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Briding large defects in bone

GUNN DR

Med J Malaya, 1962 Jun;16:267-9.
PMID: 13902959
Matched MeSH terms: Bone Transplantation*
Fulltext Spinal fusion surgery obviating bone graft harvest--a reality in the near future

Shukur MH

Med J Malaysia, 2005 Jul;60 Suppl C:1-2.
PMID: 16381272
Matched MeSH terms: Bone Transplantation*
Fulltext Clinical and radiological results of the vascularized medial femoral condyle graft for scaphoid non-union

Keller M, Kastenberger T, Anoar AF, Kaiser P, Schmidle G, Gabl M, et al.

Arch Orthop Trauma Surg, 2020 Jun;140(6):835-842.
PMID: 32124031 DOI: 10.1007/s00402-020-03386-7

INTRODUCTION: This study evaluated the use of a free vascularized bone graft with and without cartilage from the medial femoral condyle (MFC) in patients with recalcitrant scaphoid non-union, with a special focus on union rates and the osteochondral graft for proximal pole destruction.
MATERIALS AND METHODS: Thirty-eight avascular scaphoid non-unions in 37 patients who were treated with a free osteoperiosteal or osteochondral MFC graft were retrospectively evaluated (mean follow-up 16 months). Bone union, the scapholunate and the radiolunate angles were evaluated on X-ray images. The range of motion, grip strength, VAS, DASH and PRWE scores were evaluated clinically.
RESULTS: The overall union rate was 95%. Bone union was achieved in 27 out of 29 (93%) scaphoids treated with a free osteoperiosteal MFC grafts and in 9 out of 9 (100%) scaphoids treated with a free osteochondral MFC graft. The range of motion remained almost unchanged, while grip strength increased significantly (34 kg vs. 44 kg) and the VAS (22-5), DASH (59-19) and PRWE (62-30) score decreased significantly. The scapholunate (71°-65°) and radiolunate (28°-18°) angle decreased. No major donor site morbidity was observed. Postoperative complications were observed in eight cases (21%).
CONCLUSIONS: The vascularized medial femoral bone graft leads to a good functional outcome in the treatment of scaphoid non-unions. The graft provides adequate blood supply and structural stability to the scaphoid. A proximal pole destruction can be replaced using an osteochondral graft with promising short-term results preventing carpal osteoarthritis and collapse.

Matched MeSH terms: Bone Transplantation*
Fulltext Bone transport in the management of fractures of the tibia

Thirumal M, Shong HK

Med J Malaysia, 2001 Mar;56(1):44-52.
PMID: 11503296

A review was carried out in 21 cases of bone transport in the tibia done between May 1995 and December 1997. These were done for the treatment of compound (Grade IIIB) fractures with extensive bone and soft tissue loss and in infective non-unions of the tibia using the Ilizarov technique and ring fixator. In 5 cases, 2 or 3 additional procedures were needed such as tendo achilles (TA) lengthening, bone grafting, revision of construct or revision of scar at the docking site. Average resection of infected bone was 5.2 cms in the infective non-union group and average bone and soft tissue loss was 8 cms in the compound Grade IIIB fracture group. The defect was bridged and regenerate bone occurred in all the cases except one. Union was achieved in all the cases although 10 needed bone grafting. Infection was eradicated in all the cases. Limb length discrepancy was corrected in all the cases except three. Mean duration of treatment was 12 months.

Matched MeSH terms: Bone Transplantation*
Effects of processing and gamma radiation on mechanical properties and organic composition of frozen, freeze-dried and demineralised human cortical bone allograft

Mansor A, Ariffin AF, Yusof N, Mohd S, Ramalingam S, Md Saad AP, et al.

Cell Tissue Bank, 2023 Mar;24(1):25-35.
PMID: 35610332 DOI: 10.1007/s10561-022-10013-9

Bone processing and radiation were reported to influence mechanical properties of cortical bones due in part to structural changes and denaturation of collagen composition. This comparative study was to determine effects of bone processing on mechanical properties and organic composition, and to what extent the radiation damaging after each processing. Human femur cortical bones were processed by freezing, freeze-drying and demineralisation and then gamma irradiated at 5, 15, 20, 25 and 50 kGy. In the compression test, freeze drying significantly decreased the Young's Modulus by 15%, while demineralisation reduced further by 90% (P bone by 93% (P bones irradiated at 25 and 50 kGy showed by the highest peak of the amide I collagen in the Fourier Transfer Infra-Red spectra indicating more collagen was exposed after calcium was removed in the demineralised bone, however radiation showed no effect on the collagen crosslink. The study confirmed that demineralisation further reduced the ability to resist deformation in response to an applied force in freeze-dried bones due to calcium reduction and collagen composition. Sterilisation dose of 25 kGy has no effect on mechanical properties and collagen composition of the processed human cortical bone.

Matched MeSH terms: Bone Transplantation*
Fulltext A Novel Technique for Fixation of Non-union Unicondylar Hoffa's Fracture: A Case Report

Harna B, Dutt DD, Sabat D

Malays Orthop J, 2020 Nov;14(3):174-176.
PMID: 33403081 DOI: 10.5704/MOJ.2011.028

Hoffa fractures are rare and difficult fractures to manage. Hoffa fracture involves a coronal plane fracture of posterior femoral condyle. Non-union in Hoffa fracture is further difficult to manage. The surgical management for such nonunion includes open reduction with recon/LCP plate or screw fixation with bone grafting. The problem with plates is the difficulty in contouring the plates according to the shape of posterior femoral condyles. We describe a new technique with 2 L shaped neutralisation plates placed in a circular fashion. This technique provides a more rigid construct and gives better holding strength of screws in Hoffa fragment. This enhances union and mobilisation can be started early.

Matched MeSH terms: Bone Transplantation
Heterotopic implantation of autologous bone marrow in rock pigeons (Columba livia): possible applications in avian bone grafting

Sanaei MR, Abu J, Nazari M, Faiz NM, Bakar MZ, Allaudin ZN

J. Avian Med. Surg., 2011 Dec;25(4):247-53.
PMID: 22458179

Autologous bone marrow, alone or as a composite marrow graft, has received much attention in various species. To assess the potential osteogenicity of autologous, extramedullary bone marrow implants in an avian model, 24 adult pigeons (Columba livia) were given intramuscular implantations of autologous marrow aspirated from the medial tibiotarsus. Birds were euthanatized at 1, 4, 6, 8, 10, and 12 weeks after surgery to evaluate whether ectopic bone had formed at the implant sites. Primary evaluations by in situ radiography and postmortem histologic examinations showed no evidence of bone formation. Further evaluation with histologic scores and histomorphometry revealed a significantly increased rate of angiogenesis at the implant sites by the sixth and tenth week postimplantation (P < .05). No significant differences between the treatment and control sites were present at any other endpoints. Results of this study show that, although autologous bone marrow lacks heterotopic osteogenic potentials in this avian model, it could still function as a useful adjunct to routine bone grafting techniques because of its unique capabilities to promote early angiogenesis.

Matched MeSH terms: Bone Transplantation/veterinary*
Current Updates on Bone Grafting Biomaterials and Recombinant Human Growth Factors Implanted Biotherapy for Spinal Fusion: A Review of Human Clinical Studies

Li G, Li P, Chen Q, Thu HE, Hussain Z

Curr Drug Deliv, 2019;16(2):94-110.
PMID: 30360738 DOI: 10.2174/1567201815666181024142354

BACKGROUND: Owing to their great promise in the spinal surgeries, bone graft substitutes have been widely investigated for their safety and clinical potential. By the current advances in the spinal surgery, an understanding of the precise biological mechanism of each bone graft substitute is mandatory for upholding the induction of solid spinal fusion.
OBJECTIVE: The aim of the present review is to critically discuss various surgical implications and level of evidence of most commonly employed bone graft substitutes for spinal fusion.
METHOD: Data was collected via electronic search using "PubMed", "SciFinder", "ScienceDirect", "Google Scholar", "Web of Science" and a library search for articles published in peer-reviewed journals, conferences, and e-books.
RESULTS: Despite having exceptional inherent osteogenic, osteoinductive, and osteoconductive features, clinical acceptability of autografts (patient's own bone) is limited due to several perioperative and postoperative complications i.e., donor-site morbidities and limited graft supply. Alternatively, allografts (bone harvested from cadaver) have shown great promise in achieving acceptable bone fusion rate while alleviating the donor-site morbidities associated with implantation of autografts. As an adjuvant to allograft, demineralized bone matrix (DBM) has shown remarkable efficacy of bone fusion, when employed as graft extender or graft enhancer. Recent advances in recombinant technologies have made it possible to implant growth and differentiation factors (bone morphogenetic proteins) for spinal fusion.
CONCLUSION: Selection of a particular bone grafting biotherapy can be rationalized based on the level of spine fusion, clinical experience and preference of orthopaedic surgeon, and prevalence of donor-site morbidities.

Matched MeSH terms: Bone Transplantation*
Fulltext Minimal guided bone regeneration procedure for immediate implant placement in the esthetic zone

Kumar NS, Sowmya N, Mehta DS, Kumar PS

Dent Res J (Isfahan), 2013 Jan;10(1):98-102.
PMID: 23878571 DOI: 10.4103/1735-3327.111808

The anterior maxilla presents a challenging milieu interior for ideal placement of implants because of the compromised bone quality. With the advent of intraoral bone harvesting and augmentation techniques, immediate implant placement into fresh extraction sockets have become more predictable. Immediate implant placement has numerous advantages compared to the delayed procedure including superior esthetic and functional outcomes, maintenance of soft and hard tissue integrity and increased patient compliance. This case report exhibits immediate implant placement in the maxillary esthetic zone by combining a minimal invasive autogenous block bone graft harvest technique for ensuring successful osseointegration of the implant at the extraction site.

Matched MeSH terms: Bone Transplantation
Fulltext Commentary: Vascularized bone graft is an effective technique for extra-cortical bone bridging to combat cemented megaprosthesis loosening at the bone-implant junction

Singh VA

J Orthop Surg (Hong Kong), 2020 12 22;28(3):2309499020972483.
PMID: 33345709 DOI: 10.1177/2309499020972483
Matched MeSH terms: Bone Transplantation
Proximal Tibia Bone Graft: An alternative Donor Source especially for Foot and Ankle Procedures

Jia TY, Gurmeet S, Asni A, Ramanathan R

Malays Orthop J, 2015 Mar;9(1):14-17.
PMID: 28435589 MyJurnal DOI: 10.5704/MOJ.1503.016

Bone graft is essential in various orthopaedic procedures. Among the many donor sites for harvesting autologous bone graft, the iliac crest has been the most commonly used. However, for foot and ankle procedures the proximal tibia has gained popularity as an alternative donor site due to its anatomic proximity to the primary surgical site. In this article we evaluated the possible complications associated with harvesting proximal tibia bone graft. Our study showed the low incidence of morbidity in harvesting proximal tibia bone graft, thereby providing a good alternative donor for foot and ankle procedures.

Matched MeSH terms: Bone Transplantation
Fulltext Alveolar Bone Grafting Without Closure Of Oronasal Fistula In Cleft And Palate Patient

Abdul Rahman, Z.A.

Ann Dent, 2004;11(1):-.
MyJurnal

The standard procedure for alveolar cleft closure in cleft lip and palate patients is by alveolar bone grafting (ABG) where the residual opening of oronasal fistula in the palate is also closed simultaneously. Occasionally there is a situation of soft tissue inadequacy and attempt to close the fistula at the same procedure as ABG may compromise the result of the bone graft itself. An unforeseen leakage at the closure may cause graft infection leading to failure. This article reports on a technique where alveolar bone grafting was done without closure of residual palatal fistula to provide adequate soft tissue coverage for the grafted bone. This may reduce the risk of leakage at the oral mucosal coverage of the graft . The residual palatal fistula will be closed at later stage by muco-palatal flap or tongue flap. We reported on a case of a failed ABG which was reconstructed using this technique. Various other techniques to ensure success of ABG were also discussed. Conclusion: The alveolar bone grafting without closure of oro-nasal fistula reduced the risk of failure of ABG in a wide alveolar cleft.

Matched MeSH terms: Bone Transplantation
Successful commercialisation of locally fabricated bioceramics for clinical applications

Fazan F, Besar I, Osman A, Samsudin AR, Khalid KA

Med J Malaysia, 2008 Jul;63 Suppl A:49-50.
PMID: 19024978

This paper chronicled the development of a locally produced bone graft substitute based on calcium phosphate bioceramics called "GranuMaS--from concepts to clinics, and finally to its successful commercialization all within 5-year duration. It was a Prioritized Research (PR) collaborative project of 5 institutions namely SIRIM, ANM, USM, UKM and IIUM, funded by MOSTI to the amount of approximately RM2.5 millions under RM8. This paper also highlighted the requirements needed in terms of technical expertise/manpower, facilities and infrastructure, and government/institutional supports, as well as the challenge faced in developing and commercializing such product.

Matched MeSH terms: Bone Transplantation/instrumentation*; Bone Transplantation/methods
Fulltext Revision total hip arthroplasty using impaction bone grafting technique

Nisar A, Choon DS, Varaprasad M, Abbas AA

Med J Malaysia, 2006 Feb;61 Suppl A:100-2.
PMID: 17042242

A variety of reconstructive options exist for revision of both femoral and acetabular components in total hip replacement surgery. The use of impaction bone grafting with morsellised allograft has shown promising results in revision total hip arthroplasty. It works as a biologic reconstitution of bone stock defects and provides a solid construct with stable fixation. We present a case of bilateral revision total hip arthroplasty with poor bone stock where reconstructive surgery was done by using impaction bone grafting, mesh and C-stem implants.

Matched MeSH terms: Bone Transplantation/instrumentation; Bone Transplantation/methods*
Radiological results of Shelf acetabuloplasty in adolescent hip dysplasia with aspherical femoral head: how to get an ideal placement of the Shelf graft

Ramdhan Ibrahim MA, Kamegaya M, Morita M, Saisu T, Kakizaki J, Oikawa Y

J Pediatr Orthop B, 2020 May;29(3):261-267.
PMID: 31688334 DOI: 10.1097/BPB.0000000000000681

Shelf acetabuloplasty continues to be effective in the prevention or delay of osteoarthritis in adolescent dysplastic hips. We aimed to evaluate the efficacy and to determine the correct level of the bone graft objectively. We retrospectively analyzed 16 hips underwent Shelf acetabuloplasty originated by Spitzy. The mean age at surgery was 15.3 years old with the mean caput index at 39.7%. The average follow-up was 11 years. The radiological evaluation was based on acetabular-head index (AHI) at preoperative and latest radiographs, acetabular-Shelf distance (ASD) and Shelf-head ratio at immediate postoperative and latest radiographs. The cutoff value for the ideal ASD was determined by receiver operating characteristic (ROC) and the Pearson correlation test used in statistical analysis to assess the relationship between ASD and Shelf graft resorption. Clinical evaluation was performed using Harris Hip Score (HHS) at the latest follow-up. The AHI was improved in all cases, from mean 56.9 to 91.0% (P bone resorption over time was at the level of 6 mm from the joint space. Level III - therapeutic study.

Matched MeSH terms: Bone Transplantation/methods*; Bone Transplantation/trends
A Case of Non-Union of Ulna Fracture Managed with Tibial Strut Cortico-Cancellous Bone Grafting in a Paediatric Patient

Looi CSK, S A R, Gill RS

J Hand Surg Asian Pac Vol, 2017 Sep;22(3):396-402.
PMID: 28774257 DOI: 10.1142/S0218810417720327

Forearm fractures in children complicated with non-union are uncommon. Various methods have previously been reported to manage this condition. Well documented techniques would include iliac crest grafting, cancellous insert grafting, ulnar segment grafting, cortical tibial grafting, vascularized fibular grafting and bone transport by ring fixation. The authors present a case of a child with an atrophic non-union of the ulna who was successfully treated with a cortico-cancellous tibial strut bone graft.

Matched MeSH terms: Bone Transplantation/methods*; Cancellous Bone/transplantation*
Long-term effect on foot and ankle donor site following vascularized fibular graft resection in children

Sulaiman AR, Wan Z, Awang S, Che Ahmad A, Halim AS, Ahmad Mohd Zain R

J Pediatr Orthop B, 2015 Sep;24(5):450-5.
PMID: 26049965 DOI: 10.1097/BPB.0000000000000197

This study was carried out to evaluate the long-term effect on the donor side of the foot and ankle following vascularized fibular graft resection in children. Eight patients underwent resection of the fibula for the purpose of a vascularized fibular graft by a surgical team who practiced leaving at least 6 cm residual distal fibula. The age of these children at the time of surgery was between 3 and 12 years. They were reviewed between 3 and 12 years after surgery. Two patients who underwent resection of the middle shaft of the fibula at 3 and 5 years of age developed abnormal growth of the distal tibia, leading to ankle valgus. They were treated with growth modulation of the distal tibial physis and supramalleolar osteotomy with tibiofibular synostosis. Another patient who underwent the entire proximal fibula resection at the age of 6 years had developed hindfoot valgus because of weakness of the tibialis posterior muscle. He required talonavicular fusion and flexor hallucis to tibialis posterior muscle transfer. Patients operated at the age of older than 8 years neither had ankle nor hindfoot deformity. We concluded that resection of the middle shaft of the fibula for the purpose of a vascularized fibula graft, leaving a 6 cm distal fibular stump in children younger than 6 years old, may give rise to abnormal growth of the distal tibial physis, leading to valgus ankle. The entire proximal fibular resection for the similar purpose in a 6-year-old child may give rise to weakness of tibialis posterior and hindfoot valgus.

Matched MeSH terms: Bone Transplantation/adverse effects; Bone Transplantation/methods*
Fulltext Skeletal union following long bone reconstruction using vascularised fibula graft

Imran Y, Zulmi W, Halim AS

Singapore Med J, 2003 Jun;44(6):286-7.
PMID: 14560858

Thirteen patients had skeletal reconstruction using vascularised fibula graft following resection of the diseased bone. Eleven patients had reconstruction of the lower limbs and two patients of the upper limbs. Clinical and radiographical evidence union were achieved with the average time of 32 weeks (earliest eight weeks). Six out of 11 patients (54%) in lower limb reconstruction started weight bearing at the average of 27 weeks. Bony union in this study is comparable with other studies using vascularised fibula graft.

Matched MeSH terms: Bone Transplantation/mortality; Bone Transplantation/rehabilitation*
Fulltext Application of platelet rich fibrin for management of an electrosurge induced osteonecrosis involving maxillary alveolus

Suresh N, Chandrasekaran B, Muthusamy S, Kannan S, Muthu K

Singapore Dent J, 2015 Dec;36:39-43.
PMID: 26684495 DOI: 10.1016/j.sdj.2014.11.004

BACKGROUND: Application of principles of electrocautery for hemostasis dates back to prehistoric times. Its modern implementation in various fields of general and head and neck surgeries have been well documented. However its usage in minor oral surgical procedures has gained popularity only recently. Complications associated with electro-surgery in the dental field are relatively rare and there is insufficient literature on its management.
CASE REPORT: We present a case report on management of an electrosurgery induced osteonecrosis involving maxillary alveolus of left premolars.
DISCUSSION: Inadvertent contact of the electrosurgery tip on bone can result in necrosis making it necessary to remove the sequestrum and graft the defect. Platelet rich fibrin in combination with bone grafts have been well documented to provide successful periodontal regeneration.
CLINICAL IMPLICATIONS: Our aim of presenting this report is to create awareness among the health care providers regarding electrosurgical injuries. To our knowledge, this is the first time platelet rich fibrin has been used in the management of intraoral electrosurgical injury. Combining bone grafts with platelet rich fibrin is a good alternative as it can be done with relative ease and predictable outcome.

Matched MeSH terms: Bone Transplantation
Fulltext Free non-vascularized fibular graft for treatment of pediatric traumatic radial bone loss: a case report

Thevarajan K, Teo P

Malays Orthop J, 2013 Jul;7(2):37-40.
PMID: 25722825 MyJurnal DOI: 10.5704/MOJ.1307.003

Various methods, such as vascularized bone transfers, Illizarov bone transport, allogenic bone grafts, bone graft substitutes, are available in treating traumatic bone loss. Free non-vascularised fibular graft is an autografting method that only requires minimal facilities or expertise. However, this method is not popularized due to its avascular property and there is not many reports regarding its use in treating a large traumatic bone loss. We reported a case in our center to demonstrate its possibility of successfully treating the traumatic radial bone loss in pediatric patient. Patient had good recovery with the regain of good range of movement of forearm and there is no harvest site morbidity after two years of follow up.

Matched MeSH terms: Bone Transplantation

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