[Long-term outcome of large bone and osteochondral allografts]. / Devenir à long terme des allogreffes osseuses et ostéo-cartilagineuses massives cryopréservées.

Since 1978 the Marseille Bone Tissue Bank has stored 7466 specimens. Of these, 578 were large allografts, of which 529 have so far been used. The grafts are stored in liquid nitrogen with a cryopreserver, and are not sterilized by irradiation. They have been used to replace lost tissue after tumor excision, trauma, and repeated reconstructive surgery. Three hundred and thirteen patients were operated on between 1983 and 1998, and good integration was achieved in 82 % of cases. Immunological complications occurred in 14 % of cases. They were often confused with non microbial sepsis and responded well to immunosuppressive treatment, even though the fluid surrounding the graft sometimes fistulised to the skin. In 4.2 % of cases the graft had to be replaced, and in 6.4 % of cases a joint prosthesis had to be used.

Functional and radiographic outcome of thoracolumbar and lumbar burst fractures managed by closed orthopaedic reduction and casting.

STUDY DESIGN: Retrospective review. OBJECTIVES: To determine clinical and radiographic outcomes of thoracolumbar and lumbar burst fractures without neurologic injury treated by closed reduction and casting. Patient factors associated with poor outcome are identified. SUMMARY OF BACKGROUND DATA: The results of ambulatory bracing, surgery, and prolonged recumbency for burst fractures have been reported. There are no reports of results of closed reduction and casting. METHODS: Retrospective review of 41 neurologically intact patients with thoracolumbar and lumbar burst fractures was performed. Four patients with neurologic injury who refused surgery were included, for a total of 45 patients. All patients had closed reduction and casting. Functional, pain, and employment status were assessed using the Denis system. Neurologic function was graded using the Frankel scale. Radiographic evaluation of vertebral kyphosis, regional kyphosis, anterior body compression, and sagittal index were performed at time of injury, postreduction, 4 months, and final follow-up. RESULTS: Sixty-four percent of patients had minimal or no pain. Eight percent had constant, severe pain. At time of injury, 71% of patients were employed. At 8-month follow-up, 58% of patients were employed. Closed reduction resulted in significant correction of vertebral wedging from a mean of 15 degrees to 5 degrees. Deformity tended to recur by 4 months, but the degree of residual deformity appears to be less than that reported in other series. No complications resulted from the fracture reduction procedure. CONCLUSIONS: Closed reduction and casting of thoracolumbar and lumbar burst fractures is a safe treatment method that yields acceptable functional and radiographic results.