This study examined the use of radionuclide bone scanning in the early assessment of free autologous cancellous bone grafts used in augmentation rhinoplasty. Twenty patients underwent bone scanning between 2-15 weeks after rhinoplasty surgery. Bone scans predicted graft failure in 2 of 20 patients, where graft uptake was less than or equal to soft tissue. These failures were confirmed by clinical assessment and X-ray evidence of bone resorption 3 months later. Both failures involved grafts from the calvaria. However, failure rates between calvaria and iliac grafts were not significantly different. Bone scanning appears useful for early detection of nasal bone graft failure.
This document summarizes a study on the outcomes of occlusion treatment for amblyopia in children under 12 years old with strabismus. The study reviewed medical records of 38 Qatari children treated with occlusion therapy for strabismic amblyopia from 1992-2002. Good outcomes, defined as final visual acuity of 6/9 or better, were found in 73% of patients. Poor outcomes with visual acuity less than 6/9 occurred in 26% of patients. Factors like age at presentation, type of strabismus, presence of anisometropia and compliance did not significantly affect treatment outcomes.
Retrograde Intramedullary Nail with Femoral Head Allograft for Large Deficit ...skisnfeet
The document summarizes a study that evaluated the outcomes of using a retrograde intramedullary nail with femoral head allograft for large defect tibiotalocalcaneal arthrodesis. Eleven patients were included who had this procedure for conditions such as Charcot neuroarthropathy, avascular necrosis, or revision fusion. While complications occurred in six patients, eight patients were considered successes based on clinical and radiographic criteria, such as stability and union. The technique provides a powerful one-stage method to address large bony deficits but also carries risk, as only partial unions were observed in some cases. Overall, it was deemed a useful technique for this difficult patient population.
This study evaluated morbidity after bone graft harvesting from the anterior or posterior iliac crest for maxillofacial and orthopedic procedures. 97 patients underwent either anterior or posterior iliac crest bone harvesting to augment the jaws. Postoperative pain levels were similar for both approaches based on patient questionnaires, with pain decreasing over 6 months. Most patients reported their scars were similar and nearly all would undergo the procedure again, suggesting both approaches provide bone grafts with acceptable morbidity. The posterior approach allows harvesting of larger amounts of bone.
Revision Total Ankle Arthroplasty to Tibial Stemmed Implant: A Case Reportskisnfeet
This case report describes the revision of a failed total ankle replacement (TAR) using two different methods. Initially, the failed TAR was revised using a tibial stemmed implant. However, this revision failed due to infection, requiring a second revision involving removal of the implant and tibiotalocalcaneal arthrodesis with a retrograde nail. While the tibial stemmed implant revision had short term success in other patients, this case demonstrates the difficulty and risk of infection in revision surgeries.
Percutaneous fixation of bilateral anterior column acetabular fractures: A ca...Apollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
There are clinical situations where open reduction is either
not feasible (due to associated medical problems) or when the fractures are not significantly displaced, then minimal invasive means of internal fixation of these fractures seems to be an attractive option. Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy (narrow corridor of bone) and risk of intra-articular penetration.
2012 krohn-bone graft scintigraphy. a new diagnostic tool to assess perfusion...Klinikum Lippe GmbH
Intraoperative bone graft perfusion scintigraphy can assess vascularized bone graft viability during mandible reconstruction surgery. In a pilot study of 3 patients, scintigraphy using the Sentinella and declipseSPECT gamma cameras successfully visualized iliac crest bone graft perfusion before and after harvesting and mandibular transplantation. Before harvesting, scintigraphy clearly delineated the well-perfused iliac crest graft area. After transplantation and vessel reanastomosis, scintigraphy still showed adequate graft perfusion through the arterial connection in all patients. Intraoperative scintigraphy is a potential new tool for ensuring bone graft viability during complex mandible reconstruction surgeries.
The document compares the results of MACI (matrix-induced autologous chondrocyte implantation), a two-step cartilage repair technique, to AMIC (autologous matrix-induced chondrogenesis), a one-step technique. A retrospective study of 30 patients who underwent MACI found mostly normal or near-normal arthroscopic and biopsy results. A separate study of 18 patients who received AMIC also found largely positive clinical outcomes and biopsy results indicating hyaline-like tissue, though further large prospective studies are still needed to directly compare the techniques.
This study compared donor-site morbidity after harvesting iliac bone grafts as either vascularized or nonvascularized transplants. An age-matched comparison of 34 patients in each group found that while no significant differences in donor-site morbidity existed between the groups if a similar amount of bone was taken, harvesting a vascularized bone graft was associated with higher rates of leg pain, functional disturbances, and sensory disturbances. Additionally, patients receiving a vascularized graft had longer hospital stays on average. However, no patients in either group experienced serious long-term complications, suggesting the iliac crest is a suitable donor site for both vascularized and nonvascularized bone grafts up to 10x3 cm in size.
This document summarizes a study on the outcomes of occlusion treatment for amblyopia in children under 12 years old with strabismus. The study reviewed medical records of 38 Qatari children treated with occlusion therapy for strabismic amblyopia from 1992-2002. Good outcomes, defined as final visual acuity of 6/9 or better, were found in 73% of patients. Poor outcomes with visual acuity less than 6/9 occurred in 26% of patients. Factors like age at presentation, type of strabismus, presence of anisometropia and compliance did not significantly affect treatment outcomes.
Retrograde Intramedullary Nail with Femoral Head Allograft for Large Deficit ...skisnfeet
The document summarizes a study that evaluated the outcomes of using a retrograde intramedullary nail with femoral head allograft for large defect tibiotalocalcaneal arthrodesis. Eleven patients were included who had this procedure for conditions such as Charcot neuroarthropathy, avascular necrosis, or revision fusion. While complications occurred in six patients, eight patients were considered successes based on clinical and radiographic criteria, such as stability and union. The technique provides a powerful one-stage method to address large bony deficits but also carries risk, as only partial unions were observed in some cases. Overall, it was deemed a useful technique for this difficult patient population.
This study evaluated morbidity after bone graft harvesting from the anterior or posterior iliac crest for maxillofacial and orthopedic procedures. 97 patients underwent either anterior or posterior iliac crest bone harvesting to augment the jaws. Postoperative pain levels were similar for both approaches based on patient questionnaires, with pain decreasing over 6 months. Most patients reported their scars were similar and nearly all would undergo the procedure again, suggesting both approaches provide bone grafts with acceptable morbidity. The posterior approach allows harvesting of larger amounts of bone.
Revision Total Ankle Arthroplasty to Tibial Stemmed Implant: A Case Reportskisnfeet
This case report describes the revision of a failed total ankle replacement (TAR) using two different methods. Initially, the failed TAR was revised using a tibial stemmed implant. However, this revision failed due to infection, requiring a second revision involving removal of the implant and tibiotalocalcaneal arthrodesis with a retrograde nail. While the tibial stemmed implant revision had short term success in other patients, this case demonstrates the difficulty and risk of infection in revision surgeries.
Percutaneous fixation of bilateral anterior column acetabular fractures: A ca...Apollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
There are clinical situations where open reduction is either
not feasible (due to associated medical problems) or when the fractures are not significantly displaced, then minimal invasive means of internal fixation of these fractures seems to be an attractive option. Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy (narrow corridor of bone) and risk of intra-articular penetration.
2012 krohn-bone graft scintigraphy. a new diagnostic tool to assess perfusion...Klinikum Lippe GmbH
Intraoperative bone graft perfusion scintigraphy can assess vascularized bone graft viability during mandible reconstruction surgery. In a pilot study of 3 patients, scintigraphy using the Sentinella and declipseSPECT gamma cameras successfully visualized iliac crest bone graft perfusion before and after harvesting and mandibular transplantation. Before harvesting, scintigraphy clearly delineated the well-perfused iliac crest graft area. After transplantation and vessel reanastomosis, scintigraphy still showed adequate graft perfusion through the arterial connection in all patients. Intraoperative scintigraphy is a potential new tool for ensuring bone graft viability during complex mandible reconstruction surgeries.
The document compares the results of MACI (matrix-induced autologous chondrocyte implantation), a two-step cartilage repair technique, to AMIC (autologous matrix-induced chondrogenesis), a one-step technique. A retrospective study of 30 patients who underwent MACI found mostly normal or near-normal arthroscopic and biopsy results. A separate study of 18 patients who received AMIC also found largely positive clinical outcomes and biopsy results indicating hyaline-like tissue, though further large prospective studies are still needed to directly compare the techniques.
This study compared donor-site morbidity after harvesting iliac bone grafts as either vascularized or nonvascularized transplants. An age-matched comparison of 34 patients in each group found that while no significant differences in donor-site morbidity existed between the groups if a similar amount of bone was taken, harvesting a vascularized bone graft was associated with higher rates of leg pain, functional disturbances, and sensory disturbances. Additionally, patients receiving a vascularized graft had longer hospital stays on average. However, no patients in either group experienced serious long-term complications, suggesting the iliac crest is a suitable donor site for both vascularized and nonvascularized bone grafts up to 10x3 cm in size.
Orthobiologics is a current terminology for the application of various cells, cytokines, growth factors.Tissue Engineering,Gene Therapy,Osteoarthritis,Avascular Necrosis,Sickle Cell Disease,Disc Regeneration,PRP,Autologous Chondrocyte Transplantation,BMAC,Spinal cord Injury paraplegia,Autoimmnune disorders,Diabetic foot,Tendinopathies,Wound Healing,,SCAFFOLDS IN STEM CELL THERAPY.Regenerative medicine is now an recognized specialty which has evolved from degerative diseases of Orthopaedic Surgery.Articular Cartilage : Repair To Regenerate To Replace Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com
This case report describes a 26-year-old woman who developed chronic osteomyelitis of the tibia caused by Vibrio alginolyticus after her tibial fracture was contaminated with seawater. She underwent aggressive surgical debridement and bifocal osteosynthesis according to the Ilizarov technique. Bone cultures during surgery isolated V. alginolyticus. She was treated with ciprofloxacin and tetracycline and responded well without reactivation of the osteomyelitis. This represents the first reported case of chronic osteomyelitis caused by V. alginolyticus treated successfully with the Ilizarov technique.
Biocartilage to Treat Osteochondral Defects of the Talus: Case Report and Tec...Jennifer Gerres, DPM
The document describes a case study and technique using BioCartilage to treat a large osteochondral defect of the talus. The key points are:
1) A 24-year old male presented with ankle pain and imaging revealed a 1.2cm x 1.6cm osteochondral defect of the talus.
2) The defect was excised and microdrilled. BioCartilage, a micronized hyaline cartilage allograft, mixed with blood or PRP was used to fill the defect.
3) BioCartilage offers advantages over other techniques like autografts in eliminating donor site morbidity and over ACI in being a single-stage procedure without wait time.
-often suffer from cartilage injuries. Cartilage surgery is available in India to cure cartilage problems and prevent them from developing knee osteoarthritis. Autologous cartilage cell implantation is being done by Madras Joint replacement center at an affordable cost. This biological intervention will hopefully avoid a knee replacement in young individuals.
This document contains a series of questions and answers related to adult reconstructive surgery of the hip and knee. It includes radiographs, diagrams, and descriptions of clinical scenarios. For one scenario, it describes radiographs of an 82-year old man with loosening of the tibial component of a total knee arthroplasty. The preferred treatment is listed as revision of the tibial component with porous metal augmentation.
The document summarizes a journal club discussion on autologous chondrocyte implantation (ACI) for treating articular cartilage defects in the knee. It provides details on the ACI procedure, which involves harvesting cartilage cells from a patient's knee, growing them in culture, and implanting them back into the defect using a periosteal patch or collagen membrane. The document compares ACI to other cartilage repair techniques like microfracture and drilling, finding ACI can regenerate hyaline-like cartilage while other techniques only produce fibrocartilage with limited lifespan. Rehabilitation guidelines and long-term assessment of ACI grafts via MRI, biopsy and arthroscopy are also summarized.
This study assessed anchor resorption and bone ingrowth over time after shoulder labral repairs using biocomposite anchors. CT scans at 12 and 24 months found 68% and 98% of anchor material had been absorbed, with 56% and 78% replaced by soft tissue and 9% and 20% replaced by bone, respectively. MRI found no mechanical failures. Tunnel widening was seen in 55% of anchors but decreased over time. Subjective outcomes scores were good. The study provides evidence that biocomposite anchors resorb and are replaced by bone while maintaining clinical success after labral repair.
Arthroscopic Single Row Versus Double-Row Suture Anchor Rotator Cuff Repair |...Peter Millett MD
Twenty fresh-frozen cadaveric shoulders were randomly assigned to 4 arthroscopic repair techniques. The repair was performed as either a single-row suture anchor rotator cuff repair technique or 1 of 3 double-row techniques: diamond, mattress double anchor, or modified mattress double anchor. Angle of loading, anchor type, bone mineral density, anchor distribution, angle of anchor insertion, arthroscopic technique, and suture type and size were all controlled. Footprint length and width were quantified before and after repair. Displacement with cyclic loading and load to failure were determined. For more shoulder surgery and rotator cuff studies, visit Peter Millett, MD, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
Open Anterior Capsular Reconstruction of the Shoulder for Chronic Instability...Peter Millett MD
Stability of the shoulder comes from a complex interaction of various factors. Dynamic and static components are provided by soft tissue and bony structures creating joint stability. Recurrent anterior glenohumeral instability can be a difficult problem because there is a wide variety of possible pathologies. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
This document describes a technique for arthroscopically grafting cysts in the greater tuberosity during rotator cuff repair. The technique involves debriding the cyst, drilling a socket, and implanting a resorbable scaffold to fill the defect. The authors present a case of using this technique to successfully repair a rotator cuff tear and fill a associated greater tuberosity cyst. They believe this technique offers a minimally invasive option for addressing cysts during rotator cuff repair.
Cartilage injuries most commonly occur in the knee joints and can affect both young and elderly populations through traumatic or degenerative means. Treatment depends on the severity and location of the injury. For partial thickness injuries, arthroscopic debridement can provide short-term relief. For full thickness injuries, options include stimulating intrinsic healing by microfracture, altering joint loads through osteotomy, transferring autologous tissue through mosaicplasty or chondrocyte implantation, or using allografts. Future approaches may involve gene therapy to enhance the repair process.
This document discusses stem cells and their potential applications in orthopedics. It begins with an overview of stem cell classifications and sources, including embryonic stem cells, induced pluripotent stem cells, and adult stem cells like mesenchymal stem cells derived from bone marrow. The document then focuses on the properties and differentiation potential of mesenchymal stem cells, describing their use in treating conditions like osteonecrosis, cartilage defects, spinal cord injuries, and intervertebral disc regeneration. It presents several case studies on using bone marrow concentrate containing mesenchymal stem cells for avascular necrosis. In summary, the document reviews stem cell types and their emerging role in regenerative orthopedic therapies.
Bone and Cartilage regeneration with cells and tissue engineering products - ...Enric Caceres
Bone and Cartilage regeneration with cells and tissue engineering products - Dr. Enric Cáceres - B-Debate 17/02/2015 http://www.bdebate.org/en/forum/advanced-therapies-and-regenerative-medicine-promise-21st-century
The document provides an overview of articular cartilage injuries and treatment methods. It discusses the composition and limited self-repair ability of cartilage. Imaging can detect cartilage defects and bone marrow edema. Treatment methods include non-invasive platelet rich plasma and bone marrow concentrate injections as well as surgical options like microfracture, mosaicplasty/OATS, and autologous chondrocyte implantation. Mosaicplasty has shown good long-term outcomes for small to medium defects while autologous chondrocyte implantation improves large defects, though both generate fibrocartilage. Future advances may include tissue engineering and 3D bioprinting of cartilage.
This document summarizes research from several studies on orthodontics and craniofacial research. It discusses tolerance for deviations in eye and mouth position, using 3D imaging to track facial changes in identical twins over time, examining differences in palate length in fetuses with Down syndrome, measuring friction of different archwire and bracket combinations, evidence of temporary loss of cell membrane integrity during orthodontic tooth movement, identifying growth patterns of the mandibular condyle through molecular and biochemical analysis, and investigating the use of stem cells for craniofacial and dental tissue engineering applications like periodontal and orthognathic surgery.
The document discusses several studies on the applications and efficacy of hydroxyapatite (HA) scaffolds and composites for bone tissue engineering. Specifically:
1) A long-term study of 276 dual radius HA-coated acetabular cups found an 11% revision rate after 10 years due to aseptic loosening and osteolysis.
2) HA scaffolds containing varying ratios of collagen supported human osteoblast viability, proliferation, and phenotype maintenance in culture.
3) Scaffolds combining HA microparticles and extracellular matrix derived from osteoblasts or fibroblasts in vitro enhanced bone repair in a rat calvarial defect model.
4) A composite of poly-ε-caprolactone and HA supported mouse
This study retrospectively reviewed 11 patients who underwent laparoscopic repair of large hiatal hernias with reinforcement of the diaphragmatic crura using various biologic grafts. Three different biologic grafts were used - acellular human dermal collagen in 6 patients, cellular porcine dermal implant in 1 patient, and porcine urinary bladder matrix in 4 patients. Outcomes were evaluated including perioperative data, complications, recurrence rates, and improvement in symptoms. The study found the laparoscopic repair of large hiatal hernias can be safely performed in rural hospitals using biologic grafts for crural reinforcement, with the choice of graft depending on availability, cost and surgeon preference.
- The document discusses principles of limb salvage surgery for bone tumors. It covers staging of tumors, including radiological and surgical staging. Radiological modalities like CT, MRI, PET scans help determine tumor extent and metastases.
- Principles of biopsy and factors affecting success of limb salvage surgery are outlined. Surgical resection aims to remove the tumor with an adequate margin while reconstructing the limb functionally. Pre-operative staging and adjuvant therapy can aid resectability.
- The goal of limb salvage surgery is a painless, functional reconstructed limb while achieving oncologic control.
This document summarizes several case studies using mesenchymal stem cells (MSCs) for regenerative medicine applications:
1. A pre-clinical study using ovine MSCs implanted in a critical-sized bone defect in sheep tibias showed effective bone regeneration compared to autograft or no cell controls.
2. A large animal study treating induced osteonecrosis of the femoral head in sheep with ovine MSCs implanted at the lesion site showed persistence of cells differentiating into bone and effective treatment compared to controls.
3. A Phase I/IIa clinical trial in humans with osteonecrosis of the femoral head treated with implanted human MSCs showed safety and potential efficacy based on imaging follow-up
This document summarizes a study of 110 patients who underwent distal femur resection and endoprosthetic reconstruction between 1980-1998. The majority had malignant bone tumors. Reconstruction was performed with modular, custom-made, or expandable prostheses. At minimum 2-year follow up, function was good or excellent in 85% of patients. Complications included deep infection in 5%, aseptic loosening in 5%, and prosthetic failure in 5%. The limb salvage rate was 96%. Distal femur endoprosthetic reconstruction provided good function and local tumor control in most patients.
1. The document describes three cases of patients with giant aneurysmal bone cysts (ABCs) that were treated with en bloc resection and reconstruction with non-vascularized fibular bone grafts.
2. All patients achieved bony union following the procedure and had no recurrence of the cysts or limitations in range of motion.
3. Non-vascularized fibular grafts provided an effective reconstruction method for large bone defects left after resection of giant ABCs.
Orthobiologics is a current terminology for the application of various cells, cytokines, growth factors.Tissue Engineering,Gene Therapy,Osteoarthritis,Avascular Necrosis,Sickle Cell Disease,Disc Regeneration,PRP,Autologous Chondrocyte Transplantation,BMAC,Spinal cord Injury paraplegia,Autoimmnune disorders,Diabetic foot,Tendinopathies,Wound Healing,,SCAFFOLDS IN STEM CELL THERAPY.Regenerative medicine is now an recognized specialty which has evolved from degerative diseases of Orthopaedic Surgery.Articular Cartilage : Repair To Regenerate To Replace Dr.Sandeep C Agrawal Agrasen Hospital Gondia India www.agrasenortho.com
This case report describes a 26-year-old woman who developed chronic osteomyelitis of the tibia caused by Vibrio alginolyticus after her tibial fracture was contaminated with seawater. She underwent aggressive surgical debridement and bifocal osteosynthesis according to the Ilizarov technique. Bone cultures during surgery isolated V. alginolyticus. She was treated with ciprofloxacin and tetracycline and responded well without reactivation of the osteomyelitis. This represents the first reported case of chronic osteomyelitis caused by V. alginolyticus treated successfully with the Ilizarov technique.
Biocartilage to Treat Osteochondral Defects of the Talus: Case Report and Tec...Jennifer Gerres, DPM
The document describes a case study and technique using BioCartilage to treat a large osteochondral defect of the talus. The key points are:
1) A 24-year old male presented with ankle pain and imaging revealed a 1.2cm x 1.6cm osteochondral defect of the talus.
2) The defect was excised and microdrilled. BioCartilage, a micronized hyaline cartilage allograft, mixed with blood or PRP was used to fill the defect.
3) BioCartilage offers advantages over other techniques like autografts in eliminating donor site morbidity and over ACI in being a single-stage procedure without wait time.
-often suffer from cartilage injuries. Cartilage surgery is available in India to cure cartilage problems and prevent them from developing knee osteoarthritis. Autologous cartilage cell implantation is being done by Madras Joint replacement center at an affordable cost. This biological intervention will hopefully avoid a knee replacement in young individuals.
This document contains a series of questions and answers related to adult reconstructive surgery of the hip and knee. It includes radiographs, diagrams, and descriptions of clinical scenarios. For one scenario, it describes radiographs of an 82-year old man with loosening of the tibial component of a total knee arthroplasty. The preferred treatment is listed as revision of the tibial component with porous metal augmentation.
The document summarizes a journal club discussion on autologous chondrocyte implantation (ACI) for treating articular cartilage defects in the knee. It provides details on the ACI procedure, which involves harvesting cartilage cells from a patient's knee, growing them in culture, and implanting them back into the defect using a periosteal patch or collagen membrane. The document compares ACI to other cartilage repair techniques like microfracture and drilling, finding ACI can regenerate hyaline-like cartilage while other techniques only produce fibrocartilage with limited lifespan. Rehabilitation guidelines and long-term assessment of ACI grafts via MRI, biopsy and arthroscopy are also summarized.
This study assessed anchor resorption and bone ingrowth over time after shoulder labral repairs using biocomposite anchors. CT scans at 12 and 24 months found 68% and 98% of anchor material had been absorbed, with 56% and 78% replaced by soft tissue and 9% and 20% replaced by bone, respectively. MRI found no mechanical failures. Tunnel widening was seen in 55% of anchors but decreased over time. Subjective outcomes scores were good. The study provides evidence that biocomposite anchors resorb and are replaced by bone while maintaining clinical success after labral repair.
Arthroscopic Single Row Versus Double-Row Suture Anchor Rotator Cuff Repair |...Peter Millett MD
Twenty fresh-frozen cadaveric shoulders were randomly assigned to 4 arthroscopic repair techniques. The repair was performed as either a single-row suture anchor rotator cuff repair technique or 1 of 3 double-row techniques: diamond, mattress double anchor, or modified mattress double anchor. Angle of loading, anchor type, bone mineral density, anchor distribution, angle of anchor insertion, arthroscopic technique, and suture type and size were all controlled. Footprint length and width were quantified before and after repair. Displacement with cyclic loading and load to failure were determined. For more shoulder surgery and rotator cuff studies, visit Peter Millett, MD, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
Open Anterior Capsular Reconstruction of the Shoulder for Chronic Instability...Peter Millett MD
Stability of the shoulder comes from a complex interaction of various factors. Dynamic and static components are provided by soft tissue and bony structures creating joint stability. Recurrent anterior glenohumeral instability can be a difficult problem because there is a wide variety of possible pathologies. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
This document describes a technique for arthroscopically grafting cysts in the greater tuberosity during rotator cuff repair. The technique involves debriding the cyst, drilling a socket, and implanting a resorbable scaffold to fill the defect. The authors present a case of using this technique to successfully repair a rotator cuff tear and fill a associated greater tuberosity cyst. They believe this technique offers a minimally invasive option for addressing cysts during rotator cuff repair.
Cartilage injuries most commonly occur in the knee joints and can affect both young and elderly populations through traumatic or degenerative means. Treatment depends on the severity and location of the injury. For partial thickness injuries, arthroscopic debridement can provide short-term relief. For full thickness injuries, options include stimulating intrinsic healing by microfracture, altering joint loads through osteotomy, transferring autologous tissue through mosaicplasty or chondrocyte implantation, or using allografts. Future approaches may involve gene therapy to enhance the repair process.
This document discusses stem cells and their potential applications in orthopedics. It begins with an overview of stem cell classifications and sources, including embryonic stem cells, induced pluripotent stem cells, and adult stem cells like mesenchymal stem cells derived from bone marrow. The document then focuses on the properties and differentiation potential of mesenchymal stem cells, describing their use in treating conditions like osteonecrosis, cartilage defects, spinal cord injuries, and intervertebral disc regeneration. It presents several case studies on using bone marrow concentrate containing mesenchymal stem cells for avascular necrosis. In summary, the document reviews stem cell types and their emerging role in regenerative orthopedic therapies.
Bone and Cartilage regeneration with cells and tissue engineering products - ...Enric Caceres
Bone and Cartilage regeneration with cells and tissue engineering products - Dr. Enric Cáceres - B-Debate 17/02/2015 http://www.bdebate.org/en/forum/advanced-therapies-and-regenerative-medicine-promise-21st-century
The document provides an overview of articular cartilage injuries and treatment methods. It discusses the composition and limited self-repair ability of cartilage. Imaging can detect cartilage defects and bone marrow edema. Treatment methods include non-invasive platelet rich plasma and bone marrow concentrate injections as well as surgical options like microfracture, mosaicplasty/OATS, and autologous chondrocyte implantation. Mosaicplasty has shown good long-term outcomes for small to medium defects while autologous chondrocyte implantation improves large defects, though both generate fibrocartilage. Future advances may include tissue engineering and 3D bioprinting of cartilage.
This document summarizes research from several studies on orthodontics and craniofacial research. It discusses tolerance for deviations in eye and mouth position, using 3D imaging to track facial changes in identical twins over time, examining differences in palate length in fetuses with Down syndrome, measuring friction of different archwire and bracket combinations, evidence of temporary loss of cell membrane integrity during orthodontic tooth movement, identifying growth patterns of the mandibular condyle through molecular and biochemical analysis, and investigating the use of stem cells for craniofacial and dental tissue engineering applications like periodontal and orthognathic surgery.
The document discusses several studies on the applications and efficacy of hydroxyapatite (HA) scaffolds and composites for bone tissue engineering. Specifically:
1) A long-term study of 276 dual radius HA-coated acetabular cups found an 11% revision rate after 10 years due to aseptic loosening and osteolysis.
2) HA scaffolds containing varying ratios of collagen supported human osteoblast viability, proliferation, and phenotype maintenance in culture.
3) Scaffolds combining HA microparticles and extracellular matrix derived from osteoblasts or fibroblasts in vitro enhanced bone repair in a rat calvarial defect model.
4) A composite of poly-ε-caprolactone and HA supported mouse
This study retrospectively reviewed 11 patients who underwent laparoscopic repair of large hiatal hernias with reinforcement of the diaphragmatic crura using various biologic grafts. Three different biologic grafts were used - acellular human dermal collagen in 6 patients, cellular porcine dermal implant in 1 patient, and porcine urinary bladder matrix in 4 patients. Outcomes were evaluated including perioperative data, complications, recurrence rates, and improvement in symptoms. The study found the laparoscopic repair of large hiatal hernias can be safely performed in rural hospitals using biologic grafts for crural reinforcement, with the choice of graft depending on availability, cost and surgeon preference.
- The document discusses principles of limb salvage surgery for bone tumors. It covers staging of tumors, including radiological and surgical staging. Radiological modalities like CT, MRI, PET scans help determine tumor extent and metastases.
- Principles of biopsy and factors affecting success of limb salvage surgery are outlined. Surgical resection aims to remove the tumor with an adequate margin while reconstructing the limb functionally. Pre-operative staging and adjuvant therapy can aid resectability.
- The goal of limb salvage surgery is a painless, functional reconstructed limb while achieving oncologic control.
This document summarizes several case studies using mesenchymal stem cells (MSCs) for regenerative medicine applications:
1. A pre-clinical study using ovine MSCs implanted in a critical-sized bone defect in sheep tibias showed effective bone regeneration compared to autograft or no cell controls.
2. A large animal study treating induced osteonecrosis of the femoral head in sheep with ovine MSCs implanted at the lesion site showed persistence of cells differentiating into bone and effective treatment compared to controls.
3. A Phase I/IIa clinical trial in humans with osteonecrosis of the femoral head treated with implanted human MSCs showed safety and potential efficacy based on imaging follow-up
This document summarizes a study of 110 patients who underwent distal femur resection and endoprosthetic reconstruction between 1980-1998. The majority had malignant bone tumors. Reconstruction was performed with modular, custom-made, or expandable prostheses. At minimum 2-year follow up, function was good or excellent in 85% of patients. Complications included deep infection in 5%, aseptic loosening in 5%, and prosthetic failure in 5%. The limb salvage rate was 96%. Distal femur endoprosthetic reconstruction provided good function and local tumor control in most patients.
1. The document describes three cases of patients with giant aneurysmal bone cysts (ABCs) that were treated with en bloc resection and reconstruction with non-vascularized fibular bone grafts.
2. All patients achieved bony union following the procedure and had no recurrence of the cysts or limitations in range of motion.
3. Non-vascularized fibular grafts provided an effective reconstruction method for large bone defects left after resection of giant ABCs.
This document describes a study evaluating the efficacy of using a dynamic hip screw (DHS) drill under image intensifier guidance to ablate osteoid osteoma of the lower extremities in children and adolescents. Eighteen patients between ages 4-16 were treated with this minimally invasive technique, with 16 achieving initial success from one drilling. Complications included one tibial fracture and two skin abrasions. At follow-up, all patients were classified as having a good clinical response. The combination of intraoperative localization using image intensifier guidance and ablation with a DHS drill provided an efficient, safe, and curative procedure with minimal bone loss for treating osteoid osteoma.
Crestal approach for maxillary sinus augmentation in patients with less than ...droliv
This study evaluated the success of a crestal approach sinus lift procedure combined with immediate implant placement in patients with varying amounts of residual alveolar bone (RAB). 102 patients received 109 implants across three clinical sites. Patients were divided into two groups based on RAB height: group 1 had 24 mm RAB and group 2 had >4 mm RAB. The success rate was 100% for group 1 and 98.5% for group 2 after 6-100 months. Both groups experienced minimal crestal bone loss on average (0.55 mm for group 1 and 0.07 mm for group 2) with no significant difference between groups. The study concludes the crestal approach is a viable technique for patients with as little as
This study reviewed the long-term outcomes of total knee arthroplasty (TKA) in patients with severe valgus knee deformity (variant-III). 32 patients (37 knees) underwent TKA with an average follow up of 10 years. The mean preoperative valgus alignment of 33 degrees was corrected to nearly neutral alignment postoperatively. Clinical and functional outcomes significantly improved based on HSS knee scores and range of motion. No revisions were required. Complications included 3 transient peroneal nerve palsies and 2 DVTs, but no infections or loosening. TKA can successfully treat severe valgus deformity with proper soft tissue balancing and implant selection.
This study evaluated the diagnostic accuracy of cone beam computed tomography (CBCT) and panoramic radiography in predicting exposure of the inferior alveolar nerve during third molar extraction surgery. The study assessed 59 impacted third molar extraction sites, examining pre-operative panoramic and CBCT images for signs suggesting nerve exposure. During surgery, actual nerve exposure was evaluated and compared to the radiographic predictions. CBCT correctly classified nerve exposure in 93.3% of cases, significantly more accurately than panoramic radiography which correctly classified 67.7% of cases. CBCT demonstrated high sensitivity, specificity, and predictive values, while panoramic radiography had lower sensitivity but high positive predictive value. This study indicates CB
This case report describes an unusual osteoblastoma located in the first metatarsal bone of a 25-year-old man that was treated successfully with wide surgical excision and reconstruction using a fibular autograft. The patient presented with 4 years of progressive pain and swelling in the left foot. Imaging showed a mixed lytic and blastic lesion in the first metatarsal bone. The lesion was diagnosed as an osteoblastoma based on histopathology. The patient underwent surgical resection of the first metatarsal bone and reconstruction with a fibular autograft. At 3 years post-operatively, the graft was well-incorporated with no recurrence of the osteoblastoma. Wide surgical excision and fibular autograft reconstruction
Functional outcome of Arthroscopic reconstruction of single bundle anterior c...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
(1) The study analyzed bone biopsy samples from 8 patients who underwent corticotomy to accelerate tooth movement as part of orthodontic treatment.
(2) Bone samples were taken before surgery and 90 days after from both the corticotomized and non-corticotomized sites and analyzed histologically.
(3) The results found higher levels of primary bone formation and osteocyte counts in the corticotomized sites 90 days after surgery compared to the non-corticotomized sites, suggesting corticotomy promotes reversible bone injury and remodeling without long-term harm.
This clinical article evaluates the long-term effectiveness of percutaneous curettage and allogenic bone grafting for treating aneurysmal bone cysts (ABCs). Nineteen patients with primary ABCs were treated with percutaneous curettage and impaction of allogenic bone fragments mixed with autologous bone marrow. All patients showed bone remodeling and radiographic resolution of their cysts within 6 months, with no recurrences or complications during follow-up of 2-18 years. The results suggest percutaneous curettage with allogenic bone grafting is an efficient, minimally invasive, and affordable procedure for treating primary ABCs.
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12-45 months). For the clinical evaluation, we used modified Merle d'Aubigné scoring system.
In group of Vancouver A fractures, 3 patients were treated with a mean score of 15,7 points (good result). We recorded a mean score of 14,2 points (fair result) in 6 patients with Vancouver B1 fractures, 12,4 points (fair result) in 24 patients with Vancouver B2 fractures and 12,8 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16,2 points (good result) in 7 patients.
Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable and checking the stability of the prosthesis fixation during surgery should be performed.
The implementation of MDCT in urological imaging has solved much of the diagnostic dilemma. Thanks to its multiplanar capabilities and post processing techniques.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
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How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
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because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
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Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
1. and hence viability at a relatively early stage for both
cortical (12,15) and cancellous (9,10,16—18) grafts. It
therefore provides a way of predicting graft failure
before X-ray or clinical changes are apparent. This
allows intervention before nonviable bone tissue be
comes necrotic, infected, or the region fibroses. Bone
scanning has been studied in grafts to other sites in the
facial skeleton in humans (17-19), but it has not pre
viously been systematically assessed in rhinoplasty. Rhi
noplasty may well represent a different situation as bone
grafts are being placed in a highly vascular region that
is not contiguous with other bony structures.
The current study had a number of purposes. First,
it looked at the timing of revascularization of free
autologous cancellous nasal bone grafts as measured by
radionucide bone scanning. Second, it examined the
usefulness of bone scanning in the early assessment of
the ultimate success or failure of these grafts. Third, it
compared the results ofgrafts from calvarial donor sites
withthosefromiliacsitesto determinewhethereither
site produced better graft survival.
MATERIALS AND METHODS
Patients
Twenty patients (9 males and 11 females aged 17 to 43)
who presented consecutivelyfor augmentation rhinoplasty
using bone grafts were studied. Only one patient had had
previous surgery,and twice he had undergone insertion of
silasticprostheseswith an unsatisfactoryresulton each occa
sion. Eleven subjects had partial thickness bone grafts har
vested from the calvaria, while the other nine had similar
grafts harvested from the iliac crest.
Bone Scanning
Each patient had three-phase bone scintigraphy ofthe facial
skeleton performed both preoperatively and postoperatively.
Thefirst 10patientsalsohada delayedsingle-photonemission
computed tomography (SPECI') study ofthe head performed.
For the radionucideangiography,the patientwas posi
tionedwiththe nosecenteredin the fieldofview ofa GE 400
AC analogcamerainterfacedwith a PDP I1/34 computer.
All studies were acquired using a LEAP collimator. A bolus
of 1 GBq of technetium-99m-MDP (methylene diphospho
nate) was injected via an antecubital vein and a 2-sec/frame
dynamic image was collected for 30 sec. Immediately follow
This study examinedthe role of radiOnuClidebone scanning
intheearlyassessmentoffreeautologouscancellousbone
grafts in augmentation rhinoplasty and compared the fail
ure rates of grafts taken from the calvariaand ilium.Twenty
patients had three-phase bone scanning of the facial re
glons performed between 2 and 15 wk after rhinoplasty,
and a comparison was made with the results of clinical
assessmentandX-rayfindings3 moaftersurgery.Eleven
patients had grafts taken from the calvana and nine had
iliac grafts. On lateral views, bone graft uptake of isotope,
whichwas lessthanor equalto the adjacentsoft tissue,
wasfoundin2 outof 20 patientsandthisfindingpredicted
subsequent graft failure as measured by clinical assess
ment and X-ray evidence of bone resorption. Both failures
had grafts taken from the calvana while none from the
ilium failed. These failure rates, however, were not signifi
candy different.
J NucI Med 1991; 32:33—36
ugmentation rhinoplasty is employed after
trauma, after resection of malignancy, for repair of
congenital defects, and in cosmesis. The use of autolo
gous cancellous bone grafts in this procedure has been
shown to have significant advantages over the use of
either cartilaginous grafts or the use of nonorganic
materials such as silastic (1—5).These grafts are usually
harvested from the iliac crest (2,6) or calvaria (1,3, 7,8),
with the calvaria being considered superior by some
(1,3,8).
The results of such bone grafts have usually been
assessedby the degreeof patient and surgeonsatisfac
tion with the final result and by radiologic assessment
ofthe extent ofbone graft resorption (1—3,5-7).How
ever, these methods cannot provide an early assessment
of revascularization of the bone fragments: a factor
which ultimately determines graftoutcome (9—14).
Radionucide bone scanning has been shown to be a
useful method of determining bone graft vascularity
ReceivedJan. 26, 1990; revIsionaccepted Jun. 11, 1990.
Forrepilntscontact:Dr.StuartRamsey,DepartmentofNuclearMedl@
cine,St.Vincent'sHospital,Darllnghurst,NSW,Australia.
33Three-PhaseBone Scanning and Bone Graft Viability •Ramsey et al
Bone Scanning in the Early Assessment of
Nasal Bone Graft Viability
StuartC.Ramsey,Michael0. Yeates,andLawrenceC.Y.Ho
Department ofNuclear Medicine, St. Vincent'sHospital, Sydney, Australia and Department of Surgery,
ConcordHospital, Sydney, Australia
by on September 21, 2017. For personal use only.jnm.snmjournals.orgDownloaded from
2. TABLE1Number
of Patients from Each Donor Site GroupwithEach
Bone ScanGradeDonor
site
Bone scan
grade Calvaria* Iliaccrest*
ing this, 400,000 count blood-pool images ofthe anterior face
positionedidenticallyto the blood flowimagesand 300,000
count images of both laterals of the face were performed.
Three hundred thousand count views of the anterior face and
similar images ofright and left laterals ofthe skull were taken
3 hr later. The initial patients had normal size delayed images,
however, it was found that in patients with grafts harvested
fromthe calvariathe harvestsiteappearedin the fieldof view
interfering with acquisition. Images ofthe face only, magnified
times 2, were therefore acquired to exclude the donor site.
The SPECT images were acquired over 64 angles with each
angle collected for 30 sec. These scans were reconstructed
using an in-house developed Metz prefilter (20) and Philips
Gamma- 11 software and were then displayed as standard
transaxial, sagittal, and coronal slices.
Toallowassessmentofthe timecourseofrevascularization,
the timing of the bone scan was varied after surgery. Five
patients had their bone scans performed 2—3wk postopera
tively, 10had scans 4—8wk postoperatively, and the remaining
5 werescanned10—15wk aftersurgery.Two patientshadtwo
postoperativescansperformed,one becauseof failureof the
initial scan to visualize the grafted bone.
An assessmentof the successof revascularizationand the
volume of revascularized bone was obtained by dividing the
bone scans into four categories. This grading system was based
on the uptake by the graft fragments compared with that of
the frontal bones on lateral views (Fig. 1).
FIGURE 1
Lateralfacialviewsshowingbonescangradingsystem.(A)
Grade 0: Graft uptake equal to or less than adjacent soft
tissue. (B) Grade 1: Graft activity greater than soft tissue but
less than frontal bones. (C) Grade 2: Graft activity equal to
frontalbones.(0) Grade3: Graftactivitygreaterthanfrontal
bones.
X-rays
Thirteen patients had radiographs of the nasal bones per
formed 3 mo after surgery as part oftheir routine postoperative
follow-up. The graft was classified as either resorbed or intact,
depending on its appearance on lateral views.
Clinical Progress
Patients were routinely reviewed by the operating surgeon,
who assessed their progress clinically 3 mo after surgery. At
this time, the grafts were classified according to their success
or failure.
Statistics
The failure rates ofgrafts taken from the calvaria and ilium
were compared using Fisher's exact probability test. The bone
scan grades for the two donor sites were compared using the
Wilcoxon two-sample test.
RESULTS
The bone scan results according to donor site are
shown in Table 1. Their correlation with clinical results
and X-ray assessment of the degree of bone graft re
sorption 3 mo after surgery is shown in Table 2.
Only two patients were considered to have failure of
their grafts when assessed by the surgeon 3 mo after
surgery (Table 3). In both ofthese cases, bone scanning
showed uptake by the grafts that was less than or equal
to the adjacent soft tissue (grade 0). These two patients
were also the only two who showed resorption of the
B bone grafts on X-ray. All other patients were regarded
by the surgeon as having successful grafts clinically; all
had isotope uptake by the grafts of greater than the
adjacent soft tissues (grades 1to 3), and the 11who had
X-raysshowed no evidence ofbony resorption.In none
of the 10 SPECT studies was graft uptake discordant
with that seen on the planar views.
Of the 11 patients whose graftswere harvested from
the calvaria, 2 had grafts which were regarded as failures
clinically and both had grade 0 uptake and X-ray evi
dence of bone graft resorption. One was scanned at
D both 4—8wk and 10—15wk after surgery, while the
other was scanned at 10—15wk only. Of those grafts
taken from the ilium, all were clinically successful and
none had grade 0 uptake. The failure rates of the grafts
A
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RLATERFIL MAGX2
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The Journal of Nuclear Medicine •Vol. 32 •No. 1 •January 199134
by on September 21, 2017. For personal use only.jnm.snmjournals.orgDownloaded from
3. 00202180702302037020
TABLE3Success
Ratesof BoneGrafts According to DonorSiteDonor
siteSuccessFailure
TABLE 2
Comparison of Bone Scan Grade with Clinical Progress
and X-Ray Assessment of Bone Graft Resorption
Clinical X-ray
Bonescan
grade Success Failure Normal Resorbed
This was true for scans performed at 4—8wk and 10-
15 wk after surgery. Scans performed 2—4wk after
surgery were able to predict graft success. However, no
failures occurred in this patient group so the efficacy of
bone scanning at 2—4wk after surgery in the prediction
ofgraft failure is inferred rather than proven.
Delayed SPECT studies of the head did not contrib
ute any extra information in the prediction of graft
failure in the first 10 patients, including one patient
with a failed graft. This differs from some other pub
lished work (14,21—23),which suggests that the skull
and facial region is best assessed by SPECT scanning.
The fact that nasal bone grafts are positioned away from
the complicated bony anatomy of the skull, and can be
projected off the skull using lateral views, probably
explains why SPECT was not helpful.
Radionuclide angiography also proved unhelpful.
However, no postoperative infections were encountered
and dynamic studies would be expected to be most
helpful in differentiating osteomyelitis from cellulitis or
normal postoperative change.
Reports using animal models show that grafts taken
from the calvaria maintain their volume better than
those taken from the ilium, especially when grafted to
skull or facial sites (10, 16,24), and it has been suggested
this is also true for humans (1,3). In the current study,
only two grafts were considered to be inadequate and
both were taken from the calvaria. One ofthese patients
had previously undergone insertion ofsilastic prostheses
twice and this may have resulted in scarring, reduced
vascularity, and, hence, inadequate invasion ofthe bone
grafts by new blood vessels. The other patient could not
be distinguished preoperatively from patients who had
successful grafts. However, no statistically significant
difference was found between the failure rates of grafts
taken from the two sites nor the volume of revascular
ized bone as assessed by bone scan grades.
In conclusion, planar bone scanning is a useful
method in the early detection ofnasal bone graft failure.
A larger study is required to answer the question of
whether calvarial or iliac donor sites produce lower
failure rates in humans.
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taken from the two different sites, however, were found
not to be significantly different (p>O.25).
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and hence of the success of the graft, the bone scan
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were compared. Again no significant difference was
found between grafts taken from each site (p>'O.10).
DISCUSSION
Radionuclide bone scanning is an accepted method
for the early assessment of bone graft viability in many
sites (9, 12, 13, 15, 17—19).Bone grafts to various sites in
the facial skeleton have been assessed by bone scanning,
and it has been suggested that SPECT adds extra infor
mation in this region (14,21). The nose, however, offers
a different environment. First, it is highly vascular and
revascularization of grafts might therefore be expected
to occur earlier in this region than in other sites in the
face. Second, most of the graft is not contiguous with
adjacent bone, hence, interpretation of bone scans
should be less difficult.
The current study shows that bone scan evidence of
revascularization of free cancellous bone grafts in the
nasal region is present at least as early as 2—3wk after
surgery compared with the 6 wk (18) and 3 wk (13)
reported for iliac grafts to the mandible in the dog
model or the 4 wk reported for split rib grafts to the
mandible in the human (17,19). It also shows that
radionuclide bone scanning can be used as an early
predictor of graft outcome in the nasal region. When
assessed on delayed lateral facial views, uptake of iso
tope by the bone grafts which was equal to or less than
the adjacent soft-tissue uptake was predictive of subse
quent graft failure assessed 3 mo after surgery by clinical
means and radiographic evidence of bony resorption.
Calvana92*Iliac
crest90*
*Nosignificantdifferencebetweenfailurerates(p>0.25)
35Three-PhaseBoneScanningandBoneGraftViability•Ramsayet al
by on September 21, 2017. For personal use only.jnm.snmjournals.orgDownloaded from
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cellousbonegrafts.OrthopClinNorthAm l987;l8:l79—185.
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dibular bone grafts.J NudMed 1979;20:297—302.
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