Charcoal bamboo as a bone substitute: an animal study.

Charcoal bamboo (Bambusae glaucescens) was placed in the resected tibial diaphysis of sixteen New Zealand White rabbits. At two, four and six weeks and again at six months after the operations, four rabbits in each period were killed and all specimens were examined under a light microscope and a scanning electron microscope. The six-week specimens showed that there was neobone invasion into the pores of the charcoal bamboo. There was no evidence of fibroencapsulation or inflammatory response. Due to its structure as a uniform porous material with interconnecting pores and carbon composition, the charcoal bamboo has been proved to be an osteotropic material. Clinical relevance: Charcoal bamboo should be an alternative bone substitute which may be used in humans in the near future. This material is available and easy to produce and prepare in developing countries.

Iliotibial band for anterior cruciate ligament reconstruction: a new technique for graft augmentation, placement and fixation.

A simple surgical technique to reconstruct the ACL deficient knee was described. A strip of ITB and fascia lata augmented by degradable suture materials was used as the substitute. The strip was introduced into the isometric area of the original ACL attachment through a drill hole made in the lateral femoral condyle. Drilling was guided by the anatomical landmarks without using special device. The graft was then rigidly fixed to the tibia by intraosseous compression, the method previously described by the author. Clinical results were assessed by both subjective symptoms and physical examinations. In 33 patients followed-up for an average of 34.1 months, thirty of them who were chronic cases had few or no symptoms concerning pain, swelling, laxity and stiffness at the last visit. Lachman test, anterior drawer and Slocum test were negative in 87.92, 81.87 and 100 per cent respectively. This technique requires only basic instruments and skill, and is thus generalizable to institutions having limited surgical facilities.

Reconstruction of bone and skin defect using the osteocutaneous free fibular graft.

The attempt to use an osteocutaneous free fibular graft (OCFFG) to reconstruct composite bone and skin defects of the extremities following trauma was carried out in eighteen cases. Ten of seventeen cases were successful with the method without surgical complications and bony union occurred after 3 to 6 months (average 5.2 months). Three cases had skin flap necrosis (2 partial and 1 total) and required further skin grafting or skin coverage. Four cases failed due to thrombosis of the vascular anastomosis. The procedure was abandoned in one case because of failure to identify a reliable septocutaneous vessel to the skin flap.

Congenital pseudarthrosis of the tibia: treatment with free vascularized fibular graft.

Five children with congenital pseudarthrosis of the tibia were treated by resection of the lesion and reconstruction of the extremity with a free vascularized fibular graft (FVFG). Two of five cases had had multiple surgical procedures before FVFG. These two cases were complicated with the non-union of the proximal grafthost junction. Of these, one case achieved bone union after further resection of the non-union and adding allogenic bone graft and another case denied further operation and was lost to follow-up 6 months postoperatively. Three cases, two of which underwent FVFG as a primary treatment and another one after failure from the Sofield procedure respectively, were initially treated successfully and solid union of the grafthost junctions was within four months postoperatively. Problems including: anterior bowing, refracture, valgus deformity of the ankle and leg length discrepancy occurred in all four followed cases.

Rotational deformity of the distal humerus in cubitus varus.

The medial rotation deformity of the distal humerus usually exists in the cubitus varus deformity but has received little attention. Study of this deformity in 29 cases of cubitus varus was carried out using the osteotomized bony specimens that were removed during closed wedge osteotomy in order to determine the actual bone deformity. The average duration of the varus deformity was 5.6 yrs (range 1 to 11). The medial rotation deformity of the distal humerus averaged 27 degrees (range 15 to 45). There was no correlation between the degree of rotation and that of the varus deformity (correlation coefficient r = 0.15). The affected-side shoulder compensated well in both internal and external rotation, and had a greater arc of rotation than that of the normal side. The affected-side shoulder exhibited an internal rotation deformity with an average of 16 degrees (range 5 to 25), with restriction of external rotation of only 13 degrees (range 0 to 20) in comparison to normal side shoulder.

Vastus lateralis myocutaneous flap: the treatment for trochanteric pressure sores in paraplegic patient.

The vastus lateralis myocutaneous flap for trochanteric pressure sore is simple and reliable. A good padding is obtained, the donor site is closed primarily. It should always be considered with every paraplegia patient.