Clinical outcomes of autogenous cancellous bone grafts obtained through the portal for tibial nailing
ABSTRACT The purpose of this study is to introduce and review the clinical outcomes of a new technique for harvesting autogenous cancellous bone grafts in association with tibial intramedullary (IM) nailing.
We retrospectively reviewed 21 patients who received autogenous cancellous bone grafts obtained from the entry portal of a tibial IM nail for fracture gaps, malalignment or nonunion in the lower extremities. All patients were scheduled to receive IM nailing or had already received IM nailing for the fixation of an ipsilateral tibia shaft fracture. A total of 33 patients who received only tibial IM nailing were selected as a control group. Through the follow-up, postoperative complications related to the bone harvest were monitored. Further by taking serial X-rays, radiographic changes of the donor site and the knee joint were closely observed. Knee pain (visual analogue scale (VAS)) and function (Lysholm knee score) were compared between the study group and the control group.
At the last follow-up, the average VAS in the study group was 1.28 (0-5), which was not significantly different from the control group (VAS: 1.36, range 0-7) (P=0.985). The range of motion of the knee joint was similar in both groups, averaging 130.23° (range: 115-135°) and 131.36° (range: 115-135°), respectively. There was no significant difference in the Lysholm knee score between the study and control groups (P=0.610). All patients exhibited complete fracture healing at an average of 6 months and no complications associated with the bone donor site were observed.
By using the new technique, autogenous cancellous bone grafting can be performed conveniently and safely to treat fracture gaps, malalignment or nonunion in the lower extremities without additional morbidity at the donor site.
SourceAvailable from: Nicola Maffulli[Show abstract] [Hide abstract]
ABSTRACT: This review analyzes the literature of bone grafts and introduces tissue engineering as a strategy in this field of orthopedic surgery. We evaluated articles concerning bone grafts; analyzed characteristics, advantages, and limitations of the grafts; and provided explanations about bone-tissue engineering technologies. Many bone grafting materials are available to enhance bone healing and regeneration, from bone autografts to graft substitutes; they can be used alone or in combination. Autografts are the gold standard for this purpose, since they provide osteogenic cells, osteoinductive growth factors, and an osteoconductive scaffold, all essential for new bone growth. Autografts carry the limitations of morbidity at the harvesting site and limited availability. Allografts and xenografts carry the risk of disease transmission and rejection. Tissue engineering is a new and developing option that had been introduced to reduce limitations of bone grafts and improve the healing processes of the bone fractures and defects. The combined use of scaffolds, healing promoting factors, together with gene therapy, and, more recently, three-dimensional printing of tissue-engineered constructs may open new insights in the near future.Journal of Orthopaedic Surgery and Research 03/2014; 9(1):18. DOI:10.1186/1749-799X-9-18 · 1.58 Impact Factor