Percutaneous Curettage and Allogenic Bone Grafting with Bone Marrow in Management of Simple Bone Cyst.

Introduction: Simple bone cyst or unicameral bone cysts are benign osteolytic lesions seen in metadiaphysis of long bones in growing children. Various treatment modalities with variable outcomes has been described in the literature. Case report show novel surgical technique of minimally invasive method of treatment with better outcome. Case study: A 14-year-old boy diagnosed as active simple bone cyst proximal humerus with pathological fracture. Patient was treated by minimally invasive percutaneous curettage with curved titanium elastic nail (TENS) and allogenic bone grafting mixed with bone marrow under image intensifier guidance. Results: Pathological fracture was healed and allograft filled in the cavity well taken-up. Patient achieved full range of motion with successful outcome. Conclusion: Minimally invasive percutaneous method using elastic intramedullary nail give benefit of curettage cyst decompression and stabilization of fracture. Allogenic bone graft fills the cavity and healing of lesion occurs by osteointegration. This method may be considered with advantage of minimally invasive technique in treatment of benign cystic lesions of bone. Level of evidence: Therapeutic level IV.

The Use of Fresh Frozen Allogenic Bone Graft in the Impacted Tibial Plateau Fractures

PURPOSE: To assess the behaviour of fresh frozen cancellous allograft used for supporting the reconstructed articular surface in impacted tibial plateau fractures. MATERIALS AND METHODS: Between May 2004 and May 2008, 13 cases of impacted tibial plateau fracture were evaluated retrospectively. All fractures were treated with open reduction-internal fixation after restoration of the tibial plateau surface and insertion of fresh frozen cancellous allograft chips for subchondral support. Mean age was 46.6 (31~65) years. Average follow-up period was 36 (13~58) months. The radiological and clinical result for every patient was assessed according to the modified Rasmussen's system and Lysholm's knee score. RESULTS: According to last follow-up weight bearing A-P X-ray, the fresh frozen cancellous allograft incorporated soundly in all cases and no complications such as joint depression, fracture reduction loss, angular deformity, and malunion were found. The mean time to complete bone union was postoperative 10+/-0.7 weeks. The mean range of motion was 135 (115~145) degrees. The mean Rasmussen's radiological score at last follow up was 15.3 (10 cases: excellent, 3 cases: good). The mean Lysholm's knee score at last follow up was 88.2+/-4.3. CONCLUSION: We concluded that fresh frozen cancellous allograft in impacted tibial plateau fractures showed good results in terms of bone union and functional improvement and was considered to be a good structural supporter.

The Short-term Follow-up Results of Open Wedge High Tibial Osteotomy with Using an Aescula Open Wedge Plate and an Allogenic Bone Graft: The Minimum 1-Year Follow-up Results

BACKGROUND: This study examined the results of open wedge high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft as a surgical technique for the patients who suffer from osteoarthritis of the knee with a genu varum deformity. METHODS: From March 2007 to August 2007, 33 patients (37 cases) with osteoarthritis of the knee and a genu varum deformity underwent a high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft. The patients were followed up for more than 1 year. Before and after surgery, the correction angle of the genu varum was measured by the lower extremity scannogram and the posterior tibial slope, the joint space distance and the time to bone union were evaluated. The functional factors were evaluated using the Knee Society Score. RESULTS: The average knee score and function score improved from 52.19 +/- 11.82 to 92.49 +/- 5.10 and 52.84 +/- 6.23 to 89.05 +/- 5.53, respectively (p < 0.001). According to the lower extremity scannogram, the mean preoperative varus angle was -1.86 +/- 2.76degrees, and the average correction angle at the last follow-up was 10.93 +/- 2.50degrees (p < 0.001). The tibial posterior slope before surgery and at the last follow-up were 8.20 +/- 1.80degrees and 8.04 +/- 1.30degrees, respectively (p = 0.437). The joint space distance increased from 4.05 +/- 1.30 mm to 4.83 +/- 1.33 mm (p < 0.001). The average time to complete bone union was 12.69 +/- 1.5 weeks. CONCLUSIONS: An open wedge high tibial osteotomy using an Aescula open wedge plate and an allogeneic bone graft to treat osteoarthritis of the knee with a genu varum deformity showed good results for the precision of the correction angle, the time to bone union and the functional improvement.

The immunosuppression effect of cyclosporine A on the allogenic calvarial bone graft in mice

INTRODUCTION: This study examined the effect of cyclosporine A (CsA) on the allogenic cranial bone graft in the mice. MATERIALS AND METHODS: Twenty eight 12-week-old male ICR mice weighing 40 g were used. The experimental group was injected subcutaneously with CsA (10 mg/kg/day) diluted in Caster oil for 7 days prior to the graft until sacrifice. The control group was injected with the same solution without CsA. RESULTS: In the experimental group, fibrous connective tissues and small amounts of inflammatory cells were observed. At 2 weeks after the allograft in the experimental group, new bone formation in fibrous collagenous tissue and around the allogenic bone was noted. At 4 weeks after the allograft, new bone formation was active along and at the periphery of the mature allogenic bone. The proliferation of blood vessels increased in bone marrow. In the control group, fibrous tissues and inflammatory cells were observed around the allogenic bone and existing bone at 1 week. At 2 weeks after the allograft, the proliferation of blood vessels accompanied by inflammatory cells were scattered in the fibrous connective tissues. New bone formation around the allogenic and existing bone could be observed. At 4 weeks after the allograft, inflammatory cells were severely infiltrated around the allogenic bone. Osteoclasts were scattered along the allogenic bone and induced bone resorption. CONCLUSION: These results suggest that the daily administration of CsA (10 mg/kg/day) induces efficient immunosuppression without serious complications ,and this protocol might be useful for the experimental model of allogenic bone grafts.