Autogenous Iliac Bone Grafting for the Treatment of Nonunion in the Hand Fracture

PURPOSE: To evaluate autogenous iliac bone graft for nonunion after hand fracture. MATERIALS AND METHODS: From October 2006 through September 2008, we analyzed 35 patients, 37 cases of autogenous iliac bone graft for nonunion after hand fracture that have followed up for more than 12 months. We analyzed about etiology, fracture site, initial treatment, time to bone graft, grafted bone size, grafted bone fixation method, radiologic time of bony healing and bone union rate retrospectively. Also we evaluated VAS and range of motion of each joints (MCP, PIP, DIP) at final follow-up assessment. RESULTS: Etiology was open fracture 23 cases (62.2%), crushing injury 12 cases (32.4%), direct trauma 2 cases (5.4%). Fracture site was metacarpal bone 7 cases, proximal phalanx 17 cases, middle phalanx 8 cases, distal phalanx 5 cases. Time to bone graft was average 20.7 weeks. Grafted bone fixation method was fixation with K-wire 27 cases (73.0%), fixation with only plate 6 cases (16.2%), fixation with K-wire plus plate 2 cases (5.4%), fixation with K-wire plus cerclage wiring 2 cases (5.4%). Grafted bone size was average 0.93 cm3 and bony union time was average 11.1 weeks and we had bone union in all cases. CONCLUSION: Autogenous iliac bone graft is the useful method in the reconstruction of non-union as complication after hand fracture.

A Novel Autogenous Iliac Bone Graft Technique for Distal Humeral Bone Loss in Revisional Total Elbow Arthroplasty: A Technical Note / 대한정형외과학회잡지

As the incidence of total elbow arthroplasty has increased, revisions of the procedure also increase including reconstruction of bony defects caused by bone destruction. Reconstruction techniques depend on location and severity of the bony defect, and allografts are useful in cases of substantial bone loss. However, this procedure is technically difficult and has a high complication rate. Here, we describe a novel autogenous bone graft technique using tricortical iliac bone for reconstruction of a distal bone loss in a revisional total elbow arthroplasty, providing an additional method to restore bone stock.

Anterior Cervical Fusion with Autogenous Iliac Bone Graft with or without Plate Fixation for Degenerative Cervical Spinal Disorders / 대한정형외과학회잡지

PURPOSE: This study compared the results of anterior cervical discectomy and fusion with autogenous bone graft (AFA) with or without plate fixation through a retrospective review of one or two-level degenerative cervical disorder, and the average follow-up was 6 years. MATERIALS AND METHODS: Group A (n=40) underwent one-level (A-1/26) or two-level (A-2/14) fusion and AFA alone. Group B (n=36) underwent one-level (B-1/24) or two-level (B-2/12) fusion and AFA with plate construct. The following parameters were analyzed: the fusion rate, the change of Cobb's angle, the adjacent level degeneration (ALD), the clinical outcome and the rate of complications. RESULTS: There was a significant difference in the fusion rate between group A and B (p=0.028). Group B had a significant increase in the change of Cobb's angle compared to groups A (p=0.004). ALD were developed in 16 of 40 cases (40%) in group A, and in 4 of 36 cases (11%) in group B. There was a significant difference in ALD between group A and group B (p=0.004). CONCLUSION: We think that plate augmentation is necessary for the maintenance of lordosis, for reducing the pseudarthrosis and adjacent level degeneration, and to improve the clinical outcome after treatment of degenerative cervical disorders.

Comparative histomorphologic study of regenerated bone for dental implant placement in the atrophied posterior maxilla

The purpose of this study is to evaluate the regenerative capacity of reconstruction in the atrophied posterior maxilla by comparing bone graft procedures and alveolar distraction osteogenesis (ADO) techniques. We performed the autogenous iliac bone graft (AGB group, 5 specimens in 3 patients), and the combination (Mixed group, 3 specimens in 3 patients) of the autogenous and deproteinized bovine bone (Bio-Oss(R), Geistlich Co., Switzerland) as the ratio of 2:1 in the sinus floor elevation procedures. ADO procedures using TRACK(R). (KLS Martin Co., Germany) were also performed to augment vertical alveolar height in atrophied posterior maxilla (ADO group, 5 specimens in 4 patients). Newly generated bone tissues were obtained with the 2.0mm diameter trephine bur (3i Co., USA) during implant fixture installation after 5-7 months. Routine histolomorphological observation, immunodot blot assay for quantitative evaluation, and immunohistochemical staining with antibodies to MMP-1, -9, -10, TIMP-1, -2, and BMP-2, -4 were all carried out. Lamellar bone formation was well shown in all specimens and new bone formations of ADO group increased than those of other procedures. In immunohistochemical staining, the strong expression of BMP-2 was shown in all specimens, and immunodot blot assay showed that bone formation is accompanied by the good induction of factors associated with angiogenesis and appeared more increased amount of osteogenic and angiogenic factors in ADO group. ADO is the most effective technique for new bone formation compared to sinus floor elevation with autogenous or mixed bone graft in the atrophied posterior maxilla. In the quantitative immunodot blot assay, the regenerated bone after ADO showed more increased products of VEGF, BMP-2, PCNA and MMP-1 than those after the other procedures, and these findings were able to be confirmed by immunohistochemical stainings.

Stability of simultaneous implantation with autogenous iliac bone graft in the severely atrophic maxilla

The Clinical Results in Compression Plate Fixation with Autogenous Cancellous Bone Graft for Humerus Diaphyseal Nonunion

PURPOSE: A The purpose of this retrospective study was to evaluate the results of compression plating and autogenous iliac bone graft in the management of humeral diaphyseal nonunion. MATERIALS AND METHODS: Twenty patients who underwent the surgical treatments between May. 1998 and May. 2002 were included in this study. Nine of them are males and the others are females. The average age of them, when they was on operation, was 45 years. The symptoms lasted 23 months on average. They have been followed up for 33 months at an average. Treatment of nonunion consisted of resecting the atrophic nonunion, shortening the bone, apposing bleeding diaphyseal surface. Rigid fixation was then achieved using a compression plate and autogenous bone graft. RESULTS: Solid bony union was achieved in all patients. In one patient, the bone was not healed at the first operation of plating and autogenous bone graft, but achieved union after the use of intramedullary nailing. In another patient, because of infected nonunion, we achieved union after several surgical debridement and stabilization by internal fixation. CONCLUSION: This study documents that compression plate fixation with autogenous cancellous bone graft is a viable option with predictable and satisfactory results for humerus diaphyseal nonunion.

The Fate of Grafted Bone and the Satisfaction of Patient in Brachymetatarsia after Autogenous Iliac Bone Graft

The purpose of this study was to analyze the fate of intercalated bone graft and the satisfaction of patients with brachymetatarsia of the 4th toe on the clinical results after one-stage lengthening with autogenous iliac bone graft. In last 6 years, 30 feet in 17 patients with brachymetatarsia were corrected with one-stage operation that was composed of Z-plasty of skin, extensor tendon and intercalated iliac bone graft, which appeared as ball-and- socket figure at the metatarsophalangeal joint. The length of harvested iliac bone graft was 18 mm in average(14 -23 mm) and there was bone resorption about 1.1 mm(0.1- 3.0), (7.1%) postoperatively. Postoperative digital fluoroscopy showed 83%(25/30) new joint(pseudojoint) formation of intercalated iliac bone grafts between proximal phalangeal bone and metatarsal bone. The objective functional evaluation with AOFAS scale was 89.4 in average(80 - 100) and subjective satisfaction on the aesthetic aspect was also high. There was no neurovascular impairment nor recurrence of brachymetatarsia even after one-stage lengthening with intercalated iliac bone graft.