. Donor site morbidity represented 10.7% of the total complications. A 24.6% reintervention rate was documented (CI 21.0-28.1%), and 2.8% of the patients underwent amputation. CONCLUSIONS This systematic review and meta-analysis documented good long-term outcomes both in the upper and lower limb. However, VFG is a complex and demanding technique; this complexity means an average high number of complications, especially fractures, non-unions, and vascular problems. Both potential and limitations of VFG should be considered when choosing the most suitable approach for the treatment of long-bone defects.
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Affiliation(s)
- Pietro Feltri
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, 6900, Lugano, Switzerland
| | - Luca Solaro
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1/10, 40136, Bologna, Italy.
| | - Costantino Errani
- Orthopaedic Service, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Guglielmo Schiavon
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, 6900, Lugano, Switzerland
| | - Christian Candrian
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, 6900, Lugano, Switzerland.,Facoltà Di Scienze Biomediche, Università della Svizzera Italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy.,Facoltà Di Scienze Biomediche, Università della Svizzera Italiana, Via Buffi 13, 6900, Lugano, Switzerland
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Long-Term Follow-Up of Biological Reconstruction with Free Fibular Graft after Resection of Extremity Diaphyseal Bone Tumors. J Clin Med 2022; 11:jcm11237225. [PMID: 36498798 PMCID: PMC9741265 DOI: 10.3390/jcm11237225] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
This study aimed to evaluate the clinical outcomes and complications of reconstruction with a composite free fibula inside other biological grafts. We retrospectively reviewed 26 patients who underwent reconstruction after bone tumor resection of the diaphysis of the long bone. Surgical data, time to bony union, functional outcomes, and complications were evaluated in all cases. The median follow-up was 72.5 months. The limb salvage rate was 100%. Primary osseous union was achieved in 90.4% of the junctions. The union rates at the metaphyseal and diaphyseal junctions were 100% and 85.7%, respectively (p = 0.255). The mean time of bony union in the upper (87.5%) and lower (91.7%) extremity was 4.6 ± 1.6 months and 6.9 ± 2 months, respectively. The mean MSTS score was 27.2 ± 3.2, with a mean MSTS rating of 90.7%. Complications occurred in 15.4% of the cases. The administration of vascularized or non-vascularized grafts did not significantly influence the union time (p = 0.875), functional outcome (p = 0.501), or blood loss (p = 0.189), but showed differences in operation time (p = 0.012) in lower extremity reconstruction. A composite free fibula inside other biological grafts provides a reasonable and durable option for osseous oncologic reconstruction of the long bone diaphysis of the extremities with an acceptable rate of complications. A higher union rate was achieved after secondary bone grafting. In lower-extremity reconstruction, two plates may be considered a better option for internal fixation. Vascularizing the fibula did not significantly affect the union time.
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Reátiga J, Arzuza L, Guzmán J, Molina J, Ríos X. Fibular strut graft placement for an open distal femur fracture with a critical bone defect: A case report. Trauma Case Rep 2022; 42:100712. [PMID: 36210920 PMCID: PMC9535308 DOI: 10.1016/j.tcr.2022.100712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
Case We herein present a case involving a 23-year-old man with an open fracture of the distal portion of the left femoral diaphysis, substantial bone loss, and soft tissue injuries. He was initially treated with antibiotics, limb stabilization, and surgical debridement. On the sixth day, he underwent internal fixation and fibular strut graft placement for bone defect restoration. After 4 years, osteosynthesis, perfect graft integration and consolidation, excellent knee functionality, and painless gait were evident. Conclusion Preservation of bone and soft tissue vitality, complete debridement, antibiotic therapy, and early limb stabilization are all crucial factors for restoring knee functionality.
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Affiliation(s)
- Juan Reátiga
- Orthopedics and Traumatology, Grupo Campbell, Barranquilla, Colombia,Corresponding author.
| | - Laura Arzuza
- Epidemiology, Grupo Campbell, Barranquilla, Colombia
| | - Julio Guzmán
- Physician, Fundación Clínica Campbell, Barranquilla, Colombia
| | - Juan Molina
- Physician, Fundación Clínica Campbell, Barranquilla, Colombia
| | - Ximena Ríos
- Orthopedics and Traumatology, Grupo Campbell, Barranquilla, Colombia
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14
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Intercalary frozen autografts for reconstruction of bone defects following meta-/diaphyseal tumor resection at the extremities. BMC Musculoskelet Disord 2022; 23:890. [PMID: 36180843 PMCID: PMC9526247 DOI: 10.1186/s12891-022-05840-6] [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: 03/07/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
For patients with malignant limb tumors, salvage surgery can be achieved using endoprosthesis or biological reconstructions like allograft or autograft. In carefully selected patients, resected bone can be recycled after sterilization using methods like autoclaving, irradiation, pasteurization or freezing with liquid nitrogen. We evaluated the clinical outcome and complications of malignant limb tumors treated with intercalary resection and frozen autograft reconstruction.
Methods
We reviewed 33 patients whose malignant bone tumors were treated by wide resection and reconstruction with recycling liquid nitrogen-treated autografts between 2006 and 2017. Limb function, bone union at the osteotomy site and complications were evaluated. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system.
Results
The cohort comprised 16 males and 17 females, with a mean age of 35.4 years (14–76 years). The most common tumor was osteosarcoma (7 cases). Tumors were located in the humerus (5), ulna (1), femur (10) and tibia (17). The mean follow-up was 49.9 months (range 12–127 months). Of the 33 patients, 16 remained disease-free, and 3 were alive with disease. The mean size of the defect after tumor resection was 11.6 cm (range 6–25 cm). Bone union was achieved in 32 patients, with a mean union time of 8.8 months (range 4–18 months). Complications included 1 graft nonunion, 2 infections (1 superficial, 1 deep infection), 1 leg length discrepancy, 2 graft fractures and 3 local recurrences. The mean MSTS score was 87.2% (range 70–100%).
Conclusion
Liquid nitrogen-treated tumor-bearing autograft is an effective option for biological reconstruction after meta-/diaphyseal tumor resection of long bones. This method has excellent clinical outcomes and is especially recommended for patients with no severe osteolytic bone tumors.
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15
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Chen YS, Yang CY, Chang CW, Chen YN. Anterior tibial artery pseudoaneurysm as a rare technical complication after corrective fibular osteotomy: a case report. Patient Saf Surg 2022; 16:25. [PMID: 35907905 PMCID: PMC9338537 DOI: 10.1186/s13037-022-00334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Partial fibular osteotomy has been recognized as a surgical alternative to treat medial compartment osteoarthritis of the knee. Related peroneal neuropathies are of concern among the relatively few complications after this procedure. In our clinical practice, the osteotomy level has therefore been modified to avoid the above defects. However, a rare case of vascular injury was encountered. Herein we describe an accidental anterior tibial artery pseudoaneurysm as a rare technical complication after this corrective osteotomy. Case presentation A 55-year-old male visited our emergency room, presenting a painful swelling over his right anterolateral shin along with surrounding ecchymosis. Thirteen days ago, he just underwent a corrective fibular osteotomy over his right painful varus knee at our institute, and was discharged after an uneventful postoperative stay. Urgent angiography revealed an out-pouching vascular lesion, pseudoaneurysm, involving his right anterior tibial artery. Prompt endovascular repair with stent insertion and balloon compression successfully stopped the persistent extravasation from the injured artery. Follow-up angiography as well as outpatient review confirmed the regression of this lesion and associated symptoms without sequelae. Conclusion Although corrective fibular osteotomy is a simple surgical procedure, it is not free of complications. The suggested osteotomized level in the pertinent literature predisposes patients to certain neuromuscular deficits, which could be avoided by the modified level of osteotomy. However, our case highlights surgeons’ familiarity with certain risky neurovascular structures around the osteotomy site and corresponding technical considerations. A recent surgical history along with alarming symptoms/signs should arouse clinical suspicion, aid in timely identification and make appropriate interventions for potential vascular complications.
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Affiliation(s)
- Yu-Sheng Chen
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chyun-Yu Yang
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Orthopedics, Kuo General Hospital, Tainan, Taiwan
| | - Chih-Wei Chang
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Orthopedics, Kuo General Hospital, Tainan, Taiwan. .,Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Yen-Nien Chen
- Department of Physical Therapy, Asia University, Taichung, Taiwan
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16
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Chen YS, Ang MD, Yang CY, Chang CW. Proximal fibular osteotomy relieves pain in spontaneous osteonecrosis of the knee: A retrospective study. Medicine (Baltimore) 2022; 101:e29585. [PMID: 35905203 PMCID: PMC9333514 DOI: 10.1097/md.0000000000029585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Spontaneous osteonecrosis of the knee (SONK) causes knee pain and joint motion limitation. Ischemia or insufficiency fracture may be the cause, but no consensus has been developed. Proximal fibular osteotomy (PFO) has been reported to relieve pain from osteoarthritis through medial compartment decompression. We reviewed the effect of this procedure on medial compartment SONK patients and explored clinical and radiological results. Since January 2018 to January 2020, the data of 12 knees (8 right and 4 left) from 11 SONK patients (9 women and 2 men) who received PFO were analyzed. The average age was 61.5 years. The diagnosis of SONK was established through weight-bearing anterior-posterior radiographs or magnetic resonance imaging (MRI). Visual analog scale (VAS) scores, Oxford knee score (OKS), Femorotibial angle (FTA), medial joint space, and lateral joint space were documented preoperatively and at follow up visits. Outcome assessment for the clinical and radiographic data was reviewed at 12- and 24-month follow-up visits. The mean follow up period was 33 months. All patients were able to walk with or without cane assistance the day after surgery. Both VAS score and OKS (preoperative: 6.6 ± 0.9 and 24.7 ± 3.8, respectively) improved significantly at the 12-month follow-up, and to 24-month follow-up (3.6 ± 1.3 and 35.6 ± 4.5, respectively, P < .05). Medial joint space ratio increased from 0.36 to 0.50 (P < .05). Changes of FTA were insignificant at any point of follow up. Four patients underwent follow-up MRI, and a decrease in the osteonecrotic area was clearly observed in 2 patients. By achieving medial knee decompression, PFO allowed quick weight-bearing recovery, pain relief, and improvement in knee function in SONK patients.
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Affiliation(s)
- Yu-Sheng Chen
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Min-De Ang
- Department of Internal medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chyun-Yu Yang
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan City, Taiwan
- Department of Orthopedics, College of Medicine, National Cheng Kung University Hospital, Tainan City, Taiwan
- Department of Orthopaedics, Kuo General hospital, Tainan City, Taiwan
| | - Chih-Wei Chang
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan City, Taiwan
- Department of Orthopedics, College of Medicine, National Cheng Kung University Hospital, Tainan City, Taiwan
- Department of Orthopaedics, Kuo General hospital, Tainan City, Taiwan
- *Correspondence: Chih-Wei Chang, Department of Orthopedics, National Cheng Kung University Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan (e-mail: )
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17
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Mechanical Fatigue Performance of Patient-Specific Polymer Plates in Oncologic Mandible Reconstruction. J Clin Med 2022; 11:jcm11123308. [PMID: 35743379 PMCID: PMC9224531 DOI: 10.3390/jcm11123308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 12/10/2022] Open
Abstract
Mandible defects are conventionally reconstructed using titanium plates. However, titanium causes metallic artifacts which impair radiological imaging. This study aims at evaluating mechanical fatigue of radiolucent fiber-reinforced polyetheretherketone (f-PEEK), polyetheretherketone (PEEK), polyetherketoneketone (PEKK), and polyphenylsulfone (PPSU) polymer plates for mandible reconstruction. A total of 30 plates (titanium [n = 6], f-PEEK [n = 6], PEEK [n = 6], PEKK [n = 6], PPSU [n = 6]) were implanted in synthetic mandibulectomized polyurethane mandibles. Servo-pneumatic mechanical testing with cyclic application of 30−300 N at 3 Hz was conducted. Bite forces were 70% on the unresected and 30% on the resected side. Total number of cycles was set to 250,000. Testing was aborted in case of plate or screw failure. Axial load to failure was tested with a speed of 1 mm/s. Kruskal−Wallis and Dunn’s post hoc tests were used. Titanium, f-PEEK, and PEEK showed no failure in fatigue testing and PPSU (p < 0.001) failed against titanium, f-PEEK, PEEK, and PEKK. Titanium allowed the highest load to failure compared to f-PEEK (p = 0.049), PEEK (p = 0.008), PEKK (p < 0.001), and PPSU (p = 0.007). f-PEEK, PEEK, and PEKK withstood expected physiological bite force. Although titanium plates provided the highest fatigue strength, f-PEEK and PEEK plates showed no failure over 250,000 chewing cycles indicating sufficient mechanical strength for mandible reconstruction.
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18
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Wang Y, Wang M, Li C, Nakamura Y, Deng L, Yamako G, Chosa E, Pan C. Biomechanical effect of metal augment and bone graft on cup stability for acetabular reconstruction of total hip arthroplasty in hip dysplasia: a finite element analysis. BMC Musculoskelet Disord 2022; 23:277. [PMID: 35321681 PMCID: PMC8943934 DOI: 10.1186/s12891-022-05168-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Different methods of acetabular reconstruction with total hip arthroplasty (THA) for Crowe II and III of adult developmental dysplasia of the hip (DDH) acetabular bone defect have been implemented clinically. However, the biomechanical effect of different augmented materials for acetabular reconstruction in THA on shell stability has never been discussed. Methods In the present study, autologous bone graft (BG)and metal (Ti6Al4V) augment (MA) were simulated with several acetabular bone defect models of DDH in THA. The contact pressure and micromotion between the shell and host bone were measured for evaluating the shell stability using a finite element method. Results The peak contact stress between shell and host bone was higher in the MA situation (12.45 vs 8.71 MPa). And the load transfer path was different, for BG models, the high local contact stresses were found at the junction of bone graft and host bone while for MA models the concentrated contact stresses were at the surface of MA. The peak relative micromotion between shell and host bone was higher in the MA situation (12.61 vs 11.13 µm). However, the peak micromotion decreased in the contact interface of MA and cup compared to the BG models. Conclusions The higher micromotion was found in MA models, however, enough for bone ingrowth, and direct stronger fixation was achieved in the MA-cup interface. Thus, we recommended the MA can be used as an option, even for Crowe III, however, the decision should be made from clinical follow-up results.
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Affiliation(s)
- Yuzhu Wang
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Mincong Wang
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Chengguo Li
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yoshihiro Nakamura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Liwei Deng
- Department of Radiology, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Go Yamako
- Department of Mechanical Engineering, Faculty of Engineering, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Etsuo Chosa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Chenglong Pan
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China.
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19
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Ajit Singh V, Teck Wei K, Haseeb A, Yasin NF. Functional outcome following excision of giant cell tumour of the distal radius and reconstruction by autologous non-vascularized osteoarticular fibula graft. J Orthop Surg (Hong Kong) 2022; 30:23094990221074103. [PMID: 35100910 DOI: 10.1177/23094990221074103] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Giant cell tumour (GCT) of the bone is a benign but locally aggressive tumour, commonly occurs at the metaphyseal-epiphyseal junction of the distal femur, proximal tibia, and distal radius. For Campanacci grade II and III lesions of the distal radius and in cases of recurrence, we usually carry out wide resection and reconstruction. There are numerous publications on the treatment of GCT of the distal radius. Still, reports on the functional outcome using non-vascularized fibular graft arthroplasty without fusion remain limited. METHOD We reviewed patients who underwent wide resection and non-vascularized fibular graft arthroplasty from 2007 to May 2014. The assessment was done with Musculoskeletal Tumour Society Score (MSTS), Toronto Extremities Scoring System (TESS) and Disability of the Arm, Shoulder and Hand (DASH) scores. We also reviewed the radiographic results. RESULTS Fifteen patients were recruited, of whom 10 cases used ipsilateral fibular graft and five used contralateral non-vascularized fibular graft. The average duration of follow up was 6 years (3.25-9.92 years). The average grip strength was 48.1% compared to the non-operated hand. The average MSTS score was 78.4 %, TESS score was 84%, and DASH score was 25.2. The average time to radiological union was 12.5 weeks. 64% (29-78%) of the range of movement is preserved compared to the normal side. The complication rate was 20%. CONCLUSION Fibula autograft arthroplasty is a feasible method of reconstruction after distal radius resection with good functional outcomes.
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Affiliation(s)
- Vivek Ajit Singh
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Koh Teck Wei
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Amber Haseeb
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Nor Faissal Yasin
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
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20
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VICENTI G, OTTAVIANI G, BIZZOCA D, CARROZZO M, SIMONE F, GROSSO A, ZAVATTINI G, ELIA R, MARUCCIA M, SOLARINO G, MORETTI B. The role of biophysical stimulation with pemfs in fracture healing: from bench to bedside. MINERVA ORTHOPEDICS 2022. [DOI: 10.23736/s2784-8469.21.04116-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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21
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Lai CC, Wang TM, Chang CH, Pao JL, Fang HW, Chang CC, Lin SM, Lan TY. Calcaneal lengthening using ipsilateral fibula autograft in the treatment of symptomatic pes valgus in adolescents. BMC Musculoskelet Disord 2021; 22:977. [PMID: 34814872 PMCID: PMC8609868 DOI: 10.1186/s12891-021-04855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background Evans calcaneal lengthening osteotomy is used to treat symptomatic flexible flatfoot when conservative treatment fails. Grafts such as autologous iliac bone grafts, allografts, and xenografts are implanted at the osteotomy site to lengthen the lateral column of the hindfoot. This study aimed to present the outcomes of an autologous mid-fibula bone graft used for calcaneal lengthening in symptomatic pes valgus in adolescents. Methods We retrospectively examined 23 ft of 13 adolescents who underwent surgery between July 2014 and January 2018. The radiological and clinical outcomes (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores) were assessed during a mean follow-up of 49.7 (range, 30.9–73.4) months. The mean distance of the lengthening site was measured to evaluate graft sinking or collapse. The Goldberg scoring system was used to determine the degree of union at the donor and recipient sites. Results The calcaneal pitch and the anteroposterior and lateral talo-first metatarsal (Meary) angles showed significant correction, from 14.4 to 19.6 (p < 0.001), and from 14.5 to 4.6 (p < 0.001) and 13.5 to 8.5 (p < 0.001), respectively. The mean distance of the lengthening site showed no significant change (p = 0.203), suggesting no graft sinking or postoperative collapse. The lateral distal tibial angle showed no significant difference (p = 0.398), suggesting no postoperative ankle valgus changes. Healing of the recipient and donor sites occurred in 23 and 21 ft, respectively. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scores improved significantly, from 68.0 to 98.5 (p < 0.001). Conclusions Evans calcaneal lengthening using an ipsilateral mid-fibula bone autograft resulted in significant improvement in clinical and radiological outcomes without ankle valgus deformity. Hence, it could be a treatment option for lateral column calcaneal lengthening in adolescents.
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Affiliation(s)
- Chien-Cheng Lai
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan.,Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Ting-Ming Wang
- Department of Orthopedic Surgery, School of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hung Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan.,Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
| | - Jwo-Luen Pao
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan
| | - Hsu-Wei Fang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Chun-Chien Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan
| | - Shang-Ming Lin
- Department of Materials and Textiles, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Tsung-Yu Lan
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City, 220, Taiwan. .,Department of Orthopedic Surgery, School of Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Materials and Textiles, Asia Eastern University of Science and Technology, New Taipei City, Taiwan.
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22
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Migliorini F, La Padula G, Torsiello E, Spiezia F, Oliva F, Maffulli N. Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature. Eur J Med Res 2021; 26:118. [PMID: 34600573 PMCID: PMC8487570 DOI: 10.1186/s40001-021-00593-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/20/2021] [Indexed: 12/16/2022] Open
Abstract
Large bone defects resulting from musculoskeletal tumours, infections, or trauma are often unable to heal spontaneously. The challenge for surgeons is to avoid amputation, and provide the best functional outcomes. Allograft, vascularized fibular or iliac graft, hybrid graft, extracorporeal devitalized autograft, distraction osteogenesis, induced-membrane technique, and segmental prostheses are the most common surgical strategies to manage large bone defects. Given its optimal osteogenesis, osteoinduction, osteoconduction, and histocompatibility properties, along with the lower the risk of immunological rejection, autologous graft represents the most common used strategy for reconstruction of bone defects. However, the choice of the best surgical technique is still debated, and no consensus has been reached. The present study investigated the current reconstructive strategies for large bone defect after trauma, infections, or tumour excision, discussed advantages and disadvantages of each technique, debated available techniques and materials, and evaluated complications and new perspectives.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Gerardo La Padula
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Ernesto Torsiello
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Filippo Spiezia
- Ospedale San Carlo Potenza, Via Potito Petrone, 85100, Potenza, Italy
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England
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23
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Chi G, Ren H, Lin B, Huang K. Subtrochanteric femoral fracture with postoperative chronic osteomyelitis treated successfully by 1-stage operation: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:514. [PMID: 33850911 PMCID: PMC8039705 DOI: 10.21037/atm-21-413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Chronic osteomyelitis is a chronic infectious disease of bone tissue, which can cause necrosis of bone and surrounding soft tissue, and is a common complication of open fracture, internal fixation, diabetic foot and blood-borne bone infection. Traumatic osteomyelitis is caused by bone tissue infection after open fracture surgery or open reduction of fracture or other bone and joint surgery. The lesion is near the fracture end. Intramedullary infection is the most serious infection in acute stage, with high fever, chills and other toxemia symptoms, similar to acute hematogenous osteomyelitis. The other is the skin and muscle necrosis infection near the fracture, which makes Fractures that lose blood supply are exposed to air and become dry and necrotic, and the course of disease turns to chronic, often accompanied by infectious nonunion or bone damage. The course of disease is prolonged and the treatment is difficult. Subtrochanteric femoral fracture with postoperative chronic osteomyelitis is a rare condition requiring complex treatment. In the present study, we report on a 49-year-old male patient who received open reduction with intramedullary nail fixation due to subtrochanteric femoral fracture, but later suffered postoperative infection and developed chronic osteomyelitis. On the basis of the complete removal of the osteomyelitis lesion, we performed a 1-stage operation where free vascularized fibula was used to repair the bone defect, followed by effective internal fixation. The patient was followed up for 24 months and finally recovered from chronic osteomyelitis, with good functional recovery of the hip joint and a Harris score of 85.
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Affiliation(s)
- Genying Chi
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Haiyong Ren
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Bingyuan Lin
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Kai Huang
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
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24
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Venkatesh MS, Kumaraswamy MK, Shivalingappa SK, Waiker VP. Fibula Musculo-Osteocutaneous Flap with Full Thickness of Flexor Hallucis Longus Muscle. World J Plast Surg 2021; 10:22-29. [PMID: 33833950 PMCID: PMC8016380 DOI: 10.29252/wjps.10.1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Fibula flap has been a gold standard method for reconstruction of the mandible. It has been used for reconstruction of maxilla as well as long bones, effectively. Fibula flap in selected cases has been used as a pedicled flap. The flexor hallucis longus muscle has been used to obliterate the dead space during the reconstruction. With a wide range of indications, the use of flexor hallucis muscle has studied for the reconstruction. METHODS In a retrospective case record analysis study, 38 subjects were enrolled, included 32 patients with reconstruction of mandible, 1 patient with reconstruction of maxilla, 4 patients with 3 free flaps and 1 pedicled flap with reconstruction of the tibia. RESULTS The success rate was 89%, with 4 flap failures. The muscle was used for reconstruction of the tongue, floor of the mouth, antrum, and to cover the fibula graft. CONCLUSION Flexor hallucis longus muscle harvested with the flap could decrease the operative time, ease the harvest, and fill the dead space during reconstruction.
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Affiliation(s)
- Mysore Srinivas Venkatesh
- Department of Plastic Surgery, Ramaiah Medical College and Hospital, Bengaluru, 560040, Bangalore, India
| | - Mohan Kumar Kumaraswamy
- Department of Plastic Surgery, Ramaiah Medical College and Hospital, Bengaluru, 560040, Bangalore, India
| | | | - Veena Prabhakar Waiker
- Department of Plastic Surgery, Ramaiah Medical College and Hospital, Bengaluru, 560040, Bangalore, India
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Tuncay İ, Tözün R, Aliyev O, Dikmen G, Uzer G, Özden VE, Yıldız F. Onlay fibula autografting technique and its comparison with cortical allograft for the reconstruction of periprosthetic bone defects around the femur. INTERNATIONAL ORTHOPAEDICS 2020; 45:71-81. [PMID: 33206205 DOI: 10.1007/s00264-020-04876-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bone defect around the femur related to revisions or periprosthetic fractures (PFF) is an issue. We present a bone defect reconstruction technique in femoral revisions and/or PFF using fibula autograft and compared our radiological and clinical results to that of allograft. METHODS A total of 53 patients who underwent revision hip arthroplasty and/or PFF fixation with the use of cortical fibula autograft (FG group) or cortical allograft (CG group) were evaluated. After exclusions, 20 patients who had minimum two years of follow-up were investigated for each group, for their radiological and clinical outcomes. RESULTS In FG and CG groups, the median ages were 69.5(44-90) and 62(38-88) years, follow-ups were 59(28-72) and 120(48-216) months, defect lengths were seven (1-10) and ten (1-17) cm, and grafts lengths were 16.5(10-30) and 20(12-37) cm, respectively. The rate of graft incorporation was 90% in each group and median time to incorporations were seven (4-12) and 12(6-24) months (p < 0.001), and graft resorption (moderate and severe) rates were 10% and 25% (p = 0.41), respectively. Median Harris Hip (77.6 vs 78.0), WOMAC (23.2 vs 22), SF-12 physical (50.0 vs 46.1), and SF-12 mental (53.8 vs 52.5) scores were similar between the groups, respectively. Kaplan-Meier survivorship analyses revealed an estimated mean survival of 100% at six years in FG group and 90% at 14 years in CG group. CONCLUSION In the reconstruction of periprosthetic bone defects after femoral revision or PPF, onlay cortical fibula autografts provide comparable clinical and radiological outcomes to allografts. Its incorporation is faster, it is cost-effective and easy to obtain without apparent morbidity.
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Affiliation(s)
- İbrahim Tuncay
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey
| | - Remzi Tözün
- Department of Orthopedics and Traumatology, School of Medicine, Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Darüşşafaka Büyükdere Caddesi No No:40, Sarıyer, Istanbul, 34457, Turkey
| | - Orkhan Aliyev
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey
| | - Göksel Dikmen
- Department of Orthopedics and Traumatology, School of Medicine, Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Darüşşafaka Büyükdere Caddesi No No:40, Sarıyer, Istanbul, 34457, Turkey
| | - Gökçer Uzer
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey
| | - Vahit Emre Özden
- Department of Orthopedics and Traumatology, School of Medicine, Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Darüşşafaka Büyükdere Caddesi No No:40, Sarıyer, Istanbul, 34457, Turkey
| | - Fatih Yıldız
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Adnan Menderes Blv., Fatih, Istanbul, 34093, Turkey.
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Sallent A, Soza D, Duarri G, Busquets R. Checkrein deformity: a case report of two patients with hallux deformity and pain following mandibular reconstruction in oral cancer treatment. Oral Maxillofac Surg 2020; 24:359-362. [PMID: 32500381 DOI: 10.1007/s10006-020-00852-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Checkrein deformity is an uncommon disease with a well-described etiology. It is characterized by a dynamic deformity of the hallux or great toe. We report two cases of checkrein deformity due a fibular graft harvesting in two patients with a mandibular bone defect secondary to an oral cancer treatment. CASE REPORT We report two young patients with mandibular cancers that had been treated several years before our visit and were currently free of disease. The patients had a mandibular bone defect due to the maxillofacial treatment, solved with a free fibular graft. The current complaint was a great toe deformity that caused pain and made them walk with difficulties. Diagnosis was a checkrein deformity, and after a surgical release of the flexor hallucis longus tendon, both cases returned to normal activities with no walking limitations. CONCLUSION Our cases highlight that an accurate patient examination is warranted following these reconstructions as many of them can be misdiagnosed, and a relatively simple surgery can improve the patients' limitations.
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Affiliation(s)
- Andrea Sallent
- Orthopedic Department, Hospital Vall d'Hebron, Paseo Vall d'Hebron, 119-129 08035, Barcelona, Spain.
| | - Diego Soza
- Orthopedic Department, Hospital Vall d'Hebron, Paseo Vall d'Hebron, 119-129 08035, Barcelona, Spain
| | - Gemma Duarri
- Orthopedic Department, Hospital Vall d'Hebron, Paseo Vall d'Hebron, 119-129 08035, Barcelona, Spain
| | - Rosa Busquets
- Orthopedic Department, Hospital Vall d'Hebron, Paseo Vall d'Hebron, 119-129 08035, Barcelona, Spain
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Kamal AF, Muhamad A. Outcomes of En bloc resection followed by reconstruction of giant cell tumor around knee and distal radius. A case series. Ann Med Surg (Lond) 2020; 49:61-66. [PMID: 31890200 PMCID: PMC6926124 DOI: 10.1016/j.amsu.2019.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION This study is to evaluate the outcomes of En bloc resection and reconstruction in patients with GCT of the bone around the knee and in the distal radius. MATERIALS AND METHODS We reviewed 41 cases of GCT of the bone that was treated by En bloc resection around the knee joint and in the distal radius from 2011 to 2018. The local recurrence, metastases, complications and functional score were evaluated for each operation technique. RESULTS The average of MSTS score for all group was 78% (excellent). In the knee joint, the megaprostheses group had an excellent MSTS score of78.9% and good 21.1%. The MAMC group had an excellent MSTS score of40.0%, good 50.0% and fair 10.0%. One patient in the megaprostheses group had metastasis to the lung and 1 patient in the knee arthrodesis group has a recurrence. Infection occurred in 2 cases of megaprostheses while only 1 case in MAMC. Both of the groups in knee joint GCT had 1 patient with implant loosening. In the distal radius, FVFG group had an excellent MSTS score 100% and NVFG group had an excellent score 77.7%, good 11.1% and fair 11.1%. One patient in the NVFG group had an infection, 1 patient has implant loosening and another one patient had graft failure. Two patients in the NVFG group had a recurrence. No metastasis was found in both of the group types of surgery in distal radius GCT. CONCLUSION Functional outcome of a patient with GCT of the bone after En bloc resection and reconstruction with the above techniques had comparable results with previous studies.
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Affiliation(s)
- Achmad Fauzi Kamal
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Almu Muhamad
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Andalas, Padang, Indonesia
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Lei P, Du W, Liu H, Wu P, Zhou Z, Yu F, Qing L, Pan D, Liu R, Zeng L, Cao Z, Ou Q, Tang J. Free vascularized iliac bone flap based on deep circumflex iliac vessels graft for the treatment of osteonecrosis of femoral head. J Orthop Surg Res 2019; 14:397. [PMID: 31779640 PMCID: PMC6883673 DOI: 10.1186/s13018-019-1440-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/30/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To investigate the feasibility and clinical efficacy of free vascularized iliac bone flap based on deep iliac circumflex vessels graft for the treatment of osteonecrosis of femoral head (ONFH) in young adults. METHODS Eighteen patients (19 hips) undergoing ONFH were included from January 2016 to May 2017. After the debridement of the necrotic bones, the contralateral vascularized iliac bone flap was designed and harvested before grafting, in which the deep circumflex iliac vessels and the transverse branch (or ascending branch) of the lateral circumflex femoral artery and their accompanying veins were anastomosed. X-ray was obtained at 1, 3, 6, 9, and 12 months respectively for evaluation of the bone flap healing. Hip function was evaluated with Harris hip score at 18 months postoperatively. RESULTS None of the patients is lost to follow-up. All the hips healed well except for four complications: one patient developed superficial wound infection, one patient had subcutaneous hematoma, and two patients developed anterolateral femoral cutaneous nerve injury. X-ray films at 12 months showed improvement in 13 hips (68.4%), five hips (26.3%) were unchanged, and one femoral head collapse with conversion to total hip arthroplasty (THA) at 14 months postoperatively (5.3%). Postoperative mean Harris hip scores were significantly improved compared to the preoperative results (P < 0.05). CONCLUSION Free vascularized iliac bone flap based on deep circumflex iliac vessels graft is an acceptable treatment option for young adult ONFH in mid-late stage with low conversion to THA rate at short-term follow-up.
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Affiliation(s)
- Pengfei Lei
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Wei Du
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of Rehabilitation Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hao Liu
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Panfeng Wu
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Zhengbing Zhou
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Fang Yu
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Liming Qing
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Ding Pan
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Rui Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Lei Zeng
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Zheming Cao
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Qifeng Ou
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Juyu Tang
- Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
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A unidirectional porous beta-tricalcium phosphate promotes angiogenesis in a vascularized pedicle rat model. J Orthop Sci 2019; 24:1118-1124. [PMID: 31421947 DOI: 10.1016/j.jos.2019.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Various types of artificial bone have been developed as alternatives to autologous bone grafts. In designing artificial bone, a porous structure is essential for the infiltration of blood and cells, which promotes angiogenesis within the bone matrix and ultimately ossification. However, it remains unclear what kind of pore system best promotes ossification. Here, we investigated angiogenesis in three different types of porous β-tricalcium phosphate (β-TCP) in a vascularized pedicle rat model. METHODS Three types of porous β-TCP-β-TCP60 (60% porosity), β-TCP75 (75% porosity), and unidirectional porous β-tricalcium phosphate (UDPTCP; 57% porosity)-were examined. A cylindrical piece of artificial bone was implanted beneath the superficial inferior epigastric (SIE) vessels in the groin of rats and angiogenesis was allowed to occur. Two weeks after surgery, India ink or lectin was systemically injected to detect newly formed blood vessels originating from the SIE vessels. Immunohistochemistry for von Willebrand factor, α-smooth muscle actin, or type IV collagen was performed to clarify the structural features of the newly formed capillaries within the vascularized UDPTCP. RESULTS The vascularity of the UDPTCP was superior to that of β-TCP60 and β-TCP75. The UDPTCP pore structure was completely filled with capillaries at 3 weeks after implantation. Immunohistochemistry showed that the walls of the capillaries contained endothelial cells, pericytes, and basement membrane originating from the SIE vessels, and that the cells proliferated and the basement membrane formed simultaneously as the newly formed capillaries extended through the unidirectional pore structure of the UDPTCP. CONCLUSIONS UDPTCP had greater angiogenic potential than β-TCP60 and β-TCP75 in a vascularized pedicle rat model. Vascularized UDPTCP grafts may be an alternative to vascularized autologous bone grafts.
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Chin BZ, Ji T, Tang X, Yang R, Guo W. Three-Level Lumbar En Bloc Spondylectomy with Three-Dimensional-Printed Vertebrae Reconstruction for Recurrent Giant Cell Tumor. World Neurosurg 2019; 129:531-537.e1. [PMID: 31207371 DOI: 10.1016/j.wneu.2019.06.056] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Primary malignancies involving the mobile spine often require total en bloc spondylectomy with complex mechanical reconstruction, which can be augmented with novel application of the 3-dimensional (3D)-printing technique. CASE DESCRIPTION A 51-year-old man presented with a 12-month history of progressive thigh pain and lower limb motor function loss, 36 months after T12-L4 instrumentation and fusion for giant cell tumor (GCT) of the L2 vertebrae before referral. The patient subsequently underwent successful curative management of recurrent GCT through denosumab treatment, L1-L3 total en bloc spondylectomy (TES), and a novel lumbopelvic reconstruction method with a 3D-printed lumbar vertebrae and screw-rod system. CONCLUSIONS To our knowledge, this is the first reported case of multilevel lumbar TES for GCT reconstructed using a 3D-printed vertebrae. Although TES-specifically in the lumbosacral spine-remains challenging due to its unique anatomy and increased risk of neurologic insult, it is an effective option for curative management of GCTs.
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Affiliation(s)
- Brian Zhaojie Chin
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China; University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, Singapore
| | - Tao Ji
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China.
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
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Gholami M, Hedjazi A, Kiamarz Milani A. Evaluation of Anatomic Variations of Fibula Free Flap in Human Fresh Cadavers. World J Plast Surg 2019; 8:229-236. [PMID: 31309061 PMCID: PMC6620816 DOI: 10.29252/wjps.8.2.229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Reconstruction of the head and neck defects is still one of the most challenging surgeries for the surgeons. This study investigated on anatomic variations of fibula free flap in human fresh cadavers. METHODS Twenty fibula free flaps harvested from 10 fresh human corpses were enrolled. The number and type of skin perforators and their origin were recorded during the flap harvesting. After the completion of flap harvesting, the length of vascular pedicle and diameter of the artery and vein at the origin, the fibula length, the distance of the head of fibula to the site of peroneal artery bifurcation and harvesting time were also recorded. RESULTS The fibula free flaps were performed on 2 women and 8 men with the mean age of 35.6 years. The average number of perforators per flap was 1.7, most of which were musculocutaneous (35.29%) from soleus muscle. The mean fibula length was 33.1 (range: 31-35) cm. The mean distance of the head of fibula to the site of peroneal artery bifurcation from the tibialis posterior trunk was 5.76 (range: 4.5-6.5) cm. The mean length of the pedicle flap was 11.15 (range: 10-13) cm. The mean diameters of the peroneal artery and vein at the origin were 2.83 and 51.5 mm, respectively. CONCLUSION Although the fibula osteocutaneous flap is a reliable choice for maxillofacial reconstruction, flap harvesting is fairly difficult. Accordingly, surgeons must be aware of anatomical variations of the flap and have a suitable case selection to minimize the risk of surgical complications.
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Affiliation(s)
- Mahdi Gholami
- Department of Oral and Maxillofacial Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arya Hedjazi
- Iranian Legal Medicine Organization and Research Center for Legal Medicine, Tehran, Iran
| | - Amir Kiamarz Milani
- Department of Oral and Maxillofacial Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
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