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Calcaneal fractures
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Devendra Mahadevan, Adam Sykes
The goal of primary subtalar fusion is not only to achieve a solid arthrodesis, but also to restore the normal shape and alignment of the hindfoot. Reduction of the fracture is the initial step in the procedure in order to return to a more anatomical shape before the fusion is undertaken. The choice of reduction technique can be either open or minimally invasive; the articular cartilage is then removed using flexible osteotomes, nibblers and/or high speed burrs. The use of structural bone graft may be required if there are large defects created by the fracture pattern. Internal fixation is undertaken using screws alone or in combination with a plate to maintain fracture reduction and secure the fusion.
Craniofacial Regeneration—Bone
Published in Vincenzo Guarino, Marco Antonio Alvarez-Pérez, Current Advances in Oral and Craniofacial Tissue Engineering, 2020
Laura Guadalupe Hernandez, Lucia Pérez Sánchez, Rafael Hernández González, Janeth Serrano-Bello
Autologous bone is still considered as the gold standard since all the necessary properties required in bone regeneration are present, it holds viable cells that can form new bone tissue (osteogenic), it provides a scaffold for the ingrowth of cells necessary for bone regeneration (osteoconductive); and promotes the proliferation of stem cells and their differentiation into osteogenic cells (osteoinductive). It is ideal in many situations because it is harvested from the patient himself or herself, thus less likely to be rejected and more likely to be incorporated. However, the use of an autograft has limitations, including donor site morbidity, limited availability of tissue, an additional operation and prolonged healing time (Henkel et al. 2013). The major and minor complication rates of autogenous bone graft harvest have been reported at 8.6 and 20.6%, respectively (Fillingham and Jacobs 2016).
The biomechanical simulation of a zygomatic bar implant using meshless methods
Published in J. Belinha, R.M. Natal Jorge, J.C. Reis Campos, Mário A.P. Vaz, João Manuel, R.S. Tavares, Biodental Engineering V, 2019
C.C.C. Coelho, J. Belinha, R.M. Natal Jorge
The edentulous condition, and consequently the bone reabsorption, restricts the use of dental implants and often the use of cantilever prostheses or bone graft procedures (Brånemark, Brånemark, Rydevik, & Myers, 2001). In the presence of a cantilever, excessive implant tension can be observed, with an increase in biomechanical complications and consequently implant failure (de Souza Batista et al., 2017). Bone graft surgery has some limitations, including multiple surgical procedures, increased risk of complications, longer treatment period, higher costs and low patient acceptance (Maló, de Araujo Nobre, & Lopes, 2008), (Bhering et al., 2016).
Combined iliac crest graft and short-scar pectoralis major flap for clavicular non-union reconstruction
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Daniel Sattler, Hans-Philipp Springorum, Rafael Maria Armbruster, Maria von Kohout, Armin Kraus
In clavicular non-unions, healing rate can be improved by addition of a bone graft in addition to plate fixation alone [2]. Particularly when nonunion resection creates a bony defect, bone graft addition is required. It has been reported that a clavicular defect of over 1.5 cm benefits from bony bridging [3,4]. According to Wei and Mardini, bone defects up to 5 cm can be bridged by non-vascularized bone grafts [5]. In case of an additional soft tissue defect, as presented here, mechanical protection, vascularization and coverage by immunocompetent tissue seemed desirable to us, so that we chose a muscle flap. There is a choice for several free and pedicled muscle flaps, such as the deltoideus [6], the trapezius [7] and the latissimus dorsi [8], all with advantages and drawbacks. As alternatives, various free flaps could also be discussed. Decision is made, not least, by experience and comfort of the surgeon with the respective method.
Recent Advances in Biomaterials for the Treatment of Bone Defects
Published in Organogenesis, 2020
Le-Yi Zhang, Qing Bi, Chen Zhao, Jin-Yang Chen, Mao-Hua Cai, Xiao-Yi Chen
Bone defects produced by large bone tumor resections, trauma-induced nonunion fractures, biochemical disorders, infections, or abnormal skeletal development due to genetic disorders, are a major cause of disability and a loss of quality of life globally.6 The treatment of bone defects to recover normal bone morphology and function represents an important and unmet clinical challenge, particularly when bone healing is impaired.7 There are several reasons for bone healing defects, including bone loss due to injury, impaired vascularization, dysregulated immune responses, infection and osteomyelitis.8 Surgical techniques, including the implantation of synthetic bone substitutes and bone graft implants, have been developed to aid bone recovery.9 Bone grafting replaces the missing bone during surgery, and as a procedure, its demand is widespread, second only to blood transplants in terms of treatment frequency.7, 10 Autographs remain the front line therapy but their attainability is complex and their effectiveness is limited by the associated morbidity during harvesting and poor clinical performance, particularly in osteoporosis patients.11 Therefore, the development of new, effective and safer alternatives is urgently required in the field of bone regenerative therapy.
Guided Bone Regeneration of Femoral Segmental Defects using Equine Bone Graft: An In-Vivo Micro-Computed Tomographic Study in Rats
Published in Journal of Investigative Surgery, 2019
Mohammed Awadh Binsalah, Sundar Ramalingam, Mohammed Alkindi, Nasser Nooh, Khalid Al-Hezaimi
Although autologous bone grafting is considered the gold standard for regeneration of osseous defects, the autologous bone harvested from the femoral defect and used in the positive control group was of low volume and predominantly cortical in nature. A further source of autologous bone from the study animals was not considered due to the risk of morbidity to the animals. The above factors could be considered an impediment to the routine use of autologous bone grafting even in true clinical scenarios.4,5,16 Moreover, the resorption of osteoconductive scaffolds also plays an important role in the process of bone remodeling in GBR.16,27 Using in-vivo micro-CT it was possible to assess the rate of resorption of equine bone graft during different study periods in addition to the new bone formation. It was found that the mean rate of bone graft resorption was proportional to the rate of new bone formation. Interestingly, the greatest amount of bone resorption and new bone formation were observed within the initial 2-weeks following bone graft placement in both the positive control and equine bone groups. However, in the equine bone group a second peak of increased bone graft resorption was observed between the 4th and 6th weeks, which could have positively contributed to the overall higher NFB-volume in this group by the 8th week.