Efficacy of allogenic bone implants in a series of consecutive elective foot procedures
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Iliac crest
Demineralized bone matrix
Cancellous bone
The efficacy of demineralized bone matrix (DBM) used alone and with bone marrow as a graft material in the treatment of osseous defects was evaluated in 48 patients. Of these 48 patients, 39 were available to follow up and review. Follow up averaged 19 months for all patients. In the entire series, 30 of 39 patients demonstrated osseous union for a 77% success rate. Patients with fracture nonunion represented the most recalcitrant group clinically, with union achieved in only 61% of these cases. Overall, the 39 patients grafted with DBM demonstrated healing that was comparable to results achieved with standard iliac crest bone graft. The results indicate the DBM and marrow composite grafting is a suitable alternative to autologous iliac crest bone graft for use in certain clinical situations, such as bone defects in children, comminuted fractures with associated bone loss, nonunited fractures, or to augment an intended arthrodesis site.
Demineralized bone matrix
Iliac crest
Bone marrow aspirate
Bone grafting
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Iliac crest
Demineralized bone matrix
Putty
Iliac bone
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Study Design. A rabbit model for lumbar intertransverse process spine arthrodesis was utilized, with blind evaluation of the control and experimental animals. Objectives. To establish an animal model for motion-induced nonunion of lumbar intertransverse process spine arthrodesis and to determine if there was an early time period during which excessive motion at the arthrodesis site was deleterious to fusion. Summary of Background Data. Most previously reported animal models for nonunion of lumbar spine arthrodesis do not use intertransverse process fusion and do not allow variable control of the nonunion-inducing factor. Methods. Forty-two adult New Zealand white rabbits underwent posterolateral intertransverse process spine arthrodesis with autogenous iliac crest graft. Rabbits in the experimental group (n = 23) underwent a lifting protocol to produce motion at the arthrodesis site; those in the control group (n = 12) remained undisturbed in their cages. Arthrodeses were assessed radiographically and manually to determine if fusion had occurred. Results. Lifted rabbits exhibited a 13% fusion rate compared to a 50% fusion rate in controls. Rabbits lifted during only the first 2 postoperative weeks exhibited a fusion rate that was significantly less (P = 0.03) than that of controls. Conclusions. A small animal model for motion-induced nonunion of lumbar intertransverse process spine arthrodesis has been established. With respect to excessive motion as a promoter of nonunion in spine arthrodeses, the early postoperative time period appears critical.
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Autogenous cancellous bone fragments can be compressed rapidly during surgery to create reproducible load-bearing grafts. Of the 32 grafts tested, 10 were constructed of composite cortical-cancellous bovine bone and 22 of cancellous human bone. Compressed composite bovine grafts and compressed human cancellous grafts supported average axial compressive loads of 2148 N and 960 N, respectively. Compared to iliac crest grafts, compression grafts may have better load-bearing capabilities and greater reproducibility. Potential applications include trauma, delayed unions, arthrodesis, and spinal fusions.
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We present a case illustrating the successful use of a conventional intramedullary rod and vascularized iliac crest graft in atrophic nonunion combined with severe osteoporosis of the femoral shaft in a child, in whom classical osteosynthesis failed after two operations. The conventional intramedullary rod offered excellent purchase in the severely porotic, partially destroyed bone. Combined with a vascularized iliac crest grafted laterally, mechanical support and an osteoinductive stimulus were provided. The atrophic nonunion healed completely after this revision surgery.
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Osteosynthesis
Femoral shaft
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Iliac crest
Demineralized bone matrix
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Iliac bone
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Fracture non-healing, also known as bone nonunion, is a common complication after fracture, but also one of the clinical problems in orthopedics. At present, there are various treatment methods for bone nonunion, and there is no perfect clinical solution. According to the specific situation of the patient, the individualized treatment plan is formulated. This paper uses the ILIAC crest and bone allograft combined with jiegudan to treat the bone nonunion, which provides a feasible idea for the setting of the clinical treatment plan.
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Iliac crest
Demineralized bone matrix
Putty
Pseudarthrosis
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Patients requiring cancellous bone grafting of an extensive deficit or multiple bone grafting procedures often lack a sufficient quantity of autogenous cancellous bone. Canine studies have indicated that a potential exists for reharvesting autogenous cancellous bone from an iliac crest donor site using a trapdoor harvesting technique. However, significant human experience with this procedure has been lacking. This report describes four patients who underwent successful reharvesting of an iliac crest donor site that provided clinically sufficient autogenous cancellous bone graft material to treat an ongoing or a new skeletal problem. These patients all met specific criteria regarding use of the trapdoor method of bone graft harvest and a minimum 24-month interval between bone grafting procedures. Preoperative computed tomography scanning of the iliac crest was useful in documenting that sufficient cancellous bone was available for reharvest. It appears that iliac crest donor site reharvesting is a specific advantage of the trapdoor technique and is a possible alternative to multiple site grafting or the use of allograft or bone substitute materials.
Iliac crest
Cancellous bone
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