Treatment of Malrotation and Limb Length Discrepancy in Osteogenesis Imperfecta Patients: Report of Two Cases

@#Malunion of recurrent fractures in Osteogenesis Imperfecta (OI) patients causes limb length discrepancy and malrotation. These cause added difficulty for OI patients to ambulate. Lengthening with distraction osteogenesis using an external fixator in OI patients is challenging. Acute lengthening with autologous bone graft is a known method in a normal bone but not a known procedure in OI patients. We present two clinic cases of adolescent OI patients with limb length discrepancy and externally rotated lower limb that underwent acute lengthening and rotational correction using a locked intramedullary nail and ipsilateral autologous iliac bone graft. Both patients obtained union and improvement of ambulatory capability without recurrence of fracture within five years of follow-up. Acute lengthening by 2cm and rotational correction with intramedullary nail improved the gait efficiency in the OI patients. Harvesting large amounts of the tricortical iliac bone graft, followed by controlled weight-bearing is a safe procedure.

Preservation of Scaphoid in Scaphoid Nonunion Advanced Collapse Stage II and III / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to investigate the outcome of open reduction and internal fixation with a headless screw and auto iliac bone graft for patients of scaphoid nonunion advanced collapse (SNAC) stage II and III. MATERIALS AND METHODS: A retrospective analysis was conducted for 10 patients diagnosed with stage II or III SNAC, and consequently treated with open reduction and internal fixation with a headless screw and auto iliac bone graft with or without radial styloidectomy between 2010 and 2013. Radiographic results were evaluated by bone union, the scapholunate angle and lateral intrascaphoid angle. Clinical results were evaluated by range of motion, pain, grip strength, Mayo wrist score, and assessment of Maudsley. RESULTS: All patients showed union after the operation. Final follow-up X-rays show smoothening of the articular surface with improvement of sclerotic lesions of the articular surface, cystic lesions and osteopenic lesions. Pain decreased after the operation compared with preoperative status, grip strength and Mayo wrist score showed significant improvement. Scapholunate angle and lateral intrascaphoid angle decreased after the operation, but it was not significant. According to assessment of Maudsley, among 10 cases, there were 4 excellent cases, 4 good cases and 2 fair cases. CONCLUSION: Restoration of stability of scaphoid is important to SNAC stage II and III, open reduction and internal fixation with a headless screw and auto iliac bone graft shows satisfactory clinical and radiologic outcomes. Thus it is considered a recommendable operation.

Usefulness of Anterior Cervical Interbody Fusion Using Locally Harvested Bone: Locally Harvested Bone Versus Autogenous Iliac Bone / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the usefulness of locally harvested bone in anterior cervical interbody fusion. MATERIALS AND METHODS: A retrospective review was conducted, including 31 patients who underwent anterior cervical interbody fusion using a polyetheretherketone (PEEK) cage and anterior plate fixation. We randomly divided the patients into two groups, local bone group and iliac bone group. In 15 patients of the local bone group, the cage was filled with locally harvested bone, and in another 16 patients of the iliac bone group, the cage was filled with autogenous iliac bone. RESULTS: Improvements in mean visual analogue scale (VAS) scores, from 5.8 and 7.7 to 1.6 and 2.3 for neck pain and arm pain, respectively, were observed in cases using locally harvested bone, while the improvements were from 5.7 and 7.2 to 1.4 and 2.2, respectively, in those using autogenous iliac bone grafts. However, no significant differences in mean VAS and neck disability index were observed between the two groups at the last follow up (p>0.05). Radiologic union was achieved at 14.0+/-2.50 weeks in the local bone group, and at 12.62+/-1.58 weeks in the iliac bone group. However, no significant difference was observed between the two groups (p=0.076). CONCLUSION: Utilization of locally harvested bone for packing in a PEEK cage for anterior cervical interbody fusion is considered a useful method because it gives satisfactory clinical results for retention of bone union and lordosis angles.

Evaluation of Bone Resorption Rate after Nonvascularized Iliac Bone Graft for Mandibular Discontinuity Defect

Polyetheretherketone Cage filled with Beta-Tricalcium Phosphate versus Autogenous Tricortical Iliac Bone Graft in Anterior Cervical Discectomy and Fusion

OBJECTIVE: To compare clinical and radiologic results of two graft materials for anterior cervical discectomy and fusion (ACDF) with rigid plate fixation for cervical spinal disorder. METHODS: Twenty-eight patients treated with single-level ACDF with rigid plate fixation were retrospectively reviewed. They were divided into twogroups: Polyetheretherketone (PEEK) cage filled with beta-tricalcium phosphate (beta-TCP) in Group A (n=15); and autogenous tricortical iliac bone graft in group B (n=13). The average follow-up durations were 16.3 months and 19.90 months for group A and group B, respectively. Clinical outcomes were graded using the visual analogue scale (VAS) score and neck disability index (NDI). Interbody height, segmental kyphotic angle and overall kyphotic angle were used as parameters to evaluate radiographic change in the 2 treatment groups. RESULTS: Clinically, VAS scores and NDI significantly improved after the surgery in both groups (p0.05). The fusion rates after 12 months in group A and B were 93.3% and 100%, respectively. One case of cage subsidence which resulted in pseudoarthrosis occurred in group A. However, statistical analysis did not show difference in fusion rate between the two groups (p>0.05). CONCLUSION: ACDF using PEEK cage filled with alpha-TCP showed comparable clinical and radiologic results with the standard of autogenous iliac bone graft. However, pseudoarthrosis did occur even with rigid plate and screw fixation in ACDF using PEEK cage filled with beta-TCP. There is high likelihood of emerging pseudoarthrosis, especially when there is a sign of chronic and progressive cage subsidence.

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.

Reconstruction of Proximal Interphalangeal Joint Instability with Autogeneous Iliac Bone-Ligament-Bone Graft: A Case Report

We report the case of radial collateral ligament injury of proximal interphalangeal joint with bone defect by machinery grinder injury which was reconstructed using autogeneous iliac bone-ligament-bone graft. A heterodigital neurovascular island flap was performed to cover the skin defect. At 6 weeks follow-up, adduction stress endurance was enough to hold objects in usual life, but stiffness remained. The collateral ligament reconstruction using bone-ligament-bone graft is suggested for chronic instability or acute ligament defect of PIP joint.

A clinical study of iliac bone graft using subperiosteal tunneling method for alveolar ridge augmentation

PURPOSE: The objective of this study was to evaluate the efficacy of the subperiosteal tunneling technique with iliac block bone graft for bone augmentation in an edentulous alveolar ridge. PATIENTS AND METHODS: Total of 8 sites in 7 patients were included in this study. The bone height was evaluated by CBCT preoperatively and 4 months after operation. Total of 11 implants were inserted and evaluated clinically and radiographically. RESULTS: Mean value of the increased bone height was 6.29 mm and no implant failure was observed. There were no complications such as soft tissue dehiscence, exposure of the grafted bone and infection. CONCLUSION: We have achieved excellent clinical outcomes by this technique, so we concluded that it is useful for augmentation of severely deficient alveolar ridge.

Central Odontogenic Fibroma in Anterior Maxilla: A Case Report

Central odontogenic fibroma is an extremely rare benign tumor, accounting for less than 0.1% of all odontogenic tumors. The most recent literature review that only 69 cases have so far been reported. This tumor has a slow persistent growth that results in painless cortical expansion clinically, and well defined unilocular or multilocular radiolucent lesion. Root resorption of associated teeth is common, and lesions located between the teeth often cause root divergence. There is occurring tendency to female more than male, and occurring in the mandible and in the maxilla with equal frequency. The treatment is surgical excision with no tendency to undergo malignant transformation. We report a case of central odontogenic fibroma in the maxilla of a 27-year male with literatures review.

Distraction Osteogenesis Followed by Implant Installation on the Reconstructed Mandible with a Free Iliac Bone Graft in a OdontogenicMandibular Myxoma Patient: Case Report

Immediate implant placement after extraction of retained deciduous teeth and impacted canines : Report of a case

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.

An Unexpected Huge Hematoma after Iliac Artery Injury as a Rare Complication at an Anterior Iliac Bone Graft Donor Site: A Case Report

Even through there are many reported complications of the iliac bone donor site during anterior cervical spine surgery, vascular injuries are very rare, especially deep circumflex iliac artery(DCIA) injury encountered after harvesting of a bone graft. A 68-year-old female was presented with neck pain and recent progressive weakness due to dislocation and instability of C5/6 with cord compression. Corpectomy and inter-body fusion from C5 to 7 was done without any definite perioperative complications including the iliac donor site. On the 2nd post-operative day, a huge hematoma and active bleeding at the retroperitoneal site was found by computed tomography and angiography revealed bleeding from DCIA. The authors report a case of massive bleeding due to DCIA injury that was difficult to control and managed by selective arterial embolization.

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.

Complications after dental implant surgery with iliac bone graft; Case report

Dental implant treatment with iliac bone graft via two-stage approach for avulsed alveolar bone defects; case report

This is about the case of loss of multiple teeth and alveolar bone caused by trauma, which needed alveolar bone augmentation before implant treatment. Alveolar bone was reconstructed using iliac bone graft, and thereafter first implant surgery was followed by consolidation period of 3 months. Iliac bone resorption was observed at the time of implant placement. And that resorption was more in the horizontal dimension than in the vertical. We conclude that additional treatment planning (e.g. using alveolar distraction osteogenesis or tissue expander) should be considered besides bone graft for vertical alveolar bone augmentation. For both maxilla and mandible, prosthodontic treatment was carried out 4~5 months after implant placement. To compensate alveolar bone deficiency, partial hybrid overdenture on maxilla and implant-supported fixed bridge on mandible were fabricated, and the total treatment was finished.

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

Reconstruction of Iliac Crest Donor Site Using 1/3 Tubular Plate / 대한척추외과학회지

STUDY DESIGN: This is a prospective study OBJECTIVES: The purpose of this study is to describe the technique for reconstruction of the iliac crest graft donor site and to determine the clinical results of its application. Summary of literature REVIEW: An iliac crest tricortical bone graft is frequently used for anterior interbody fusion of the spine. For preventing iliac crest graft donor site morbidity (pain, skin dimpling, etc), various graft materials have been used, for example, rib, cement, ceramic and so on. However, the rib needs another incision for lumbar or cervical fusion, the cement sometimes causes the wound infection, and the bioactive ceramic spacer has not had its long term results confirmed. MATERIALS AND METHODS: We prospectively analyzed 28 patients who underwent iliac crest reconstruction with a 1/3 tubular plate after bone harvesting between 1998 and 2004. Pain at postoperative 1 month, 6 months and 1 year was checked by the visual analogue scale (VAS). The cosmetic appearance, foreign body sense, overall satisfaction (according to the methods of Ito et al), complications and the radiologic evaluations were all analyzed as indicators of the outcome. RESULTS: The mean visual analogue scale was 3.5 and 0.1 at postoperative 1 and 12 months, respectively. For the cosmetic appearance, among the 28 patients, 24 patients felt a smooth and satisfactory outline (Excellent). 25 patients couldn't feel any foreign body sense. One patient experienced wound infection. No plate breakage or screw loosening were observed. CONCLUSIONS: Reconstruction of the iliac crest with a one-third tubular plate after tricortical bone graft harvest could be a favorable method. the screws during the consolidation of PMMA.

Long-term results of vertical height augmentation genioplasty using autogenous iliac bone graft

PURPOSE: In order to clarify the clinical utility of the vertical height augmentation (VHA) genioplasty using autogenous iliac bone graft (IBG), this study examined the postsurgical changes in hard and soft tissues of the chin and the stability of the grafted bone. PATIENTS AND METHODS: Twenty-three patients who had undergone VHA genioplasty using autogenous IBG were evaluated radiographically and clinically. A comparison study of the changes in hard to soft tissues after surgery in all 23 patients was performed with preoperative, 1-month, 3-months, 6-months, and/or 1-year postoperative lateral cephalograms by tracing. Stability, bone healing, and complication of the grafted bone was evaluated by follow-up roentgenograms and clinical observation. RESULTS: Between the preoperative and 6-month postoperative tracings, an average vertical augmentation of the osseous segment was 4.2 mm at menton and that of the soft tissue menton was 4.0 mm. There was a high predictability of 1: 0.94 between the amounts of hard versus soft tissue changes with surgery in the vertical plane. The position of the genial bone segment was stable immediately after surgery and soft tissue was not changed significantly from 1 month to 1 year after operation. Clinical and radiological follow-up results of the iliac bone graft showed normal bony union and were generally stable. CONCLUSIONS: VHA genioplasty using IBG is a reliable method for predicting hard and soft tissue changes and for maintaining postoperative soft tissue of the chin after surgery.