Complications in Elective Removal of 271 Bone Lengthening Nails (FITBONE, PRECICE and STRYDE)

Granulocyte colony-stimulating factor (G-CSF) was shown to promote bone regeneration and mobilization of vascular and osteogenic progenitor cells. In this study, we investigated the effects of a systemic low dose of G-CSF on both bone consolidation and mobilization of hematopoietic stem/progenitor cells (HSPCs), endothelial progenitor cells (EPCs) and mesenchymal stromal cells (MSCs) in a rat model of distraction osteogenesis (DO). Neovascularization and mineralization were longitudinally monitored using positron emission tomography and planar scintigraphy. Histological analysis was performed and the number of circulating HSPCs, EPCs and MSCs was studied by flow cytometry. Contrary to control group, in the early phase of consolidation, a bony bridge with lower osteoclast activity and a trend of an increase in osteoblast activity were observed in the distracted callus in the G-CSF group, whereas, at the late phase of consolidation, a significantly lower neovascularization was observed. While no difference was observed in the number of circulating EPCs between control and G-CSF groups, the number of MSCs was significantly lower at the end of the latency phase and that of HSPCs was significantly higher 4 days after the bone lengthening. Our results indicate that G-CSF accelerates bone regeneration and modulates mobilization of progenitor cells during DO.

Download Full-text

Unprecedented tibial bone lengthening of 33.5 cm by distraction osteogenesis for the reconstruction of a subtotal tibial bone defect. A case report and literature review

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-03950-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Abdulnassir Ali ◽

Ying Ren ◽

Chun-Hao Zhou ◽

Jia Fang ◽

Cheng-He Qin

Keyword(s):

Bone Defect ◽

Distraction Osteogenesis ◽

Chronic Osteomyelitis ◽

Weight Bearing ◽

Lower Leg ◽

Bone Lengthening ◽

Case Presentation ◽

Tibial Length ◽

Tibial Bone ◽

The Right

Abstract Background We present a case of an immense unprecedented tibial bone lengthening of 33.5 cm. The management of chronic osteomyelitis of the right tibia with subtotal tibial bone defect, talus defect and equinus ankle deformity. We demonstrate limb reconstruction by distraction osteogenesis and correction of ankle deformity with the Ilizarov technique. Limb salvage was preferred as an alternative to amputation to restore basic limb function. Case presentation A 16-year-old male patient fell and injured his right lower leg. He attempted to treat the symptoms with traditional home remedies. During 15 months of self-treating, he developed osteomyelitis of the right tibia and had lost function in his foot. Radiology revealed immense bone defect of the right tibia, including talus bone defect and equinus deformity of the calcaneus. The patient’s right tibia was non weight-bearing, had drainage sinus just below his knee and a large scar anteriorly along the entire length of the tibia. Conclusion Upon completion of treatment, the patient was able to avoid amputation of his leg with partially restored function for weight-bearing. He carried himself without assistance after 3 years of lost function in his right leg. Tibial bone distraction osteogenesis of 33.5 cm was done after 90% of the tibial length was defected. To the best of our best knowledge, this case is one of a kind to achieve distraction of tibial bone to such length.

Download Full-text

Intramedullary Bone Lengthening Following Preceding Hip Surgery—A Case Series

Journal of Clinical Medicine ◽

10.3390/jcm9124104 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4104

Author(s):

Lukas Zak ◽

Thomas Manfred Tiefenboeck ◽

Gerald Eliot Wozasek

Keyword(s):

Hip Dysplasia ◽

Young Patients ◽

Limb Lengthening ◽

Limb Length Discrepancy ◽

Limb Length ◽

Hip Surgery ◽

Bone Lengthening ◽

Safe Procedure ◽

Length Discrepancy ◽

Healing Index

Limb length discrepancy (LLD) is a common problem after joint-preserving hip surgeries, hip dysplasia, and hip deformities. Limping, pain, sciatica, paresthesia, and hip instability are common clinical findings and may necessitate limb-lengthening procedures. The study included five patients (two female and three male, mean age of 28 years (20–49; SD: 12)) with symptomatic limb length discrepancy greater than 2.5 cm (mean: 3.6 cm) after total hip arthroplasty (THA), hip dysplasia, or post-traumatic hip surgery. They underwent either ipsi- or contralateral intramedullary limb-lengthening surgeries using the PRECICE™ telescopic nail. All patients achieved complete bone healing and correction of the pelvic obliquity after intramedullary lengthening. None of the patients had a loss of proximal or distal joint motion. The mean distraction-consolidation time (DCT) was 3.8 months, the distraction index (DI) 0.7 mm/day, the lengthening index (LI) 1.8 months/cm, the consolidation index (CI) 49.2 days/cm, the healing index (HI) 1.1 months/cm, and the modified healing index (HI*) 34 days/cm. Intramedullary limb lengthening after LLD in cases of hip dysplasia, hip deformity, and various kinds of hip surgery is a useful and safe procedure in young patients to achieve equal limb length. No functional impairment of the preceded hip surgery was seen.

Download Full-text

Automating Skeletal Expansion: An Implant for Distraction Osteogenesis of the Mandible

Journal of Medical Devices ◽

10.1115/1.3071969 ◽

2009 ◽

Vol 3 (1) ◽

Cited By ~ 6

Author(s):

John C. Magill ◽

Marten F. Byl ◽

Batya Goldwaser ◽

Maria Papadaki ◽

Roger Kromann ◽

...

Keyword(s):

Distraction Osteogenesis ◽

Treatment Time ◽

Patient Activation ◽

Latency Period ◽

Bone Lengthening ◽

Loop Control ◽

New Device ◽

Distraction Device ◽

Component Failures ◽

Natural Healing

Distraction osteogenesis is a technique of bone lengthening that makes use of the body’s natural healing capacity. An osteotomy is created, and a rigid distraction device is attached to the bone. After a latency period, the device is activated two to four times per day for a total of 1 mm/day of bone lengthening. This technique is used to correct a variety of congenital and acquired deformities of the mandible, midface, and long bones. To shorten the treatment period and to eliminate the complications of patient activation of the device, an automated continuous distraction device would be desirable. It has been reported that continuous distraction generates adequate bone with lengthening at a rate of 2 mm/day, thereby reducing the treatment time. The device we describe here uses miniature high-pressure hydraulics, position feedback, and a digital controller to achieve closed-loop control of the distraction process. The implanted actuator can produce up to 40 N of distraction force on linear trajectories as well as curved distraction paths. In this paper we detail the spring-powered hydraulic reservoir, controller, and user interface. Experiments to test the new device design were performed in a porcine cadaver head and in live pigs. In the cadaver head, the device performed an 11 day/11 mm distraction with a root-mean-squared position error of 0.09 mm. The device functioned for periods of several days in each of five live animals, though some component failures occurred, leading to design revisions. The test series showed that the novel design of this system provides the capabilities necessary to automate distraction of the mandible. Further developments will focus on making the implanted position sensor more robust and then on carrying out clinical trials.

Download Full-text

METABOLIC AND ORTHOPEDIC ASPECT OF X-LINKED VITAMIN D-RESISTANT HYPOPHOSPHATEMIC RICKETS

10.36106/gjra/5801730 ◽

2021 ◽

pp. 42-43

Author(s):

Rahul Kumar ◽

Rajni Kumari ◽

Shailesh Kumar ◽

Santosh Kumar

Keyword(s):

Vitamin D ◽

Surgical Correction ◽

Lower Limbs ◽

Hypophosphatemic Rickets ◽

Bone Lengthening ◽

Normal Range ◽

Bone Deformity ◽

Bone Maturation ◽

Leg Axis

INTRODUCTION: - The X-linked vitamin D-resistant hypophosphatemic rickets (VDXLR) is a metabolic disorder. Medication treatment consists of oral phosphate substitution and supplementation of active vitamin D compounds. Our study aimed to review our patients with VDXLR, focusing on those undergoing surgery, mainly lengthening procedures. The main parameters of interest were growth, height, the axis of the lower limbs, pain, and degenerative arthropathy. METHODS: - Twelve patients with VDXLR were followed at our institution. Eight patients underwent surgical correction, and three of them in combination with bone lengthening. The corrections were executed at the end of growth in the patients. Clinical end points were height, leg axis, and pain. RESULTS: - Single bilateral surgical correction was performed in six patients; one patient had three and ve corrections. Bone lengthening was performed in three patients. At the last follow-up, the height of seven operated patients was within normal range. In addition, the leg axis was normalized in six patients with mild genua vara in two. Bone healing was excellent, and no surgical complications. There was no one radiological evidence of degenerative arthropathy. CONCLUSIONS: - In case of bone deformity, surgery can safely be performed, independent of age or bone maturation. All patients were happy with the outcomes of axial corrective surgery and bone lengthening, and in the majority. Only one corrective intervention was needed.

Download Full-text

Reconstitution of the host holobiont in germ-free born male rats acutely increases bone growth and affects marrow cellular content

Physiological Genomics ◽

10.1152/physiolgenomics.00017.2021 ◽

2021 ◽

Author(s):

Piotr J Czernik ◽

Rachel M. Golonka ◽

Saroj Chakraborty ◽

Beng San Yeoh ◽

Ahmed A Abokor ◽

...

Keyword(s):

Bone Marrow ◽

Bone Mass ◽

Bone Growth ◽

Elevated Serum ◽

Male Rats ◽

Bone Lengthening ◽

Mineral Density ◽

Germ Free ◽

Hepatic Expression ◽

Gut Colonization

Integration of microbiota in a host begins at birth and progresses during adolescence, forming a multidirectional system of physiologic interactions. Here, we present an instantaneous effect of natural, bacterial gut colonization on the acceleration of longitudinal and radial bone growth in germ-free born, 7-week-old male rats. Changes in bone mass and structure were analyzed after 10 days following the onset of colonization through cohousing with conventional rats and revealed unprecedented acceleration of bone accrual in cortical and trabecular compartments, increased bone tissue mineral density, improved proliferation and hypertrophy of growth plate chondrocytes, bone lengthening, and preferential deposition of periosteal bone in the tibia diaphysis. In addition, the number of small in size adipocytes increased, while the number of megakaryocytes decreased, in the bone marrow of conventionalized germ-free rats indicating that not only bone mass but also bone marrow environment is under control of gut microbiota signaling. The changes in bone status paralleled with a positive shift in microbiota composition toward short chain fatty acids (SCFA)-producing microbes and a considerable increase in cecal SCFA concentrations, specifically butyrate. Further, reconstitution of the host holobiont increased hepatic expression of IGF-1 and its circulating levels. Elevated serum levels of 25-hydroxy vitamin D and alkaline phosphatase pointed toward an active process of bone formation. The acute stimulatory effect on bone growth occurred independently of body mass increase. Overall, the presented model of conventionalized germ-free rats could be used to study microbiota-based therapeutics for combatting dysbiosis-related bone disorders.

Download Full-text

A NEW METHOD FOR QUANTIFICATION OF REGENERATED BONE TISSUE ON X-RAY IMAGES OF ELONGATED BONES

Image Analysis & Stereology ◽

10.5566/ias.v22.p183-191 ◽

2011 ◽

Vol 22 (3) ◽

pp. 183 ◽

Cited By ~ 2

Author(s):

Aneta Gądek ◽

Leszek Wojnar ◽

Maciej Tęsiorowski ◽

Barbara Jasiewicz

Keyword(s):

External Fixator ◽

Theoretical Background ◽

New Method ◽

Ilizarov Method ◽

Bone Lengthening ◽

X Ray ◽

Internal Part ◽

Computer Aided Analysis ◽

Computer Aided ◽

The Moment

A new method for quantification of bone regenerate on the basis of computer-aided analysis of digitized Xray images is presented and its applicability in bone lengthening using Ilizarov method is demonstrated. In contrary to classical methods the internal part of the bone image is taken into consideration instead of the bone edges. Theoretical background of this concept is presented and experimentally verified. Experimental results show that the method proposed allows us for assessment of the bone regenerate, precise choice of the moment of external fixator removal as well as prediction of abnormalities in the osteogenesis process (excluding overall decalcification). However, the rules of interpretation of the results are not discussed in details.

Download Full-text