Percutaneous, Transtrapezial Fixation without Bone Graft Leads to Consolidation in Selected Cases of Delayed Union of the Scaphoid Waist

Purpose We evaluated clinical and radiographic outcome of percutaneous transtrapezial fixation of the scaphoid delayed union or nonunion using a headless bone screw without bone grafting. Methods Sixteen patients with delayed union or nonunion of the scaphoid were included in this retrospective study between 2006 and 2011. All patients had a delayed presentation of scaphoid fracture, and none of them was treated conservatively elsewhere. Patients with bone graft, sclerotic bone debridement, or displacement of the fragment at the nonunion site were excluded. A percutaneous transtrapezial fixation technique was used in all cases. Patients were reviewed until clinical and radiographic union was observed. At the final follow-up, DASH (Disabilities of the Arm, Shoulder and Hand) and PRWHE (Patient-Rated Wrist and Hand Evaluation) outcome scores were completed. Results Radiographic union was obtained in 15 out of 16 patients (94%) at an average follow-up of 36 months (range: 12–98 months). No complications from the percutaneous technique were noted. The average DASH score was 6 (range: 0–39) and the average PRWHE score was 10 (range: 0–56). No statistical significant difference in range of motion and grip strength was found between the operated side and the contralateral side. Conclusion Percutaneous transtrapezial screw fixation for delayed or nonunion of selected scaphoid fractures without bone grafting is promising. At a mean of 4 months, 94% union was obtained with good functional results when there was no sclerosis, minimal osteolysis, and no displacement at the scaphoid nonunion site. Type of Study Therapeutic study. Level of Evidence IV.

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Role of bone marrow infiltration in management of delayed union of long bones fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203716 ◽

2020 ◽

Vol 6 (5) ◽

pp. 968

Author(s):

Sanjay Kumar Meena ◽

Naveen Goyal ◽

Devendra Tetarwal ◽

Bharat Sharma

Keyword(s):

Bone Marrow ◽

Minimally Invasive ◽

Bone Graft ◽

Bone Grafting ◽

Delayed Union ◽

Fracture Site ◽

Bone Marrow Infiltration ◽

Long Bones ◽

Safe Procedure

Background: Usually delayed union of fracture long bones are managed by putting a bone graft at fracture site , but bone grafting have donor site complication like scar, infection ,hernia ,gait disturbance , cosmetic problem, as well as recipient site complication like soft tissue trauma , de-vascularisation of fracture fragment. Bone marrow infiltration is a minimally invasive method done percutaneously. It is easy, safe procedure with no associated complications that may occur in bone grafting.Methods: This prospective study was conducted in the Department of orthopedics, Government Medical College, Kota from June 2011 to November 2013 to evaluate the efficacy of percutaneous bone marrow infiltration in cases of delayed union of long bones. 27 patients included in study with 28 bones, as one patient has given bone marrow injection in two bones (tibia & femur), so the cases included in study counted as 28 cases. The mean age of this study was 38.28 years, ranging from 18 years to 75 years. All cases were follow up after 4 to 6 weeks and thereafter one month interval. Final follow up was taken when fracture site shows clinical and radiological sign of union.Results: Out of 23 united cases 19 had excellent results and 04 cases had good results. The five cases which fail to unite were taken as poor results.Conclusions: Bone marrow infiltration is a minimally invasive, safe bone graft substitute for delayed union of long bones and have less complications.

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Bone Loss in Distal Radial Fractures Treated with A Composite Xenohybrid Bone Substitute: A Two Years Follow-Up Retrospective Study

Materials ◽

10.3390/ma13184040 ◽

2020 ◽

Vol 13 (18) ◽

pp. 4040

Author(s):

Riccardo Ferracini ◽

Alessandro Bistolfi ◽

Claudio Guidotti ◽

Stefano Artiaco ◽

Agnese Battista ◽

...

Keyword(s):

Retrospective Study ◽

Bone Loss ◽

Bone Graft ◽

Distal Radius ◽

Bone Grafting ◽

Clinical Results ◽

Distal Radius Fractures ◽

Dash Score ◽

Radius Fractures

(1) Background: Recently, surgical treatment of distal radius fractures has increased exponentially. Many locking plates’ fixation systems have been developed allowing a more stable reduction and early mobilization. Sometimes, open reduction and fixation of distal radius fractures may leave a residual bone loss requiring grafting. This retrospective study reports clinical and radiologic outcomes of distal radius fractures treated with xenohybrid bone grafting in order to assess (i) the safety of the investigated bone graft; (ii) its radiological integration and biomechanical performances, and (iii) clinical outcomes of the patients; (2) Methods: We performed a retrospective study on a cohort of 19 patients. Preoperative X-ray and CT scan were performed. The mean clinical and radiographical follow-up was two years. Safety of the xenohybrid bone graft was constantly evaluated. Clinical results were assessed through the DASH score and Mayo wrist score; (3) Results: No adverse reactions, infections, and local or general complication were related to the use of xenohybrid bone graft. The radiolucency of the xenografts suggested progressive osteointegration. No evidence of bone graft resorption was detected. All the patients reached consolidation with good to excellent clinical results; and (4) Conclusions: Clinical and radiological data demonstrated that xenohybrid bone grafting promotes new bone formation and healing in osteopenic areas caused by fracture reduction.

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Comparison between bundled multi-segment rib graft and titanium mesh bone graft in the treatment of thoracic and lumbar spinal tuberculosis

10.21203/rs.2.15387/v1 ◽

2019 ◽

Author(s):

Yifan Wang ◽

Shiyuan Shi ◽

Qi Zheng ◽

Mingfeng Zheng ◽

Yanghui Jin

Keyword(s):

Bone Graft ◽

Bone Grafting ◽

Spinal Tuberculosis ◽

Operation Time ◽

Titanium Mesh ◽

Significant Difference ◽

Group A ◽

Group B ◽

Lumbar Spinal

Abstract Background: To investigate the two different methods including bone grafting with bundled multi-segment ribs and titanium mesh bone grafting through posterior approach in patients with thoracic and lumbar spinal tuberculosis. Methods: 38 patients with thoracic spinal tuberculosis in our hospital were divided into group A (19 cases of titanium mesh bone grafting) and group B (19 cases of bone grafting with bundled multi-segment ribs). The transverse costal process approach was firstly initiated, then the necrotic tissue of tuberculosis lesions was removed thoroughly. Finally, titanium mesh bone grafting and bone grafting with bundled multi-segment ribs was applied, respectively. Results: The data demonstrated that 12 to 24 months of follow-up revealed that the operation time of Titanium mesh bone grafting in group A was 21.2+2.3 min, and that of bundled rib bone grafting in group B was 7.2+2.4 min. Compared to group A, the time in group B was significantly shorter. The amount of bleeding in group A not distinct from that in group B. There was no significant difference in Cobb angle. The fusion time in the two groups was similar. There was no significant difference in Oswestry dysfunction index between the two groups at the last follow-up. Conclusions: Bone grafting with bundled multi-segment ribs could stable the function quickly after thoracic tuberculosis lesion clearance, indicating as an alternative and development prospects of bone graft strategy.

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Regenerative Therapy Modality for Treatment of True Combined Endodontic-Periodontal Lesions: A Randomized Controlled Clinical Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126220 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6220

Author(s):

Reham AlJasser ◽

Sundus Bukhary ◽

Mohammed AlSarhan ◽

Dalal Alotaibi ◽

Saleh AlOraini ◽

...

Keyword(s):

Bone Graft ◽

Bone Grafting ◽

Endodontic Treatment ◽

Control Group ◽

Controlled Clinical Trial ◽

Bony Defect ◽

Keratinized Tissue ◽

Group I ◽

Significant Difference ◽

Grafting Procedure

The aim of this in-vivo study was to evaluate/compare the clinical periodontal parameters in patients with true combined endo-perio lesions (EPL), treated with gutta-percha (GP) and mineral trioxide (MTA) as an obturation material alone and with addition of bone grafting in such lesions. 120 Saudi patients (mean age = 41yrs) diagnosed with true combined EPL participated in this study. Group I (control group, n = 30) was treated with conventional endodontic treatment using GP for obturation. Group II (n = 30) was treated with conventional endodontic treatment using MTA for obturation. Group III (n = 30) was treated with conventional endodontic treatment using GP for obturation + grafting procedure to fill the bony defect. Group IV (n = 30) was treated with conventional endodontic treatment using MTA for obturation + grafting procedure to fill the bony defect. Clinical parameters (Pocket depth (PD); Clinical attachment loss (CAL); keratinized tissue width (KTW); gingival phenotype (G.Ph.) and Cone Beam Computed Tomography Periapical Index (CBCTPAI)) were recorded and compared at baseline, 3, 6, 12 months’ interval. For the groups III and IV, CBCTPAI showed significant difference (p < 0.0001) with the other groups at 6 months and 1-year interval. The group with MTA + bone graft showed 76% and 90% patients with 0 score at 6 months and 1-year follow-up, respectively. Comparison of mean values of PD among study groups at 3 months, 6 months and 1 year showed significant difference at 3 months, whereas the mean PD values of subjects in GP + bone graft showed significantly higher PD values than other 3 groups (p = 0.025). Use of GP and MTA for root canal obturation along with periodontal therapy and bone augmentation helps in resolving complex endo-perio lesions. Bone grafting in addition to obturation with MTA was found to be the best treatment strategy in management of EPL cases and is recommended for clinicians who are treating EPL patients.

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Shoulder girdle impairment in breast cancer survivors: the role of range of motion as predictive factor for dose distribution and clinical outcome

Tumori Journal ◽

10.1177/0300891619839287 ◽

2019 ◽

Vol 105 (4) ◽

pp. 319-330 ◽

Cited By ~ 4

Author(s):

Fabio Marazzi ◽

Valeria Masiello ◽

Domenico Marchesano ◽

Luca Boldrini ◽

Stefano Luzi ◽

...

Keyword(s):

Breast Cancer ◽

Range Of Motion ◽

Functional Impairment ◽

Predictive Factor ◽

Late Complication ◽

Shoulder Girdle ◽

Dash Score ◽

Observational Analysis ◽

Significant Difference

Background:Pain and functional impairment of the ipsilateral shoulder girdle in patients who underwent surgery and radiotherapy for breast cancer (BC) is a late complication reported in the literature. We analyze a correlation with dosimetric parameters and propose an algorithm for sparing strategies.Methods:A total of 111 patients treated for BC were included in this observational analysis during follow-up protocol visits. Exclusion criteria were the presence of moderate or severe arthrosis history and/or rheumatologic diseases. All the patients had complete physical and multidimensional examinations during joint (physiatrist and radiotherapy oncology) follow-up visits. A scapula–humeral articulation (SHA) standardized contouring was performed retrospectively on Eclipse® treatment plans. A possible correlation between patients’ characteristics, radiotherapy, and dosimetry analysis and functional impairment was investigated at statistical analysis. Results of analysis were summarized into a proposal of algorithm for sparing SHA.Results:A total of 111 patients were selected during follow-up visits. Mean age of patients was 60 years (range 41–85 years). A total of 103 patients (93%) underwent conservative surgery, with 110 patients (99%) undergoing axilla surgery as well. Fifty-two patients (46.8%) presented a reduction of range of motion (ROM) abduction on the treated side at the observational analysis. Mean ROM abduction reduction was 13°06’ (range 0°–100°). Disability of the Arm, Shoulder and Hand questionnaire (DASH) score results were excellent in 79 patients (71.2%), discrete in 15 patients (13.5%), good in 15 patients (13.5%), and sufficient in 2 patients (1.8%). Median EQD2Dmaxat SHA was 18 Gy (range 0.22–51.9 Gy) and median EQD2mean dose at SHA was 2 Gy (range 0.04–24.32 Gy). Univariate analysis showed a linear correlation between DASH score and ROM of abduction of treated side (ρ=−0.7), ROM of abduction and ROM of flexion in ipsilateral arm (ρ=0.8), or ROM of abduction and ROM of flexion in contralateral arm (ρ=0.8). A statistically significant difference in ROM abduction between the 2 arms was found at χ2test ( P<0.05 at χ2confidence interval = 95%). Cox linear regression analysis showed ROM abduction on treated arm as a predictive factor of DASH score ( P<0.0001). Age ( P<0.05), DASH score ( P=0.006), and ROM abduction on treated arm ( P=0.005) were found as independent predictive factors of mean dose at multivariate analysis. A mean dose higher than 7 Gy and ROM abduction reduction more than 30° were related to DASH score level reduction.Conclusions:This hypothesis-generating study introduces an algorithm to be validated for management of sparing SHA and improving quality of survivorship. ROM evaluation after surgery, early physiotherapy, standard contouring, and planning adaptation represent possible indications to preserve shoulder impairment. Further prospective studies are needed to discriminate impairment of surgery and radiotherapy in order to personalized therapeutic plan programs.

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Postoperative Aspirin Use and Its Effect on Bone Healing in the Treatment of Ankle Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00036 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0003

Author(s):

Allison Hunter ◽

Charles Pitts ◽

Tyler Montgomery ◽

Matthew Anderson ◽

John T. Wilson ◽

...

Keyword(s):

Retrospective Chart Review ◽

Delayed Union ◽

Ankle Fractures ◽

P Value ◽

Vein Thrombosis ◽

Significant Difference ◽

Ankle Trauma ◽

Operative Fixation ◽

Deep Vein ◽

Radiographic Union

Category: Ankle, Trauma Introduction/Purpose: There is hesitancy to administer nonsteroidal anti-inflammatories (NSAIDs) within the postoperative period following fracture care due to concern for delayed union or nonunion. However, aspirin (ASA) is routinely used for chemoprophylaxis of deep vein thrombosis (DVT) and is gaining popularity for use after treatment of ankle fractures. We examine the incidence of nonunion of operative ankle fractures and risk of DVT in patients who did and did not receive postoperative ASA. We hypothesize that time to clinical and radiographic union and the risk of DVT are no different. Methods: A retrospective chart review was performed on all patients treated between 2008 and 2018 for ankle fractures requiring operative fixation by three Foot and Ankle fellowship trained orthopaedic surgeons at a single institution with a minimum of 3 months follow up. Demographics, preoperative comorbidities, and postoperative medical and surgical complications were compared between patients who did and did not receive ASA postoperatively. For both groups, union was evaluated by clinical exam as well as by radiograph. Results: 506 patients met inclusion criteria: 152 received ASA and 354 did not. Radiographic healing at 6 weeks was demonstrated in 95.9% (94/98) and 98.6% (207/210) respectively (p-value .2134). There was no significant difference in time to radiographic union between groups. The risk of postoperative DVTs in those with and without ASA was not significantly different (0.7% (1/137) vs 1.2% (4/323), respectively; p-value .6305). Conclusion: Postoperative use of ASA does not delay radiographic union of operative ankle fractures or affect the rate of postoperative DVT. This is the first and largest study to examine the effect of ASA on time to union of ankle fractures.

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The Fate of Bone Graft for Periprosthetic Osteolysis in Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000070 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000 ◽

Cited By ~ 1

Author(s):

Yoo Jung Park ◽

Dong-Woo Shim ◽

Yeokgu Hwang ◽

Jin Woo Lee

Keyword(s):

Clinical Outcome ◽

Bone Graft ◽

Bone Grafting ◽

Distal Tibia ◽

Total Ankle Arthroplasty ◽

Implant Failure ◽

Periprosthetic Osteolysis ◽

Aofas Score ◽

Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Periprosthetic osteolysis in total ankle arthroplasty (TAA) is a substantial problem. It may cause implant failure and has potential to affect long-term implant survival. To prevent major revisional arthroplasty, it is important to make an early diagnosis of osteolysis and decide an appropriate timing of surgical intervention such as bone graft. We report our experience of bone graft for osteolysis after TAA associated with clinical and radiologic outcome. Methods: Between May 2004 and Oct. 2013, 238 primary TAA were performed on 219 patients. We excluded 37 ankles with follow-up less than 24 months; thus, 201 ankles in 185 patients with mean follow-up of 61.9 (range, 24-130) months were included in the study. Nineteen patients were treated with a total of 21 bone graft procedures for periprosthetic osteolysis after TAA. Of these patients, 12 (57.1%) were males with mean follow-up length after bone graft 35.0 months. Location of osteolysis, bone grafting method and clinical outcome parameters using visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score were recorded. Results: Radiographs revealed total of 62 osteolysis lesions in 19 patients; 35 (56.5%) distal tibial lesions, 23 (37.0%) talar lesions. Autogenous iliac bone graft was used in 18 procedures (85.7%). The mean scores (and standard deviation) improved for the VAS from 4.8 ± 1.23 points before bone graft to 3.0 ± 0.94 points at the last follow-up (p<0.05); and for the AOFAS score from 76.8 ± 5.9 before bone graft to 84.3 ± 4.5 at the last follow-up (p<0.05). After 21 bone graft procedures, 6 demonstrated detection of newly developed osteolysis. One patient needed a repeat bone graft procedure with cementation after the primary bone grafting due to large cyst on distal tibia. There was no implant failure or major revisions after the bone graft. Conclusion: Bone graft for periprosthetic osteolysis may improve patient’s clinical outcome and give support to the structures surrounding the implant. Bone grafting in optimal timing may also improve implant survivorship. However, further study is needed for the etiology of newly developed painless osteolysis even after the bone graft.

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Efficacy of anterior cervical decompression and fusion procedures for monomelic amyotrophy treatment: a prospective randomized controlled trial

Journal of Neurosurgery Spine ◽

10.3171/2013.4.spine12575 ◽

2013 ◽

Vol 19 (4) ◽

pp. 412-419 ◽

Cited By ~ 19

Author(s):

Feizhou Lu ◽

Hongli Wang ◽

Jianyuan Jiang ◽

Wenjun Chen ◽

Xin Ma ◽

...

Keyword(s):

Bone Grafting ◽

Iliac Crest ◽

Plate Fixation ◽

Cervical Collar ◽

Therapeutic Effects ◽

Iliac Crest Bone Grafting ◽

Anterior Cervical Decompression ◽

Significant Difference ◽

Internal Plate Fixation

Object Monomelic amyotrophy (MMA) is a benign, self-limiting lower motor neuron disease. Optimal surgical strategies—discectomy decompression and fusion (DDF) or corpectomy decompression and fusion (CDF)—for patients with aggravated symptoms (within 6 months of presentation) are controversial, particularly in those who are ineligible for conventional treatment. These 2 methods of anterior cervical decompression and fusion for MMA in patients unwilling or unable to wear a conventional cervical collar long term were evaluated. Methods Anterior cervical decompression and fusion were performed in 48 male patients with MMA between September 2007 and September 2010. Patients were randomly treated with anterior cervical discectomy decompression with autologous iliac crest bone grafting and internal plate fixation (DDF group: 24 patients) or anterior cervical corpectomy, posterior longitudinal ligament resection, autologous iliac crest bone grafting, and internal plate fixation (CDF group: 24 patients). Subjective symptom assessments and electromyography (EMG) examinations were conducted both preoperatively and postoperatively. Results Subjective assessments and EMG studies (mean follow-up duration 25.9 months) indicated improvement in 64.6% and 60% of patients, respectively. No significant correlations between the effectiveness of surgery and age at symptom onset, preoperative symptom duration, or postoperative follow-up time were found. Conclusions The lack of a significant difference in effectiveness between DDF and CDF favors DDF as more clinically applicable because of its lower procedural risks. As a second-line alternative to cervical collar treatment, surgical anterior cervical decompression and fusion via DDF or CDF may prevent further deterioration and produce good short-term therapeutic effects in patients with MMA; however, cervical collar treatment is recommended for eligible patients because of its lower associated risks.

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Trochanteric Bone Grafts in Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/107110079601700708 ◽

1996 ◽

Vol 17 (7) ◽

pp. 402-405 ◽

Cited By ~ 11

Author(s):

W. Richard Hayes ◽

Ronald W. Smith

Keyword(s):

Bone Graft ◽

Delayed Union ◽

Iliac Bone ◽

Patient Questionnaire ◽

Foot And Ankle ◽

Greater Trochanter ◽

Graft Harvest ◽

Iliac Bone Graft ◽

Ankle Surgery

Eighty-five patients who underwent trochanteric bone graft harvest in association with foot and ankle surgery were studied retrospectively by patient questionnaire. The average follow-up was 49 months (range, 14–101 months). Ninety-five percent of the patients expressed satisfaction with the procedure, in that they would choose to accept the trochanteric bone graft again if required to make the choice. However, 31 % of the patients acknowledged some degree of hip discomfort and 4% reported some daily pain. Nineteen of 85 patients (22%) were treated for trochanteric pain. Most patients responded to strengthening/stretching and heat/ice. Four patients (5%) had failed or delayed union of the arthrodesis in which trochanteric bone graft was utilized. The greater trochanter may be considered as an alternative for major bone graft when the iliac bone is not available and when weightbearing is restricted for at least 6 weeks after surgery. As with the use of iliac bone graft, patients should be alerted to the possibility of postoperative discomfort. Surgical details should be followed to minimize the risk of peritrochanteric fracture.

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Is Subacromial Balloon Spacer Appropriate for Treatment of Irreparable Rotator Cuff Tears in Elderly Patients?

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0013.7399 ◽

2019 ◽

Vol 21 (6) ◽

pp. 417-426

Author(s):

Kamil Yamak ◽

Hüseyin Gökhan Karahan ◽

Taşkın Altay ◽

Cemil Kayalı ◽

Fırat Ozan

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tears ◽

Dash Score ◽

X Rays ◽

Preoperative Period ◽

Subacromial Space ◽

Significant Difference ◽

The Difference ◽

Quick Dash

Background. The aim of this study was to evaluate the clinical and radiographic results of surgical treatment of irreparable rotator cuff tears by subacromial balloon spacer insertion in patients over 65 years old. Material and methods. Results of patients with failed conservative treatment for irreparable rotator cuff tears and who underwent subacromial balloon spacer insertion were evaluated retrospectively. The VAS and Quick-DASH scores were used for clinical and functional assessment. Results. Eleven patients were included. Mean age of patients was 69.1 (range: 65-77) years old. Evaluation of anteroposterior shoulder x-rays revealed Hamada grade 2 and grade 1 arthropathy in 10 patients (91%) and 1 patient (9%),respectively. Mean duration of follow-up was 45.09 (±5.43,37-52) months. The difference in the subacromial space measured from standard AP shoulder x-rays in the preoperative period, in the 6th postoperative month, and at the end of follow-up was 5.44 mm (2.29), 6.51 mm (±2.23), and 5.08 mm (±2.13), respectively. Mean Quick-DASH score was 74.49(±14.36) in the preoperative period, compared to 72.19 (±14.38) at the end of follow-up. There was no statistically significant difference between preoperative period and end of follow-up scores in terms of mean Quick-DASH scores (p= 0.232). Mean VAS score was 7.09 (±0.831) in the preoperative period and 6.64 (±0.809) at the end of follow-up. No statistically significant difference was revealed in terms of mean VAS scores when preoperative and end of follow-up scores were compared (p=0.333). Conclusion. Clinical and radiographic results of subacromial balloon spacer insertion in the treatment of irreparable rotator cuff tears could not be evaluated as satisfactory.

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