Development and verification of a novel bone collector with automatic size separating function for orthopedics surgery.

BACKGROUND: Autologous bone dust can be filled in bone defects to promote effective bone healing but typically it is lost when using suction during surgery. The aim of this study was to develop a novel bone collector that can be used to collect bone chips/dust of varying sizes without changing current surgical procedures. RESEARCH DESIGN AND METHODS: This collector was designed to connect to a surgical continuous suction system and comprised a plate filter with a 3 mm hole and featured a taper filter with a mesh size of 0.27 mm for the separation and collection of both coarse and fine bone chips/dust. The bone collector was manufactured using nylon 3D printing and plastic injection with biocompatible materials. RESULTS: The bone collector functional test revealed high bone chip collection efficiency (93%) with automatic size separation function. Low (3.42%) filtration errors showed that most of the water can be drained smoothly from the bone collector. In clinical usability testing, bone collectors can provide functions demonstrated in in vivo spinal fusion and femoral fracture surgeries with different bone grafting size requirements. CONCLUSIONS: The novel bone collector has been validated as a viable and effective surgical device, offering surgeons an additional option to enhance patient outcomes.

Evaluation optimum ratio of synthetic bone graft material and platelet rich fibrin mixture in a metal 3D printed implant to enhance bone regeneration.

BACKGROUND: This study aims to evaluate the optimal ratio of synthetic bone graft (SBG) material and platelet rich fibrin (PRF) mixed in a metal 3D-printed implant to enhance bone regeneration. METHODS: Specialized titanium hollow implants (5 mm in diameter and 6 mm in height for rabbit; 6 mm in diameter and 5 mm in height for pig) were designed and manufactured using 3D printing technology. The implants were divided into three groups and filled with different bone graft combinations, namely (1) SBG alone; (2) PRF to SBG in 1:1 ratio; (3) PRF to SBG in 2:1 ratio. These three groups were replicated tightly into each bone defect in distal femurs of rabbits (nine implants, n = 3) and femoral shafts of pigs (fifteen implants, n = 5). Animal tissue sections were obtained after euthanasia at the 8th postoperative week. The rabbit specimens were stained with analine blue, while the pig specimens were stained with Masson-Goldner's trichrome stain to perform histologically examination. All titanium hollow implants were well anchored, except in fracture specimens (three in the rabbit and one fracture in the pig). RESULT: Rabbit specimens under analine blue staining showed that collagen tissue increased by about 20% and 40% in the 1:1 ratio group and the 2:1 ratio group, respectively. Masson-Goldner's trichrome stain results showed that new bone growth increased by 32% in the 1:1 ratio PRF to SBG, while - 8% in the 2:1 ratio group. CONCLUSION: This study demonstrated that placing a 1:1 ratio combination of PRF and SBG in a stabilized titanium 3D printed implant resulted in an optimal increase in bone growth.

Operative treatment of chronic ulnar collateral ligament humeral origin avulsion fracture in young baseball players.

Chronic ulnar collateral ligament humeral origin avulsion fracture in young baseball players is a rare condition and a difficult problem to treat. Eight high school or college student baseball players with onset of symptoms in their adolescent ages were collected in this series. Their mean age at surgical intervention was 17.8 ± 1.99 years. The fracture was operated on with muscle splitting, ulnar nerve-sparing technique. Suture anchors were employed to fix the avulsed fragment. Visual analog scale, Mayo elbow performance score, and Conway scale were used for objective patient evaluation. The patients were followed up for 30.8 ± 10.2 months. Six patients have achieved solid bony union, and 2 had partial union. All patients showed no medial space widening on followed-up stress films. Visual Analogue Scale score improved from 9 to 0. The Mayo elbow performance score improved from 60 ± 10 to 85 ± 15 points pre- and post-operatively. The Conway scale had 3 excellent, 3 good, and 2 fair results. The average return to pitching occurred 7 months post-operatively at a rate of 75%. The present results indicate that open reduction and fixation with suture anchors is an effective treatment method for chronic ulnar collateral ligament humeral origin avulsion fracture in young baseball players.

Clinical Outcome of Minimally Invasive Decompression Without Discectomy in Contained Foraminal Disc Herniation: A Single-Center Study.

BACKGROUND: Foraminal disc herniation is rare. When conservative treatment fails, it is often treated with discectomy via a paraspinal or Wiltse approach. In contained foraminal disc herniation, more symptoms arise from the foraminal compression of the exiting nerve root, including the dorsal root ganglion, than from the herniation itself. We aimed to evaluate the benefits of stand-alone decompression without discectomy for patients with contained foraminal disc herniation. METHODS: This study included 17 patients with unilateral single-level foraminal disc herniation (14 women and 3 men; mean age, 62.8 ± 14.6 years, range, 37-86 years). Disc herniation was confirmed as contained by preoperative magnetic resonance imaging and/or computed tomography and by intraoperative exploration. All patients underwent thorough decompression without discectomy, via a paraspinal approach. Pain was evaluated preoperatively and at 3 and 12 months postoperatively using a visual analog scale (VAS). The Oswestry Disability Index (ODI) and Macnab criteria were used to evaluate final outcomes. RESULTS: The most commonly affected level was L5-S1. All 17 patients showed significant improvements in VAS and ODI scores at 3 and 12 months postoperatively. According to the Macnab criteria, outcome results were excellent in 13 patients and good in 4. The mean duration of follow-up was 18.4 ± 2.4 months, with no recurrences or lumbar instability at the final follow-up. CONCLUSIONS: Stand-alone decompression without discectomy is an effective method for relieving symptoms and preserving the disc in contained foraminal disc herniation. A minimally invasive approach with thorough decompression techniques yields good results.

Distraction arthroplasty of the trapeziometacarpal joint without trapeziectomy.

BACKGROUND: Thumb carpometacarpal joint (CMC) arthrosis leads to pain and joint instability. Therefore, pain relief and functional restoration of the CMC joint are primary goals of surgical treatment, after failure of conservative treatment. Several options for surgical treatment were listed, ranging from simple debridement of the joint, reconstruction with tendon graft, arthroplasty, to arthrodesis. Distraction arthroplasty is a good choice for mild to moderate CMC arthrosis or instability. METHODS: Ten patients with persistent basal joint pain who failed conservative treatment and having basal joint instability with significant poterolateral translation were included. They were treated by distraction arthroplasty without trapeziectomy. The functional outcome was evaluated by Patient-Rated Wrist Evaluation (PRWE) questionnaire. The Wilcoxon signed-rank test was used for analysis. RESULTS: The mean follow up period is 37 months (minimum 15 months). All patients achieved total or near total pain relief. Significant improvement of functional outcome was gained. The PRWE functional score showed an average improvement of 41.5 (p = 0.005). No loss of reduction or CMC joint instability was noted. CONCLUSION: Our technique (distraction arthroplasty without trapeziectomy) preserves bony and adjacent structures. It is easier and quicker than traditional arthroplasties. It serves as another effective and stable method of tendon reconstruction with a less invasive approach. A larger series is needed for further observation of validity of the procedure.