scholarly journals Effectiveness of vascularized and conventional bone grafting in achieving union in humeral pseudarthrosis

2021 ◽  
Vol 27 (2) ◽  
pp. 182-186
Author(s):  
I.O. Golubev ◽  
◽  
A.R. Sarukhanyan ◽  
M.M. Merkulov ◽  
O.M. Bushuev ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Bone Defects ◽  
Healing Time ◽  
Humeral Fractures ◽  
X Rays ◽  
Single Institution ◽  
Technical Errors ◽  
Post Traumatic ◽  
Humeral Nonunion ◽  
Vascularized Bone

Introduction Humeral fractures comprise from 5 % to 8 % of all fractures. Nonunion rate of humeral fractures is 5.5–8.7% with open reduction and internal fixation (ORIF) technique and 3–5.6 % with the use of locked intramedullary nailing technique. Its frequent causes are infection, poor vascularity, severe comminution or technical errors. Purpose Analysis of effectiveness of vascularized bone grafting and non-vascularized bone grafting in humeral nonunion and defect treatment. Material and methods Surgical management of 69 patients with humeral nonunion was performed from 2010 to 2017 at a single institution in two groups. Vascularized bone grafts were used in 41 cases and non-vascularized ones in 28 cases. X-rays and CT-scans of all the patients were studied. Results In the vascularized bone grafting group, union was achieved in 36 cases (88 %) after four to 6 months; in non-vascularized bone group union was achieved in 20 cases (71 %) after eight to 12 months. Conclusion In post-traumatic humeral nonunion and bone defects, after two or more failed surgical procedures performed previously, vascularized bone grafting yields more satisfactory results and reduces the total healing time.

scholarly journals Vascularized bone grafts for post-traumatic defects in the upper extremity

2021 ◽  
Vol 48 (1) ◽  
pp. 84-90
Author(s):  
Giovanna Petrella ◽  
Daniele Tosi ◽  
Filippo Pantaleoni ◽  
Roberto Adani
Keyword(s):  
Upper Extremity ◽  
Bone Grafting ◽  
Femoral Condyle ◽  
Bone Grafts ◽  
Bone Defects ◽  
Tissue Loss ◽  
Surgical Reconstruction ◽  
Non Union ◽  
Post Traumatic ◽  
Vascularized Bone

Vascularized bone grafts (VBGs) are widely employed to reconstruct upper extremity bone defects. Conventional bone grafting is generally used to treat defects smaller than 5–6 cm, when tissue vascularization is adequate and there is no infection risk. Vascularized fibular grafts (VFGs) are mainly used in the humerus, radius or ulna in cases of persistent non-union where traditional bone grafting has failed or for bone defects larger than 6 cm. Furthermore, VFGs are considered to be the standard treatment for large bone defects located in the radius, ulna and humerus and enable the reconstruction of soft-tissue loss, as VFGs can be harvested as osteocutaneous flaps. VBGs enable one-stage surgical reconstruction and are highly infection-resistant because of their autonomous vascularization. A vascularized medial femoral condyle (VFMC) free flap can be used to treat small defects and non-unions in the upper extremity. Relative contraindications to these procedures are diabetes, immunosuppression, chronic infections, alcohol, tobacco, drug abuse and obesity. The aim of our study was to illustrate the use of VFGs to treat large post-traumatic bone defects and osteomyelitis located in the upper extremity. Moreover, the use of VFMC autografts is presented.

scholarly journals Robot-assisted Anterior Odontoid Screw for the Treatment of Type Ⅱ Odontoid Fractures: Safety and Effectiveness Analysis

2021 ◽  
Author(s):  
Songchuan Zhao ◽  
Yang Bo ◽  
Jinpeng Du ◽  
Liang Yan ◽  
Dingjun Hao ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Operation Time ◽  
Soft Tissue Injuries ◽  
Healing Time ◽  
X Rays ◽  
Robot Assisted ◽  
Odontoid Fractures ◽  
Mayo Score ◽  
Bone Cortex ◽  
Post Traumatic

Abstract Background: Anterior odontoid screw fixation is considered to be preferred surgical treatment for the type Ⅱ odontoid fractures. However, due to the high difficulty to insert odontoid screw with barehand, the high risk of screw misalignment and damage to surrounding important tissue structures, we urgently need robot-assisted screw insert navigation technology to improve the safety and accuracy of inserting odontoid screws.Methods: We retrospectively analyzed 7 patients with type II odontoid fractures who underwent Tinavi robot-assisted screw insert technology from May 2018 to May 2019 at our hospital. All patients had received 64-row CT scans and 3D reconstructions completed preoperatively, and magnetic resonance (MRI) were performed to verify the severity of odontoid fractures, soft tissue injuries and vertebral artery height. Postoperative CT was repeated in 6 months after surgery to evaluate cervical stability and confirm whether the screw had breached the bone cortex, the accuracy of screw placement based on Rampersaud A-D grade. Functional recovery was assessed using the post-traumatic Mayor scoring system for the cervical spine.Results: All 7 patients successfully completed the robot-assisted operation without nerve and blood vessel damage. What is the operation time 103.3 minutes, intraoperative blood loss 11.1 ml. The angulation and displacement of the fracture were basically corrected by closed reduction during the operation. Postoperative CT of these 7 patients showed that the cervical spine was stable, the accuracy of “perfect” and “clinically acceptable” odontoid screw implantation was 100% (7/7), none of the seven odontoid screws breached the bone cortex. Reexamination of X-rays showed that the fractures were all healed, and the average fracture healing time was average 13.7weeks (12-15weeks). During the follow-up period, 7 patients had no surgical complications, postoperative cervical spine trauma mayo score: excellent in 6 cases and good in 1 case. Conclusion: Tinavi robot-assisted screw insert technology is a minimally invasive, accurate, safe and feasible method for the treatment of type Ⅱ odontoid fractures.

scholarly journals Effect of Systemic Zoledronic Acid Dosing Regimens on Bone Regeneration in Osteoporotic Rats

2021 ◽  
Vol 11 (4) ◽  
pp. 1906
Author(s):  
Marwa Y. Shaheen ◽  
Amani M. Basudan ◽  
Abdurahman A. Niazy ◽  
Jeroen J. J. P. van den Beucken ◽  
John A. Jansen ◽  
...  
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Femoral Condyle ◽  
Bone Defects ◽  
Histological Evaluation ◽  
Favorable Effect ◽  
Osteoporotic Bone ◽  
Bovine Bone ◽  
Graft Placement ◽  
Regeneration Of Bone

The aim of this study was to evaluate the regeneration of bone defects created in the femoral condyle of osteoporotic rats, following intravenous (IV) zoledronate (ZA) treatment in three settings: pre-bone grafting (ZA-Pre), post-bone grafting (ZA-Post), and pre- plus post-bone grafting (ZA-Pre+Post). Twenty-four female Wistar rats were ovariectomized (OVX). After 12 weeks, bone defects were created in the left femoral condyle. All defects were grafted with a particulate inorganic cancellous bovine bone substitute. ZA (0.04 mg/kg, weekly) was administered to six rats 4 weeks pre-bone graft placement. To another six rats, ZA was given post-bone graft placement creation and continued for 6 weeks. Additional six rats received ZA treatment pre- and post-bone graft placement. Control animals received weekly saline intravenous injections. At 6 weeks post-bone graft placement, samples were retrieved for histological evaluation of the bone area percentage (BA%) and remaining bone graft percentage (RBG%). BA% for ZA-Pre (50.1 ± 3.5%) and ZA-Post (49.2 ± 8.2%) rats was significantly increased compared to that of the controls (35.4 ± 5.4%, p-value 0.031 and 0.043, respectively). In contrast, ZA-Pre+Post rats (40.7 ± 16.0%) showed similar BA% compared to saline controls (p = 0.663). For RBG%, all experimental groups showed similar results ranging from 36.3 to 47.1%. Our data indicate that pre- or post-surgical systemic IV administration of ZA improves the regeneration of bone defects grafted with inorganic cancellous bovine-bone particles in osteoporotic bone conditions. However, no favorable effect on bone repair was seen for continued pre- plus post-surgical ZA treatment.

Single-institution Outcomes of Open Reconstruction Techniques for Management of Pediatric and Adolescent Post-traumatic Urethral Strictures

Urology ◽  
2011 ◽  
Vol 77 (3) ◽  
pp. 706-710 ◽  
Author(s):  
Melih Sunay ◽  
Ayhan Karabulut ◽  
Mümtaz Dadalı ◽  
Şahin Bağbancı ◽  
Levent Emir ◽  
...  
Keyword(s):  
Single Institution ◽  
Urethral Strictures ◽  
Open Reconstruction ◽  
Post Traumatic

The Isolated Scapho-Trapezio-Trapezoid Ligament Injury

1993 ◽  
Vol 18 (6) ◽  
pp. 730-735 ◽  
Author(s):  
A. C. MASQUELET ◽  
F. STRUBE ◽  
J. Y. NORDIN
Keyword(s):  
Chronic Pain ◽  
Middle Finger ◽  
Tendon Sheath ◽  
Thenar Eminence ◽  
Ligament Injury ◽  
Pinch Strength ◽  
X Rays ◽  
Complete Rupture ◽  
Trapezoid Ligament ◽  
Post Traumatic

Isolated injuries of the scapho-trapezial ligament complex are not well recognized. The ligament complex comprises the stout scapho-trapezial ligament, the floor of the flexor carpi radialis (FCR) tendon sheath and the scapho-capitate ligament. Between August 1991 and May 1992, we diagnosed and treated four cases of partial chronic post-traumatic lesions of this ligament complex. There was chronic pain at the base of the thenar eminence and instability of the thumb-index-middle finger pinch. Standard X-rays were normal. The diagnosis of ligament rupture was confirmed by mid-carpal arthrography showing filling of the sheath of FCR tendon. Surgical exploration showed complete rupture of the tendon sheath of FCR in two cases, associated in the other two cases with complete rupture of the scapho-trapezial ligament. Direct repair of the ligamentous elements was performed in all cases. The tendon of FCR was sutured to the tubercle of scaphoid to protect and to reinforce the ligament repair. The patients have been followed-up for between 6 and 12 months. All four patients recovered normal pinch strength to the middle finger. One patient suffered from chronic pain at work.

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