Tibialis Anterior Muscle: Pedicled Bone Graft for Defect of the Tibia.

Purpose: To report the result of the bone graft retrograde pedicled with the tibialis anterior muscle belly for the treatment of bone defect of tibia. Methods: Between 2017 and 2020, the bone graft pedicled with the tibialis anterior muscle was applied for the treatment of 11 patients with a cortical defect and nonunion of the tibia due to trauma and one patient with segmental bone defect caused by tramatic osteomyelitis. The tibialis anterior has the largest muscle belly, but has not been commonly used due to functional disability following use as transposition muscle flap. New anatomic and clinical data confirm that the distal half of this group of muscles can be transposed with the tendon left intact with no noticeable loss of muscle function. Based on the vascular nutrition of this muscle, we performed a retrograde pedicled bone graft using the muscle belly, thus preserving the function of this muscle. Result: The operation was relatively simple and early bone unions have been achieved without any complications. Conclusion: The bone graft pedicled with the tibialis anterior muscle is useful for the treatment of bone defect of the tibia.

Endoscopic observation finding in the core decompression procedure of osteonecrosis of femoral head and effect of additional treatments.

PURPOSE: To observe necrotic findings of the femoral head through the endoscopic examination when performing the decompression procedure widely used in the treatment of osteonecrosis of femoral head. To assess the efficacy of injection of bone marrow aspirated from the iliac crest and new vascularized bone graft into the core of femoral head based on the endoscopic findings. METHODS: The first stage of osteonecrosis of femoral head based on ARCO classification includes 23, second stage 36, and third stage eight femoral heads. Bone marrow transplantations have been performed in 49 hip joints and new vascularized bone grafts in 18 hip joints. RESULTS: The endoscopic findings of osteonecrosis of femoral heads are varied, and they can be divided into five categories. The average time in core decompression and bone marrow injection was 15 minutes, and the average time of new pedicled bone grafts was 65 minutes (45-90 minutes). The efficacy of bone marrow injection was 93.88%, and the efficacy of vascularized bone graft was 94.44% when performed based on the endoscopic findings. CONCLUSION: It is possible to increase the treatment efficacy of the osteonecrosis of the femoral head when appropriate additional treatments are applied based on endoscopic findings in the decompression procedures of pre-collapse osteonecrosis of the femoral head.