Evaluation of Nutrient Foramen in Adult Dry Human Femur

BACKGROUND Nutrient foramen is a large opening that transfers the arteries that supply the bone to the bone cavity. During surgical procedures, it is very important to have precise and complete information about the location of the foramina to determine whether the fracture line passes close to the nutrient foramina. The purpose of this study was to determine the number and position of the femoral nutrient foramina together with morphometric measurements. METHODS A total of 93 dry adult femurs with unknown sexes were examined in this study. The direction, location and the total number of nutrient foramina of the femur were investigated by using an anthropometer (Lafayette instrument, Indiana). Also, foraminal index was calculated. RESULTS The analysis revealed that 28 (53.8 %) of the femurs with a single nutrient foramen were on the right side and 22 (53.7 %) were on the left side, respectively. Femurs with double nutrient foramina were 23 (44.2 %) and 18 (43.9 %) on right and left sides, respectively. Femurs with triple nutrient foramina were 1(1.9 %) and 1 (2.4 %) on right and left sides, respectively. The foraminal index of femurs was found as (41, 58 %) and (42, 23 %) on the right and left sides, respectively. The nutrient foramen was mostly 84 (90.3 %) located at the middle third of the femur. CONCLUSIONS The findings of this study provide information and details about nutrient foramen which have clinical importance, especially in surgical procedures like bone grafting and microsurgical vascularized bone transplantation. KEY WORDS Femur, Foraminal Index, Nutrient Artery, Nutrient Foramina

Enxertos ósseos em odontologia – uma revisão integrativa da literatura

A exodontia de unidades permanentes, assim como doença periodontal e trauma bucal, estão muitas vezes relacionados ao processo de reabsorção alveolar, o que culminam na perda óssea tanto em espessura quanto em altura, sendo esse principal impasse para reabilitação oral por meio de prótese sobre implantes. Cerca de 50% dos sítios para instalação de implantes não apresentam volume ósseo suficiente para sua instalação, o leva a necessidade de utilizar biomateriais para o processo de regeneração óssea guiada. Diante da necessidade de aumentar tecido ósseo em volume e espessura, diversos biomateriais foram desenvolvidos, sendo eles classificados em enxertos do tipo autógeno, alógeno, xenógeno e aloplástico. Para realização desse estudo foi realizada uma busca completa nas bases de dados: PubMed, Scielo, Lilacs e Google Scholar, utilizando as palavras-chave “dentistry bone transplantation, surgery oral, biocompatible materials and bone regeneration”, inseridas nas buscas de maneira cruzada adotando a expressão boolena "and”. Afim de selecionar os artigos a serem analisados foram elencados critérios de inclusão e exclusão. A utilização de enxertos ósseos tem mostrado resultados promissores no ganho de osso vertical e horizontal. A associação de biomaterias permite que as melhores propriedades de cada tipo de enxerto sejam usadas de forma integrada, o que leva a resultados favoráveis tanto histologicamente como funcionalmente.

In-vitro Evaluation of Chitosan - Hydroxyapatite Nanocomposite Scaffolds as Bone Substitutes with Antibiofilm Properties

An opaque, white chitosan/ Hydroxyapatite nanocomposite was prepared by a simple blend method. Morphology, pore size and dispersion of nano-hydroxyapatite in chitosan matrix were visualized using SEM images. The FTIR and SEM with EDX analysis confirmed the bony apatite layer was formed on the outside of the composite. Porosity measurements and water uptake studies of the nanocomposite were evaluated which revealed the maximum porosity of 80% to 92% in the chitosan: hydroxyapatite nanocomposite at the ratio of 20:80. The results also showed that water absorption ability was inversely proportional to the hydroxyapatite present in the nanocomposite. The porosity of prepared nanocomposite was corresponding to the cancellous bone porosity of 50% to 90% suggesting possible applications in bone transplantation. The nanocomposite exhibited antibacterial activity towards the tested Gram-negative and Gram-positive species of bacteria and reduced the bacterial adhesion in biofilm formation.

Unidirectional porous beta-tricalcium phosphate and hydroxyapatite artificial bone: a review of experimental evaluations and clinical applications

In Japan, where allograft bone transplantation is not widespread, prospects for artificial bones are very high. Therefore, artificial bones with various compositions, porous structures, and porosities have been developed and employed for clinical use. Both Affinos® and Regenos® (made of beta-tricalcium phosphate and hydroxyapatite, respectively) are artificial bones with a unique unidirectional porous structure, in which pores with a diameter suitable for tissue penetration (25–300 μm) are aligned in one direction. The unidirectional porous structure allows rapid penetration of blood deep into the materials by a capillary effect. In animal experiments, Affinos® showed well-balanced resorption and was replaced with the host’s own bone from an early stage after implantation and new bone formation and remodeling were observed in the cortical bone and medullary cavity. When implanted for clinical situation, resorption from an early stage and good replacement with the patient’s own bone were also observed. Regenos® has an internal osteon-like material and a vascular-like structure that is maintained within the pores even after long-term implantation, as noted in an animal experiment. When implanted for clinical situation, good osteoconductivity was observed from an early stage of implantation. In addition, the material was observed to be slowly absorbed over time in some cases. We have discussed the beneficial effects of combining teriparatide and platelet-rich plasma impregnation and the potential prospects of these artificial bones.

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

Large 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.

Bone Defect Repair Using a Bone Substitute Supported by Mesenchymal Stem Cells Derived from the Umbilical Cord

Objective. Bone defects or atrophy may arise as a consequence of injury, inflammation of various etiologies, and neoplastic or traumatic processes or as a result of surgical procedures. Sometimes the regeneration process of bone loss is impaired, significantly slowed down, or does not occur, e.g., in congenital defects. For the bone defect reconstruction, a piece of the removed bone from ala of ilium or bone transplantation from a decedent is used. Replacement of the autologous or allogenic source of the bone-by-bone substitute could reduce the number of surgeries and time in the pharmacological coma during the reconstruction of the bone defect. Application of mesenchymal stem cells in the reconstruction surgery may have positive influence on tissue regeneration by secretion of angiogenic factors, recruitment of other MSCs, or differentiation into osteoblasts. Materials and Methods. Mesenchymal stem cells derived from the umbilical cord (Wharton’s jelly (WJ-MSC)) were cultured in GMP-grade DMEM low glucose supplemented with heparin, 10% platelet lysate, glucose, and antibiotics. In vitro WJ-MSCs were seeded on the bone substitute Bio-Oss Collagen® and cultured in the StemPro® Osteogenesis Differentiation Kit. During the culture on the 1st, 7th, 14th, and 21st day (day in vitro (DIV)), we analyzed viability (confocal microscopy) and adhesion capability (electron microscopy) of WJ-MSC on Bio-Oss scaffolds, gene expression (qPCR), and secretion of proteins (Luminex). In vivo Bio-Oss® scaffolds with WJ-MSC were transplanted to trepanation holes in the cranium to obtain their overgrowth. The computed tomography was performed 7, 14, and 21 days after surgery to assess the regeneration. Results. The Bio-Oss® scaffold provides a favourable environment for WJ-MSC survival. WJ-MSCs in osteodifferentiation medium are able to attach and proliferate on Bio-Oss® scaffolds. Results obtained from qPCR and Luminex® indicate that WJ-MSCs possess the ability to differentiate into osteoblast-like cells and may induce osteoclastogenesis, angiogenesis, and mobilization of host MSCs. In animal studies, WJ-MSCs seeded on Bio-Oss® increased the scaffold integration with host bone and changed their morphology to osteoblast-like cells. Conclusions. The presented construct consisted of Bio-Oss®, the scaffold with high flexibility and plasticity, approved for clinical use with seeded immunologically privileged WJ-MSC which may be considered reconstructive therapy in bone defects.

A case report of osteochondritis dissecans of the first metatarsophalangeal joint treated with autologous cancellous bone and chondral flap reconstruction

Although osteochondritis dissecans (OD) is well-described in the bibliography, cases of OD in the 1st metatarsophalangeal joint (MTP) are rare clinical situations. We present a 25-year-old male who presented to our department for big toe pain on the left side. Clinical and radiological examination showed the typical findings of OD lesion on the 1st metatarsal head (MH), establishing the diagnosis of OD. Intraoperatively the articular cartilage of the partially detached part of the MH was intact and under it, an empty cavity with a big defect was obvious. Autogenous cancellous bone transplantation from the metatarsal metaphysis, reattachment of the cartilage surface as a chondral flap and edge sealing with fibrin glue was our treatment of choice. OD of the 1st MH should be included in the differential diagnosis of big toe pain, as early diagnosis and treatment are crucial to prevent future osteoarthritis of the 1st MTP.