Applications of the Vascularized Medial Femoral Condyle for Nonunion with Associated Bone Loss of the Foot: A Case Series

Category: Hindfoot, Midfoot/Forefoot Introduction/Purpose: Persistent nonunions with large bone defects continue to represent a challenging problem for foot and ankle surgeons. Vascularized corticocancellous grafts have been well described for various applications and represent a comprehensive solution to these difficult nonunion cases. We describe four cases of nonunions with concomitant large bony defects treated with a vascularized medial femoral condyle (VMFC). Methods: We retrospectively identified four cases of VMFC flaps used for foot nonunions with large bone defects. Surgical indications included talonavicular nonunion with associated avascular necrosis of the navicular, talonavicular-cuneiform nonunion, navicular-cuneiform nonunion, and first metatarsophalangeal nonunion. All cases had large associated segmental bone defects. The average age at the time of surgery was 62-years-old. The average follow up was 2.6 years (1.5-5.0). One patient had a remote history of tobacco use. Another patient quit smoking pre-operatively and had normal nicotine metabolite levels at the time of surgery. There was one Type II diabetic. Results: Two patients underwent staged reconstruction with placement of an antibiotic cement spacer, but intra-operative cultures were negative. No patient had a previous infection. The average graft dimensions were 3 x 2.25 x 1.5 cm. After obtaining adequate compression, all grafts were secured with bridge locking plates. The average time to weight bearing was 14.5 weeks. All patients had knee pain post-operatively that resolved with time. Two patients required reoperation. In one patient, the VMFC graft did not adequately fill the defect requiring supplement allograft. The VMFC-allograft interface went on to nonunion requiring tricortical iliac crest bone grafting. Another patient developed a split-thickness skin graft (STSG) infection requiring debridement and repeat STSG. There were no VMFC graft failures, and all patients went on to successful union. Conclusion: Vascularized medial femoral condyle autografts are a technically demanding solution to difficult nonunion cases with significant associated bone loss of the foot.

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Reconstruction of Large Bone Defects and Complex Non-Unions Using a Free Fibular Bone Graft and a Supplementary Allograft

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1161-9566 ◽

2020 ◽

Author(s):

Selina Gaida ◽

Uwe Schweigkofler ◽

Wibke Moll ◽

Michael Sauerbier ◽

Reinhard Hoffmann

Keyword(s):

Bone Graft ◽

Case Series ◽

Bone Defects ◽

Bone Transplantation ◽

Patient Comfort ◽

Masquelet Technique ◽

Specialized Center ◽

Free Fibula ◽

Large Bone ◽

Large Bone Defects

AbstractLarge bone defects or complex pseudarthrosis represent an interdisciplinary challenge. Established surgical procedures include autogenous cancellous bone graft, the Masquelet technique or bone transfer via segment transport as well as free microvascular bone transplantation. However, the successful use of all these techniques requires a specialized center with great interdisciplinary expertise. In the following case series we describe the technique of free fibula transplantation and additional allograft. In both cases a good functional result with full mechanical strength of the affected extremity and satisfactory patient comfort has been achieved. In the second case, implant failure with the necessity of revision endoprosthetics occurred during the procedure.

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Use of Adipose Derived Stem Cells to Treat Large Bone Defects. Addendum

10.21236/ada586568 ◽

2009 ◽

Author(s):

Barbara D. Boyan ◽

Robert E. Gulderg

Keyword(s):

Stem Cells ◽

Bone Defects ◽

Adipose Derived Stem Cells ◽

Large Bone ◽

Large Bone Defects

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Factors related to large bone defects of bipolar lesions and a high number of instability episodes with anterior glenohumeral instability

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02395-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Noboru Matsumura ◽

Kazuya Kaneda ◽

Satoshi Oki ◽

Hiroo Kimura ◽

Taku Suzuki ◽

...

Keyword(s):

Humeral Head ◽

Glenohumeral Joint ◽

Three Dimensional ◽

Clinical Results ◽

Bone Defects ◽

Symptom Duration ◽

Glenohumeral Instability ◽

Explanatory Variables ◽

Large Bone ◽

Large Bone Defects

Abstract Background Significant bone defects are associated with poor clinical results after surgical stabilization in cases of glenohumeral instability. Although multiple factors are thought to adversely affect enlargement of bipolar bone loss and increased shoulder instability, these factors have not been sufficiently evaluated. The purpose of this study was to identify the factors related to greater bone defects and a higher number of instability episodes in patients with glenohumeral instability. Methods A total of 120 consecutive patients with symptomatic unilateral instability of the glenohumeral joint were retrospectively reviewed. Three-dimensional surface-rendered/registered models of bilateral glenoids and proximal humeri from computed tomography data were matched by software, and the volumes of bone defects identified in the glenoid and humeral head were assessed. After relationships between objective variables and explanatory variables were evaluated using bivariate analyses, factors related to large bone defects in the glenoid and humeral head and a high number of total instability episodes and self-irreducible dislocations greater than the respective 75th percentiles were evaluated using logistic regression analyses with significant variables on bivariate analyses. Results Larger humeral head defects (P < .001) and a higher number of total instability episodes (P = .032) were found to be factors related to large glenoid defects. On the other hand, male sex (P = .014), larger glenoid defects (P = .015), and larger number of self-irreducible dislocations (P = .027) were related to large humeral head bone defects. An increased number of total instability episodes was related to longer symptom duration (P = .001) and larger glenoid defects (P = .002), and an increased number of self-irreducible dislocations was related to larger humeral head defects (P = .007). Conclusions Whereas this study showed that bipolar lesions affect the amount of bone defects reciprocally, factors related to greater bone defects differed between the glenoid and the humeral head. Glenoid defects were related to the number of total instability episodes, whereas humeral head defects were related to the number of self-irreducible dislocations.

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Vascularization of Nanohydroxyapatite/Collagen/Poly(L-lactic acid) Composites by Implanting Intramuscularly In Vivo

International Journal of Polymer Science ◽

10.1155/2014/153453 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Hai Wang ◽

Xiao Chang ◽

Guixing Qiu ◽

Fuzhai Cui ◽

Xisheng Weng ◽

...

Keyword(s):

Lactic Acid ◽

Orthopaedic Surgery ◽

Bone Substitutes ◽

Bone Defects ◽

Large Defect ◽

Natural Bone ◽

Composition And Structure ◽

Large Bone ◽

Large Bone Defects

It still remains a major challenge to repair large bone defects in the orthopaedic surgery. In previous studies, a nanohydroxyapatite/collagen/poly(L-lactic acid) (nHAC/PLA) composite, similar to natural bone in both composition and structure, has been prepared. It could repair small sized bone defects, but they were restricted to repair a large defect due to the lack of oxygen and nutrition supply for cell survival without vascularization. The aim of the present study was to investigate whether nHAC/PLA composites could be vascularized in vivo. Composites were implanted intramuscularly in the groins of rabbits for 2, 6, or 10 weeks (n=5×3). After removing, the macroscopic results showed that there were lots of rich blood supply tissues embracing the composites, and the volumes of tissue were increasing as time goes on. In microscopic views, blood vessels and vascular sprouts could be observed, and microvessel density (MVD) of the composites trended to increase over time. It suggested that nHAC/PLA composites could be well vascularized by implanting in vivo. In the future, it would be possible to generate vascular pedicle bone substitutes with nHAC/PLA composites for grafting.

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