Autologous Transplantation of Press-fit Bone Cylinders in the Treatment of Pelvic Nonunion

The Antibacterial Effect, Biocompatibility, and Osteogenesis of Vancomycin-Nanodiamond Composite Scaffold for Infected Bone Defects

Purpose

The repair and treatment of infected bone defects (IBD) is a common challenge faced by orthopedic clinics, medical materials science, and tissue engineering.

Methods

Based on the treatment requirements of IBD, we utilized multidisciplinary knowledge from clinical medicine, medical materials science, and tissue engineering to construct a high-efficiency vancomycin sustained-release system with nanodiamond (ND) and prepare a composite scaffold. Its effect on IBD treatment was assessed from materials, cytology, bacteriology, and zoology perspectives.

Results

The results demonstrated that the Van-ND-45S5 scaffold exhibited an excellent antibacterial effect, biocompatibility, and osteogenesis in vitro. Moreover, an efficient animal model of IBD was established, and a Van-ND-45S5 scaffold was implanted into the IBD. Radiographic and histological analyses and bone repair-related protein expression, confirmed that the Van-ND-45S5 scaffold had good biocompatibility and osteogenic and anti-infective activities in vivo.

Conclusion

Collectively, our findings support that the Van-ND-45S5 scaffold is a promising new material and approach for treating IBD with good antibacterial effects, biocompatibility, and osteogenesis.

Clinical Outcomes of Treatment Strategies for Postoperative Plate Fracture and In Situ Fracture of the Femoral Shaft

Objective

To investigate the treatment and clinical efficacy of postoperative plate fracture and in situ fracture of the femoral stem.

Methods

We have retrospectively analyzed the clinical data, revised surgery information, and clinical efficacy of patients with postoperative plate fracture of the femoral stem in our hospital. A total of 33 cases were included whose original fractures were located in the upper and cadaveric femur and treated with paralleling intramedullary pins for revision surgery, as well as patients whose original fractures were located in the lower femur which were fixed with retrograde intramedullary nailing or anatomical locking and compression splints in the distal femur. For the selection of bone grafting, the original fracture site with Fernadez-Esteve scab grades I and II was treated with an autologous iliac bone graft. Postoperatively, patients were evaluated for fracture healing time, the clinical outcome of the affected limb, and complications in the iliac bone donor area.

Results

All patients were followed up until fracture healing, and all patients achieved clinical healing with a healing rate of 100% and a mean healing time of 6.3 months. No internal fixation failure such as rebreakage or loosening of the internal fixation occurred in all patients during the follow-up period. According to the Tohner-Wrnch criteria, 23 cases were excellent, 10 cases were good, and 0 cases were poor, with an excellent rate of 100%. Complications in the autologous iliac bone donor area amounted to 36.7%.

Conclusion

For patients with original fractures located in the upper femoral segment or cadre, it is recommended to perform revision surgery with a paralleling intramedullary pin, while patients with original fractures located in the lower femoral segment are fixed with the retrograde intramedullary nailing or an anatomical type of distal femoral locking and compression splint. Patients with postoperative plate fractures of the femoral stem do not require routine autologous bone grafting for revision surgery.

Treatment options in non-unions of the pelvis: A retrospective analysis of a single center experience over 12 years

BACKGROUND

Non-unions and chronic instability of the pelvis remain rare complications after complex high velocity injuries with vertical and rotational instability of the pelvis. Treatment options are insufficiently supported by data evidence due to the rareness of this condition.

PATIENTS AND METHODS

we conducted a single center, retrospective study of all non-unions and pelvic instabilities between 1.1.2008 and 1.1.2019, excluding fragility fractures. Patients' characteristics, fracture patterns, procedures and outcomes with regard to developing treatment options and successful union in the follow-up were obtained.

RESULTS

26 patients were included in this retrospective analysis. The mean age was 55 years (range 34-78 years). Seventy-seven percent of the patients were male. The standard procedure consisted of radical debridement of the non-union, interposition of autologous bone graft and rigid stabilization systems. Three patients were lost to follow up. In the remaining n = 23 patients (88%) consolidation of the non-union was achieved. The mean follow up was 31.3 months (range 6-144). Follow up showed that an iliolumbar fixation seems to be favorable regarding outcome and complications.

DISCUSSION

Non-union and remaining instability of the pelvic ring represent a rare complication after high grade pelvic trauma. There are only limited data regarding the incidence and the treatment regimen is based on small study populations only. Based on our findings we recommend to combine autologous bone grafts with rigid fixation systems especially for non-union of the pelvis to restore the posterior sacroiliac arch.

A novel press-fit minimally-invasive symphysiodesis technique

Objective

Instability of the pubic symphysis often results in a poor outcome and reduced mobility of the patient. In some cases, an arthrodesis of the pubic symphysis is required. Until today, there is no data published how many of these procedures are performed annually and there is also no data about the outcome after this extensive surgery.

Methods

We developed a novel surgical technique to address the arthrodesis of the pubic symphysis in a minimally invasive approach. Therefore, we used for this purpose modified instruments and performed the transplantation of a cylindrical bone substitute into the pubic symphysis, without an extensive approach or dissecting the anterior or posterior symphyseal ligaments.

Results

Using this novel technique, a minimally invasive symphysiodesis was achieved in radiological findings, after the procedure.

Conclusion

Thus, this actually minimally invasive surgical technique seems to be a promising advancement for the arthrodesis of the pubic symphysis.