Healing of Artificially Created Gap Non-union Using Autologous Cultured Osteoblasts Impregnated Over Three-Dimensional Biodegradable Scaffold: An Experimental Study (Rabbit).

BACKGROUND: The large bone defect often require bone transplant or its substitutes to restore bone integrity which have some limitations. The study was conducted to analyze role of autologous osteoblast that are amplified in vivo and impregnated in a synthesized three-dimensional gelatin hydroxyapatite scaffold for treating artificially created critical size defect in rabbit's iliac crest. METHODS: In this research, 4-month-old ten healthy white male rabbits of average weight 2-3 kg were chosen. Osteoblasts cells were isolated from the rabbit iliac crest and were taken in transfer medium to the laboratory and cultured for 2-3 weeks. These osteoblast cells were seed on 3-dimensional scaffold and culture the construct for 2 weeks. The cultured autologous osteoblasts over the scaffold were transplanted into the defect by reopening the iliac crest of the same rabbit from which is cells were extracted. Serial radiograph of pelvis was done to see progressive signs of union. RESULTS: Out of ten rabbits chosen for study two rabbits were passed during study. Gross and radiological examination of rabbits was done at 0, 4, 8 and 12 weeks. Features of union was seen in six rabbits on follow-up. There is no signs of union or minimal new bone formation around the implant material were seen in two case. CONCLUSION: The study demonstrated using autologous cultured osteoblasts impregnated over three-dimensional biodegradable scaffold for large bone defect is a good option. The importance of three-dimensional biodegradable scaffold is that it provide scaffolding for sufficient interval for new bone formation.

Fixation of Posterior Tibial Plateau Fracture with Additional Posterior Plating Improves Early Rehabilitation and Patient Satisfaction.

INTRODUCTION: Posterior tibial plateau fractures (PTPF) are difficult to manage because of options of multiple approaches, paucity of implants, and lack of ideal construct for fixation. We investigated the benefits of using posterior approach and buttress plate for fixation of the posterior tibial condylar fractures in terms of the fracture healing rate, clinico-radiological, perioperative morbidity, and patient-related outcomes and compared them in those who achieved acceptable reduction without posterior stabilization. PATIENTS AND METHODS: Seventy two patients with posterior tibial plateau fractures were prospectively followed after random allocation into two Groups A and B. Thirty eight patients of Group A (dual plating) were managed with stabilization of posterior fragment with Lobenhoffer approach in addition to anterolateral plating. Thirty four patients of Group B (single plate) were managed with isolated anterolateral plating after reducing the PTPF. Twelve patients lost to follow-up and sixty patients were available (thirty in either group) for final assessment. Followup was done by clinical examination, radiographs and computed tomography scan, fracture union, articular continuity, and deformities around the knee. Subjective outcome assessment was done with the International Knee Documentation Committee (IKDC) 2000 and Knee Society Score (KSS). RESULTS: At 1-year followup, the two groups did not differ in time of fracture union. IKDC and KSS were significantly better in dual-plating group (P < 0.001). Mean operative time and blood loss were more in dual-plating group (A). The mean hospital stay and complications did not show significant differences. CONCLUSION: Addition of posterior approach for stabilization of the posterior fragment in posterior tibial plateau fractures achieves early and improved knee functions, good range of movements, minimal deformities, and pain scores by the time fracture unites. However, peri-operative morbidity, Extra implant costs and increased operative time are its disadvantages.