Non-Vascularized Tri-Cortical Iliac Crest Graft–A Reliable Option in the Management of Scaphoid Waist Non-Unions

2021 ◽  
Vol 26 (03) ◽  
pp. 383-389
Author(s):  
Vivek Singh ◽  
Nagaraj Manju Moger ◽  
Pragadeeshwaran Jaisankar ◽  
Surjala Rajkumar ◽  
Sunny Chaudhary ◽  
...  
Keyword(s):  
Iliac Crest ◽  
Wrist Joint ◽  
Successful Outcome ◽  
Iliac Crest Bone Graft ◽  
Bony Union ◽  
X Rays ◽  
Iliac Crest Graft ◽  
Non Union ◽  
Functional Scores

Background: Scaphoid non-union often leads to a change in biomechanics of the wrist joint. Various types of bone grafts and different sites of harvest have been described in the literature for scaphoid reconstruction. This study was conducted to assess the clinical and radiological outcome after non-vascularised tri-cortical iliac crest bone graft for non-union of scaphoid waist fractures. Methods: 12 adult patients who underwent reconstruction of scaphoid waist non-union with tricortical iliac crest grafting and internal fixation with headless compression screws (11 cases) and k-wires (1 case) were prospectively analysed. There were 11 males and 1 female (mean age 23.9 years). The mean duration of presentation was 5.7 months following injury. Outcome following surgery were analyzed clinically by range of movements (ROM) and functional scores like DASH and modified Mayo wrist score and radiologically by X-rays and Non contrast CT of the wrist. Radiological assessment included scaphoid length, radio-lunate (RL) angle and scapho-lunate (SL) angle at latest 6 months follow up. Results: Bony union was achieved in 10 cases (union rate 83%). All the cases which achieved union had a significant improvement in radiological and clinical outcome criterias at 6-month follow-up interval. 1 patient had persistent non-union and 1 had k-wire back out with fixation failure. Conclusions: It is important to restore scaphoid length and to correct flexion deformity for a successful outcome. This can reliably be acheived by a carefully planned wedge-shaped iliac crest graft along with secure fixation with a headless compression screw.

Wrist Arthrodesis Using an Embedded Iliac Crest Bone Graft

1993 ◽  
Vol 18 (5) ◽  
pp. 595-600 ◽  
Author(s):  
E. LENOBLE ◽  
H. OVADIA ◽  
D. GOUTALLIER
Keyword(s):  
Bone Graft ◽  
Grip Strength ◽  
Iliac Crest ◽  
Delayed Union ◽  
Iliac Crest Bone Graft ◽  
Iliac Crest Graft ◽  
Wrist Arthrodesis ◽  
Carpometacarpal Joints ◽  
Dorsal Branch

34 patients treated by the iliac crest bone graft technique for wrist arthrodesis were reviewed. The average age was 45.6 years and the mean follow-up was 45 months. The procedure is performed through a straight ulnar approach and the head of the ulna is removed. A longitudinal trench is created in both distal radius and carpus preserving the anterior, posterior and lateral cortices. A curved trapezoidal monocortical iliac crest bone graft is embedded inside the trench. The position of the arthrodesis automatically follows the curvature of the graft. No fixation device is used. A short-arm cast is applied for 2 to 3 months. All arthrodeses except two fused within 3 months. Pain was completely relieved in 85% of the cases. Pronation and supination returned to normal 5 months post-operatively. Grip strength was increased in 80% of the cases. The carpometacarpal joints remained pain-free even when not fused. Complications were rare: two lesions of the dorsal branch of the ulnar nerve; two cases of delayed union due to errors in technique, and displacement of the graft in one case. Although it is technically demanding, the embedded iliac crest graft wrist arthrodesis improves pronation and supination as a result of resection of the distal radio-ulnar joint, preserves or improves grip strength, and relieves pain.

Free vascularized medial femoral condyle corticoperiosteal flap with non-vascularized iliac crest graft for the treatment of recalcitrant clavicle non-union

2020 ◽  
Vol 73 (7) ◽  
pp. 1232-1238
Author(s):  
Charlotte Jaloux ◽  
Quentin Bettex ◽  
Michel Levadoux ◽  
Alexandre Cerlier ◽  
Aurélie Iniesta ◽  
...  
Keyword(s):  
Iliac Crest ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Iliac Crest Graft ◽  
Non Union

A Comparison of the Use of Distal Radius Vascularised Bone Graft and Non-Vascularised Iliac Crest Bone Graft in the Treatment of Non-Union of Scaphoid Fractures

2008 ◽  
Vol 33 (5) ◽  
pp. 636-640 ◽  
Author(s):  
J. BRAGA-SILVA ◽  
F. M. PERUCHI ◽  
G. M. MOSCHEN ◽  
D. GEHLEN ◽  
A. V. PADOIN
Keyword(s):  
Bone Graft ◽  
Distal Radius ◽  
Iliac Crest ◽  
Surgical Techniques ◽  
Functional Results ◽  
Iliac Crest Bone Graft ◽  
Radiographic Findings ◽  
Non Union ◽  
Vascularised Bone Graft ◽  
Mean Time

We compared two surgical techniques for the treatment of scaphoid non-union, namely, using distal radius vascularised bone graft and iliac crest non-vascularised bone graft. Eighty patients with symptomatic scaphoid non-union underwent surgical treatment, including 35 patients treated with distal radius vascularised bone graft and 45 treated by iliac crest non-vascularised bone graft. Patients were assessed objectively by examination of wrist range of motion, grip strength and radiographic findings in the postoperative period after a mean time of 2.8 (1.4) (range 1–5.2) years. Similar functional results were obtained with the two techniques. All cases of non-union in the non-vascularised group obtained consolidation in a mean time of 8.89 (2.26) months and in the vascularised group in a mean time of 7.97 (3.06) months. Three cases of consolidation failure occurred in the vascularised group and were related to technical difficulties.

An Alternative Source of Autograft Bone for Spinal Fusion: the Femur: Technical Case Report

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONSE179-ONSE179 ◽  
Author(s):  
Tann A. Nichols ◽  
H. Claude Sagi ◽  
Timothy G. Weber ◽  
Bernard H. Guiot
Keyword(s):  
Spinal Fusion ◽  
Iliac Crest ◽  
Pedicle Screw Fixation ◽  
Iliac Crest Bone Graft ◽  
X Rays ◽  
Alternative Source ◽  
Continuous Irrigation ◽  
Orthopedic Procedure ◽  
Intramedullary Reaming ◽  
Intramedullary Canal

Abstract Objective: Autograft bone obtained from the iliac crest remains the “gold standard” for spinal fusion. For various reasons, including previous harvesting or pelvic dysmorphism, the iliac crest bone graft may not be available to the spinal surgeon. We present a novel use of a common orthopedic procedure, intramedullary reaming, for obtaining autograft for revision spinal fusion. Methods: A 47-year-old woman presented with failed back syndrome after multiple lumbar surgeries with previous bilateral iliac crest bone harvest. A commercially available reaming system (Synthes Reamer-Irrigator-Aspirator; Synthes USA, West Chester, PA) was introduced into the left intramedullary canal of the femur while the patient remained in the prone position. Using continuous irrigation and aspiration, the reaming debris was collected and used as autograft for the subsequent spinal fusion. Results: The patient underwent a successful L4–L5, L5–S1 transforaminal lumbar inter-body fusion with L3–S1 pedicle screw fixation. No complications from the femoral reaming were observed, and 6-month follow-up x-rays demonstrated osseous fusion. Conclusion: Femoral reaming provides an alternative source of autograft bone when other sources are unavailable.

scholarly journals Simultaneous debridement, Ilizarov reconstruction and free muscle flaps in the management of complex tibial infection

2020 ◽  
Vol 6 (3) ◽  
pp. 63-72
Author(s):  
Max Mifsud ◽  
Jamie Y. Ferguson ◽  
David A. Stubbs ◽  
Alex J. Ramsden ◽  
Martin A. McNally
Keyword(s):  
Muscle Flap ◽  
Tissue Loss ◽  
Bony Union ◽  
Ilizarov Method ◽  
Muscle Flaps ◽  
Flap Transfer ◽  
Non Union ◽  
Free Muscle Flap ◽  
Initial Surgery

Abstract. Chronic bone infections often present with complex bone and soft tissue loss. Management is difficult and commonly delivered in multiple stages over many months. This study investigated the feasibility and clinical outcomes of reconstruction in one stage. Fifty-seven consecutive patients with chronic osteomyelitis (n=27) or infected non-union (n=30) were treated with simultaneous debridement, Ilizarov method and free muscle flap transfer. 41 patients (71.9 %) had systemic co-morbidities (Cierny-Mader group Bs hosts). Infection was confirmed with strict criteria. 48 patients (84.2 %) had segmental defects. The primary outcome was eradication of infection at final follow-up. Secondary outcomes included bone union, flap survival and complications or re-operation related to the reconstruction. Infection was eradicated in 55∕57 cases (96.5 %) at a mean follow-up of 36 months (range 12–146). No flap failures occurred during distraction but 6 required early anastomotic revision and 3 were not salvageable (flap failure rate 5.3 %). Bony union was achieved in 52∕57 (91.2 %) with the initial surgery alone. After treatment of the five un-united docking sites, all cases achieved bony union at final follow-up. Simultaneous reconstruction with Ilizarov method and free tissue transfer is safe but requires careful planning and logistic considerations. The outcomes from this study are equivalent or better than those reported after staged surgery.

scholarly journals Structural Bicortical Autologous Iliac Crest Bone Graft Combined with the Tunnel Bone Tamping Method for the Depressed Tibial Plateau Fractures

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Zhongzheng Wang ◽  
Yanbin Zhu ◽  
Xiangtian Deng ◽  
Xin Xing ◽  
Siyu Tian ◽  
...  
Keyword(s):  
Bone Graft ◽  
Tibial Plateau ◽  
Iliac Crest ◽  
Short Form ◽  
Tibial Plateau Fractures ◽  
Absolute Difference ◽  
Iliac Crest Bone Graft ◽  
Special Surgery ◽  
The Mean

Background. Clinically, autologous iliac crest bone grafts (ICBG) and bone tamping methods are often applied to manage depressed tibial plateau fractures (DTPFs). The purpose of this study was to describe and evaluate the technique of using structural bicortical autologous ICBG combined with the tunnel bone tamping method (TBTM) for treating DTPFs. Methods. All patients with DTPFs who underwent structural bicortical autologous ICBG combined with TBTM from January 2016 to February 2018 were prospectively analysed. Demographics, injury, surgery, postoperative complications, and clinical outcomes were recorded. All patients were followed up for more than 30 months. Postoperative radiography and CT were employed to assess fracture healing and the reduction quality. Results. Forty-three of the included patients completed the follow-up. No malreduction was observed. Based on the immediate postoperative imaging, the intra-articular step-off was significantly reduced (8.19 mm preoperatively vs. 1.30 mm immediate postoperatively, P < 0.001 ). From the immediate operation to the latest follow-up, the reduction was maintained significantly well, with a nonnegligible absolute difference (0.18 mm, P = 0.108 ). A remarkable secondary loss of reduction (intra-articular step   off > 3   mm ) was found in two elderly patients (2/43, 4.65%). The incidence of complications related to the bone-graft donor and bone-graft site was 2.33% and 4.65%, respectively. At the final follow-up, the mean Hospital for Special Surgery (HSS) score of the knee was 98.19 ± 2.89 , and the mean 36-Item Short-Form Health Survey (SF-36) score was 95.65 ± 4.59 . Conclusion. Structural bicortical autologous ICBG combined with TBTM is radiologically effective and stable in terms of complications for the DTPFs.

scholarly journals Treatment of Zone II and III Fifth Metatarsal Fractures Using a Novel Fixation Technique

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0019
Author(s):  
Stephanie K. Eble ◽  
Oliver B. Hansen ◽  
Martin J. O’Malley ◽  
Mark C. Drakos
Keyword(s):  
Postoperative Complications ◽  
Return To Sport ◽  
Vascular Supply ◽  
X Rays ◽  
Non Union ◽  
Anatomic Reduction ◽  
Metatarsal Fractures ◽  
Zone Ii ◽  
Operative Notes

Category: Sports; Lesser Toes Introduction/Purpose: Zone II and III 5th metatarsal fractures are common injuries which can be addressed surgically with percutaneous fixation following anatomic reduction. Limited vascular supply and the specific anatomy of the 5th metatarsal causes concern for non-union of these fractures. This study evaluated a novel screw designed to optimize 5th metatarsal fixation. The titanium alloy headless screw (Jones Union System, Extremity Medical, Parsippany, NJ) provides compression across the fracture site using variable angle pitch and is designed to minimize the occurrence of painful hardware. In addition, we use an intramedullary reamer to create local autologous bone grafting in conjunction with an osteoplasty of the cuboid to obtain ideal positioning. This study represents the first to evaluate clinical outcomes following fixation with this system. Methods: Patients treated for a 5th metatarsal fracture between 2018 and 2019 by two surgeons fellowship-trained in foot and ankle orthopedics were identified. Operative notes were reviewed to ensure that patients were treated with the headless compression screw. 21 patients (22 fractures) were identified. Postoperative x-rays were reviewed to evaluate osseous bridging and time to union was determined. Retrospective chart review was performed to determine time to return to sport. Postoperative complications, including non-unions, need for revision, and need for hardware removal, were also evaluated. Results: Of the 22 total fractures, 16 were Zone II fractures and 6 were Zone III fractures. Average time to clinical follow-up was 13.60 months (range, 3.91-25.07). Average age at time of surgery was 28.82 years (range, 16 to 66). 16 males and 5 females were represented with average BMI of 27.41 kg/m2. Average time to union was 6.78 weeks (range, 5.13-12.12), and average time to return to sport was 11.38 weeks (range, 5.87-15.12). No patients experienced a non-union or painful hardware, and no other postoperative complications were observed. Conclusion: Fixation of Jones fractures using the Jones Union System produced excellent postoperative outcomes. This system, designed to address the challenges of 5th metatarsal anatomy, demonstrated effectiveness with expeditious times to union and return to sport. Union rates were high, and our cohort did not experience any postoperative complications. Although follow-up in some cases is short, no patient has experienced painful hardware. Our results suggest that this system is an effective approach for fixation of Zone II and III 5th metatarsal fractures.

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