scholarly journals Functional outcome of non-vascularized fibula in gap non union

2019 ◽  
Vol 6 (1) ◽  
pp. 205
Author(s):  
Amit Kumar Yadav ◽  
Eknath Pawar ◽  
Prasanna Kumar G. S. ◽  
Akash Mane ◽  
Abhishek Harssor ◽  
...  
Keyword(s):  
Bone Graft ◽  
Cancellous Bone ◽  
Bone Grafting ◽  
Donor Site ◽  
Fibular Graft ◽  
Effective Treatment Option ◽  
Non Union ◽  
Special Skill ◽  
Vascularized Fibula

<p class="abstract"><strong>Background:</strong> Gap non-union is one of the most perplexing problems facing the orthopedic surgeon today. Fibula is the preferred site of non-vascularized bone graft due to its easy accessibility to surgical resection and minimal donor site complications.</p><p class="abstract"><strong>Methods:</strong> The study comprised 11 patients of gap non-union between 13 to 80 years (mean=34.9 years). The fibular graft was harvested from the mid shaft and cortico-cancellous bone graft taken from the iliac crest was applied at both ends of the fibular graft to aid in union.<strong></strong></p><p class="abstract"><strong>Results:</strong> The average bone gap was 7 cm (4-13 cm). 64% of the patients achieved bone union after the first procedure, of the remaining 4 patients, 1 patient showed union after secondary cortico-cancellous bone grafting, while two are planned for the same. The remaining one patient has only completed 16 weeks follow-up at present and is not showing signs of union at present. Functional range of motion was achieved in both the proximal and distal joints in all cases.</p><p class="abstract"><strong>Conclusions:</strong> Non-vascularized fibular bone grafting is a simple and effective treatment option which does not require any special skill, has a very low complication rate and has very high patient compliance.</p>

scholarly journals Vascularised fibular graft in the management of non-union of fracture shaft of radius: a less ventured entity

2020 ◽  
Vol 54 (4) ◽  
pp. 284-286
Author(s):  
Tapas K. Panigrahi ◽  
Ramesh C. Maharaj ◽  
Debi P. Nanda
Keyword(s):  
Donor Site ◽  
Major Complication ◽  
Fibular Graft ◽  
Dash Score ◽  
Forearm Fractures ◽  
Non Union ◽  
Fibula Graft ◽  
Excellent Functional Outcome ◽  
Both Bones

Introduction: Non-union of the radius and ulna is a major complication of forearm fractures, accounting upto 10% of all forearm fractures. Multiple modalities are available for the treatment of non-union. Vascular grafts are a less sought-after surgical choice owing to the need of expertise and skills of surgeons. We discuss a case of gap non-union of fracture shaft radius treated with vascular fibula graft. Case Report: We describe a case of 45yr old lady with closed fracture of both bones of left forearm. She underwent open reduction and internal fixation with 3.5 small DCP (6 hole) two days following trauma. On subsequent follow up in 6 months the radius fracture showed signs of infected non-union with osteolysis at screw sites while the ulnar side showed signs of satisfactory union. The patient underwent debridement with implant removal and osteosynthesis with vascularised fibula for gap non-union as second stage. 3 and 6 months follow up showed improvement in DASH score as well as VAS score and fair return of regular activity. Conclusion: In management of gap non-union of Shaft radius with gap (>6cm) vascularised fibular graft provides excellent functional outcome with far less donor site complications.

scholarly journals Novel, vacuum-assisted method for harvesting autogenous cancellous bone graft and bone marrow from the proximal tibial metaphysis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0014
Author(s):  
Paul Bagi ◽  
Raymond Walls
Keyword(s):  
Bone Marrow ◽  
Bone Graft ◽  
Cancellous Bone ◽  
Proximal Tibia ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Cancellous Bone Graft ◽  
Incision Length ◽  
Donor Site Pain

Category: Other Introduction/Purpose: Autogenous cancellous bone graft and bone marrow aspirate are commonly used in lower extremity fusion procedures. Autologous graft is considered the gold standard as it is osteogenic, osteoinductive, and osteoconductive, and is without the potential risks of graft-associated infection and immunologic reaction. Disadvantages include graft harvest time and donor site morbidity due to the surgical incision, approach and bone corticotomy. This study evaluated the safety and efficacy of a novel vacuum-assisted bone graft harvesting device which was able to obtain both cancellous bone and bone marrow for insertion into the arthrodesis sites of patients undergoing complex primary and revision lower extremity fusion procedures. Methods: Between March and November 2017, 9 patients had a foot and/or ankle complex primary or revision arthrodesis performed, with autogenous cancellous graft and bone marrow harvested from the ipsilateral proximal tibia. All patients were 18 years or older with no prior history of knee pain, injury, or surgery at the proximal tibia. Following a circular corticotomy, cancellous bone was harvested using a novel suction-powered, hand-driven bone curettage system (Avitus Orthopaedics, Farmington, CT). The donor site was backfilled with bone graft substitute. Incision length was recorded as well as surgical time from donor site incision to completion of graft acquisition. The volume of cancellous graft and bone marrow were separately recorded. All patients were non-weight bearing on the involved extremity for a minimum of 6 weeks post-operatively and all were evaluated at 2 and 6 weeks post-operatively for donor site pain and associated complications. Results: There were five male and four female patients with an average age of 51 years and 8 months. Procedures included six complex primary fusions and three revision subtalar or tibio-talar-calcaneal fusions for nonunion. Mean incision length was 2 cm (range 1.80-2.75 cm). Mean volume of obtained graft material included 25 cm3 of cancellous bone (range 9-30 cm3) and 21 cm3 bone marrow aspirate (range 10-40 cm3). Mean procedure time was 5 mins (range 4-8 mins), and average blood loss was less than 1 mL. Two patients had mild pain at 2 week follow-up; however, no patients reported donor site pain at 6 week follow-up. There were no major or minor complications including fracture, infection, hematoma formation, sensory changes, or wound healing issues. Conclusion: The use of an innovative, vacuum-assisted bone harvesting device allows large volumes of autogenous cancellous bone graft and marrow to be rapidly and readily obtained from the ipsilateral proximal tibia with minimal donor site morbidity.

Orthopaedic management of congenital pseudarthrosis of the tibia

2021 ◽  
pp. 655-660
Author(s):  
Fergal Monsell
Keyword(s):  
Bone Grafting ◽  
Fracture Site ◽  
Important Condition ◽  
Non Union ◽  
Congenital Pseudarthrosis ◽  
Vascularized Fibula ◽  
Affected Tissue

Congenital pseudoarthrosis of the tibia is an uncommon but important condition, often associated with neurofibromatosis, in which the tibia has a region of abnormal bone prone to fracture and subsequent non-union with a fibrocartilaginous pseudoarthrosis forming at the fracture site. The limb is prone to malalignment and distal deformity. Management requires correction and stabilization of the deformity with excision of the affected tissue of the tibia and reconstruction either with bone grafting, transport, or transfer of vascularized fibula.

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

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000 ◽  
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.

scholarly journals Intraosseous Ganglion of the Distal Tibia: Clinical, Radiological, and Operative Management

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Sedeek Mohamed Sedeek ◽  
Q. Choudry ◽  
S. Garg
Keyword(s):  
Cancellous Bone ◽  
Bone Grafting ◽  
Distal Tibia ◽  
Operative Management ◽  
Cystic Lesions ◽  
Cancellous Bone Grafting ◽  
Intraosseous Ganglion ◽  
Initial Surgery ◽  
Ganglion Cysts

Intraosseous ganglia are benign cystic lesions located in the subchondral bone. Intraosseous ganglion cysts of the ankle are relatively uncommon. We present a case of recurrent intraosseous ganglion in the ankle of a 41-year-old female who had recurrence after initial surgery. She was treated effectively by curettage and autogenous cancellous bone grafting. At the final follow-up, satisfactory results were obtained with no recurrence or complications.

Treatment of Scaphoid Non-Union with a Percutaneous Corticocancellous Bone Graft

2005 ◽  
Vol 30 (4) ◽  
pp. 365-368 ◽  
Author(s):  
P. H. J. BULLENS ◽  
M. DRIESPRONG ◽  
H. LACROIX ◽  
J. VEGTER
Keyword(s):  
Minimally Invasive ◽  
Bone Graft ◽  
Range Of Motion ◽  
Grip Strength ◽  
Invasive Procedure ◽  
Minimally Invasive Procedure ◽  
Normal Range ◽  
Mild Pain ◽  
Non Union

Thirty-three symptomatic scaphoid non-unions were treated by a simple, minimally invasive procedure using a percutaneous autologous corticocancellous bone graft. After an average follow-up of 3.5 years, union was observed in 29 cases. These patients had no, or mild, pain at work and an almost normal range of motion and grip strength. No progression to osteoarthritis was observed.

scholarly journals Transiliac hernia: a case report with short review of literature

2016 ◽  
pp. 1
Author(s):  
Nazmuddin Jetaji ◽  
Zubair Sorathia
Keyword(s):  
Bone Graft ◽  
Gold Standard ◽  
Iliac Crest ◽  
Donor Site ◽  
Relevant Literature ◽  
Short Review ◽  
Review Of Literature ◽  
Non Union ◽  
Bone Graft Substitutes ◽  
Femur Shaft

<p>The Iliac crest is considered gold standard among all types of bone graft available-natural or synthetic. There are many reported complications of bone graft harvestation but one of the rarely reported ones is hernia from the donor site. Not more than 15-20 cases have been reported in the last 10 years. We hereby report a case of hernia from the iliac crest used to harvest bone graft for a case of Femur shaft non-union and also review the relevant literature. The risk factors for this particular complication to occur are morbid obesity, female sex and old age. Bone graft substitutes should therefore be strongly considered in these patients. When harvested, the periosteum and soft tissue should be meticulously closed and repaired. CT scan is a fairly conclusive investigation for diagnosis.</p>

scholarly journals A case of subtrochanteric femur fracture nonunion with failed implant in situ treated with exchange nailing using interlock nail and autologous bone grafting: a case report

2021 ◽  
Vol 7 (4) ◽  
pp. 864
Author(s):  
Neetin P. Mahajan ◽  
Pranay Kondewar ◽  
Lalkar Gadod ◽  
Amey Sadar ◽  
Shubham Atal
Keyword(s):  
Clinical Outcome ◽  
Bone Grafting ◽  
Femur Fracture ◽  
Good Clinical Outcome ◽  
Non Union ◽  
Autologous Bone Grafting ◽  
Exchange Nailing ◽  
Autologous Bone ◽  
Subtrochanteric Femur Fracture

<p class="abstract">Subtrochanteric femur fracture accounts for 25% of all hip fracture and may land up in non-union due to the inadequate reduction and fixation tech, local muscle pull over fragments, biomechanical stress in subtrochanteric region and soft tissue interposition etc., non-union are managed with various choices of implants like exchange nailing , angle blade plate , dynamic condylar screw, augmentation of previous hardware with plate and by providing biological environments at fracture site using  bone graft. Strict adherence to principles of providing stability to fracture and providing environment for bony growth gives good clinical outcome. A 52 years old male with subtrochanteric femur fracture was operated with long PFN, later presented to us after 18 months with failure of the hardware and atrophic non-union manifesting as pain during walking and limping. Patient was operated with removal of implant and exchange nailing using femur interlock nail and autologous bone grafting from iliac crest graft. 1 year follow up showed complete bony union and abundant of callus formation. Patient is currently doing all the daily activities and have no complaints at present. At 1 year follow up there is complete union at non-union site and good clinical outcome is achieved. Exchange nailing with interlock nail and autologous bone grafting for treatment of atrophic non-union of subtrochanteric femur fractures gives good clinical outcome.</p>

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