scholarly journals Antibiotic cement spacer and induced membrane bone grafting in open fractures with bone loss: A case series

2019 ◽  
Vol 53 (2) ◽  
pp. 237 ◽  
Author(s):  
Srinivas Kasha ◽  
SameerSingh Rathore ◽  
Hemanth Kumar
Keyword(s):  
Bone Loss ◽  
Bone Grafting ◽  
Case Series ◽  
Open Fractures ◽  
Cement Spacer ◽  
Induced Membrane ◽  
Antibiotic Cement ◽  
Membrane Bone

scholarly journals Combined use of the Ilizarov non-free bone plasty and Masquelet technique in patients with acquired bone defects and pseudarthrosis

2020 ◽  
Vol 26 (4) ◽  
pp. 532-538
Author(s):  
D.Yu. Borzunov ◽  
◽  
D.S. Mokhovikov ◽  
S.N. Kolchin ◽  
E.N. Gorbach ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Soft Tissues ◽  
Bone Defects ◽  
Bone Transport ◽  
Long Bone ◽  
Cement Spacer ◽  
Technical Problems ◽  
Induced Membrane ◽  
Masquelet Technique ◽  
Membrane Technique

Introduction The Masquelet induced membrane technique is effective in the management of acquired heterogeneous long bone defects and pseudarthrosis. The combination of the Masquelet technology and Ilizarov non-free bone grafting seems promising and reduces the risks of recurrence at long-term in patients with congenital pseudarthrosis. Purpose Presentation of new technological solutions that allow combining the advantages of the Ilizarov bone transport and Masquelet bone grafting in patients with acquired bone defects. Materials and methods Retrospective assessment of the results of bone reconstruction in 10 patients who were treated by a combination of Ilizarov and Masquelet bone grafting technologies to repair long bone defects after failures of previous treatment. Fragments of the biomembrane formed around the cement spacer temporarily replacing the tibial gap after resection bone defect or pseudarthrosis were examined in all patients. The studies were carried out using a Reichard sledge microtome, an AxioScope stereomicroscope and an AxioCam ICc 5 digital camera, a JSM- 840 scanning electron microscope and an INCA-200 Energy X-ray electron probe microanalyzer. Results and discussion The combined Masquelet technique and Ilizarov non-free bone plasty provide the conditions that are favorable for reparative processes of the transported fragments. After removal of the spacer, there is a tunnel formed in the interfragmental gap, the walls of which are made of the induced membrane. Bone transport is carried out without technical problems through the compromised tissues which are debrided at the time of distraction initiation, outside the scars. At the same time, there are low risks of inflammation around the transosseous elements; there is no danger of cutting and perforation of soft tissues by transported fragments. Conclusions Complete organotypic rearrangement of the distraction regenerate with the use of Ilizarov non-free bone plasty and the Masquelet technique excludes the possibility of deformities or fractures at the level of newly formed bone areas. Active distraction histogenesis ensures the closure of soft tissue defects without additional reconstructive plastic interventions. The revealed dependence of the induced membrane blood supply on the method of treatment previously used might be a criterion for predicting the treatment outcome in patients with acquired bone defects and pseudarthrosis.

scholarly journals Induced Membrane Bone Grafting Technique for Treatment of Large Postinfectious Acetabular Bone Defects

2020 ◽  
Vol 6 (3) ◽  
pp. 322-329
Author(s):  
Gerald Joseph Zeng ◽  
Wei Sheng Foong ◽  
Sheng Xu ◽  
Hee Nee Pang
Keyword(s):  
Bone Grafting ◽  
Bone Defects ◽  
Acetabular Bone ◽  
Induced Membrane ◽  
Membrane Bone ◽  
Grafting Technique ◽  
Acetabular Bone Defects

scholarly journals Clinical Outcomes of Double-Screw Fixation with Autologous Bone Grafting for Unstable Scaphoid Delayed or Nonunions with Cavitary Bone Loss

2020 ◽  
Author(s):  
Eugene T. Ek ◽  
Paul R. Johnson ◽  
Carmel M. Bohan ◽  
Gayan Padmasekara
Keyword(s):  
Bone Loss ◽  
Range Of Motion ◽  
Clinical Outcomes ◽  
Cancellous Bone ◽  
Bone Grafting ◽  
Screw Fixation ◽  
Case Series ◽  
Active Motion ◽  
Active Range Of Motion ◽  
Case Series Study

Abstract Objective This study reports on the clinical outcomes of double screw fixation with autologous cancellous bone grafting and early active range of motion for delayed and nonunited scaphoid waist fractures with cavitary segmental bone loss. Patients and Methods Twenty-one consecutive patients underwent fixation using two 2.2 mm antegrade headless compression screws with autologous distal radius cancellous bone graft. Postoperatively, patients were allowed early active motion with a resting splint until union was achieved. Patients were reviewed radiologically and clinically to assess for fracture union, complications, residual pain, wrist function, and return to work and recreational activities. Results All but one patient was male, and the mean age was 23 years (range, 15–38 years). The average time from initial injury was 16 months (range, 3–144 months). Nineteen of 21 (90.5%) patients achieved union at a mean of 2.8 months (range, 1.4–9.2 months). Of the patients who failed, one underwent revision surgery with vascularized bone grafting at 10.6 months. The other patient refused further intervention as he was asymptomatic. Conclusion Double-screw fixation with bone grafting and early active range of motion is a safe and effective technique for management of delayed and nonunited unstable scaphoid fractures with cavitary bone loss. This potentially allows for earlier return to function, without compromise to union rates. Level of Evidence This is a Level IV, retrospective case series study.

Bone Loss in Open Fractures

2020 ◽  
pp. 75-92
Keyword(s):  
Bone Loss ◽  
Open Fractures ◽  
Autogenous Bone ◽  
Ilizarov Method ◽  
Challenging Problem ◽  
Related Factors ◽  
Limb Reconstruction ◽  
Induced Membrane ◽  
Optimum Mode ◽  
Autogenous Bone Grafting

This chapter deals with the management of bone loss in open fractures with particular reference to the tibia. This is a challenging problem and requires input and expertise from orthopaedic and plastic surgery specialists in limb reconstruction. The different sizes, shapes, and location of the defect will have diverse implications, and management must be individualised. Individualisation of treatment entails an assessment of the local, systemic, and patient-related factors such that the optimum mode of treatment is chosen. The techniques available include autogenous bone grafting, with or without prior induced membrane creation, vascularised free transfer of bone, and bone regeneration by the Ilizarov method.

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

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0029
Author(s):  
Devin Mangold ◽  
Allen T. Bishop ◽  
Steven L. Moran ◽  
Alexander Y. Shin ◽  
Daniel B. Ryssman
Keyword(s):  
Bone Loss ◽  
Femoral Condyle ◽  
Weight Bearing ◽  
Case Series ◽  
Bone Defects ◽  
Medial Femoral Condyle ◽  
Cement Spacer ◽  
Time Of Surgery ◽  
Large Bone ◽  
Large Bone Defects

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.

Cement Spacer as Definitive Management for Postoperative Ankle Infection

2012 ◽  
Vol 33 (3) ◽  
pp. 173-178 ◽  
Author(s):  
Paulo Ferrao ◽  
Mark S. Myerson ◽  
John M. Schuberth ◽  
Michael J. McCourt
Keyword(s):  
Bone Loss ◽  
Case Series ◽  
Wound Complications ◽  
Cement Spacer ◽  
Salvage Procedure ◽  
X Rays ◽  
Level Of Evidence ◽  
Initial Surgery ◽  
Ankle Replacement ◽  
Additional Surgery

Background: Postoperative infection can be a devastating complication of ankle replacement and arthrodesis surgery. Management consists of eradication of the infection and either, revision of the initial surgery or some form of salvage procedure. There are instances however when the patient is asymptomatic, medically unfit, or the local tissue is too tenuous to warrant performing additional surgery. We conducted a retrospective review of the outcome of the use of an antibiotic impregnated cement spacer as the definitive procedure in this kind of patient. Methods: There were nine patients with post operative deep ankle infection following surgery who did not undergo subsequent revision surgery. The initial surgeries were either total ankle replacement (TAR) ( n = 6) or ankle arthrodesis ( n = 3). The indications for the retention of the cement spacer were patients who were asymptomatic following insertion of the cement spacer, did not desire further surgery, or were medically unfit for further surgery. The patients all underwent removal of hardware or implants, debridement, and insertion of an antibiotic impregnated cement spacer. Six weeks of intravenous antibiotics were administered according to culture sensitivity results. Patients were followed up closely for complications (wound dehiscence, spacer migration, bone loss), resolution of infection, functionality, and satisfaction. Results: The average time of cement spacer retention was 20.1 months, ranging from 6 to 62 months. The most common infecting organisms were Staph. Aureus ( n = 3) and Staph. Epidermidis ( n = 3). One patient had wound complications, possibly due to the proximity of the cement spacer to the anterior skin surface. One patient had a repeat infection at 52 months. The most common co-morbidities were rheumatoid arthritis ( n = 3) and diabetes ( n = 2). At final followup, seven patients still had a retained cement spacer and two had subsequent below knee amputations (BKA) performed as a result of delayed complications. Review of the X-rays revealed two patients with loosening and migration of the cement spacer. No patients had signs of excessive bone loss. All patients with a retained antibiotic cement spacer were mobile and able to perform basic activities of daily living with minimal discomfort. Conclusion: The long-term use of antibiotic impregnated cement spacers following postoperative ankle infection is a reasonable option in the low demand patient with surgical or medical co-morbidities. Level of Evidence: IV; Retrospective Case Series

scholarly journals Management of Isolated Capitate Nonunion: A Case Series and Literature Review

2018 ◽  
Vol 07 (05) ◽  
pp. 419-423 ◽  
Author(s):  
Rishabh Jethanandani ◽  
Schneider Rancy ◽  
Keith Corpus ◽  
Jeffrey Yao ◽  
Scott Wolfe
Keyword(s):  
Literature Review ◽  
Internal Fixation ◽  
Bone Grafting ◽  
Relevant Literature ◽  
Case Series ◽  
Rare Condition ◽  
Vascular Supply ◽  
Autogenous Bone ◽  
Rare Injury ◽  
Autogenous Bone Grafting

Background Isolated capitate nonunion is rare. No consensus on the appropriate treatment for this condition exists. Case Description We reported two cases of capitate fracture nonunion presenting several months after untreated high-impact wrist trauma. Treatment was delayed as both patients' nonunions were missed on conventional radiographs. Both were ultimately diagnosed with advanced imaging and successfully treated with internal fixation and autogenous bone grafting. The relevant literature pertaining to capitate nonunion was reviewed. Literature Review Immobilization and internal fixation with bone grafting for capitate nonunion have been described in the literature. Loss of vascular supply and progression to avascular necrosis is a concern after capitate nonunion. Clinical Relevance We present two cases and review the literature on the diagnosis and treatment of this rare injury to guide management. Internal fixation with autogenous bone grafting could play a role in management for this rare condition.

scholarly journals Assessment and Trends in the Methodological Quality of the Top 50 Most Cited Articles in Shoulder Instability

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096708
Author(s):  
Avinesh Agarwalla ◽  
Kaisen Yao ◽  
Anirudh K. Gowd ◽  
Nirav H. Amin ◽  
J. Martin Leland ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Methodological Quality ◽  
Surgical Techniques ◽  
Case Series ◽  
Cross Sectional Study ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Number Of Citations

Background: Citation counts have often been used as a surrogate for the scholarly impact of a particular study, but they do not necessarily correlate with higher-quality investigations. In recent decades, much of the literature regarding shoulder instability is focused on surgical techniques to correct bone loss and prevent recurrence. Purpose: To determine (1) the top 50 most cited articles in shoulder instability and (2) if there is a correlation between the number of citations and level of evidence or methodological quality. Study Design: Cross-sectional study. Methods: A literature search was performed on both the Scopus and the Web of Science databases to determine the top 50 most cited articles in shoulder instability between 1985 and 2019. The search terms used included “shoulder instability,” “humeral defect,” and “glenoid bone loss.” Methodological scores were calculated using the Modified Coleman Methodology Score (MCMS), Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS) score. Results: The mean number of citations and mean citation density were 222.7 ± 123.5 (range, 124-881.5) and 16.0 ± 7.9 (range, 6.9-49.0), respectively. The most common type of study represented was the retrospective case series (evidence level, 4; n = 16; 32%) The overall mean MCMS, Jadad score, and MINORS score were 61.1 ± 10.1, 1.4 ± 0.9, and 16.0 ± 3.0, respectively. There were also no correlations found between mean citations or citation density versus each of the methodological quality scores. Conclusion: The list of top 50 most cited articles in shoulder instability comprised studies with low-level evidence and low methodological quality. Higher-quality study methodology does not appear to be a significant factor in whether studies are frequently cited in the literature.

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