[Show abstract][Hide abstract] ABSTRACT: Previously it has been shown that recombinant human bone morphogenetic protein (rhBMP-2) can be chemically immobilized by “anchor molecules” on titanium surfaces for serving as a drug delivery device. This opened the question of whether the insoluble immobilized rhBMP-2 retained its activity in comparison to the same amount of soluble rhBMP-2 included with the implant samples. Electropolished titanium miniplates (10 × 6 × 0.8 mm) were “surface-enhanced” by a novel treatment with chromosulfuric acid and then coated with a total amount of 150–200 ng rhBMP-2 prepared by recombinant technology. Periosteal flaps (7 × 20 mm) were detached and isolated from the anterior surface of the tibiae of adult rabbits and wrapped around the titanium sample plates which were then implanted in the M. gastrocnemius. In the first experimental group various controls without rhBMP-2 were combined (n = 12). In the second experimental group implants with chemically immobilized rhBMP-2 (n = 8) were compared with implants to which non-immobilized soluble rhBMP-2 was added (n = 8). Animals were sacrificed after 28 days and a quantitative evaluation was carried out by means of serial sections. Untreated control plates showed bone formation in 2/12 implants, rhBMP-2 coated implants in 6/8 and implants with free rhBMP-2 administered subperiostally in 8/8 cases. In the case of rhBMP-2 coated implants the induced bone had direct contact to the implant in all cases while in the group with free administered rhBMP-2 the bone had no contact to the implant in two cases, but was separated by a fibrous capsule. Bone volume, bone surface area, and trabecular number displayed no difference between the two rhBMP-2-groups. However, in the biocoated group a tendency to an increase in the bone-implant contact area was evident. No differences in osteoid area, osteoid perimeter and eroded perimeter were detected. We conclude that in the case of non-immobilized rhBMP-2 there is the danger for formation of fibrous tissue between the implant and the newly formed bone and in addition the generation of ectopic bone at inappropriate places. In contrast chemically immobilized rhBMP-2 does not have these drawbacks and at the same time displays a biological activity on surfaces similar to that of soluble rhBMP-2 demonstrating that biomaterial surfaces can be tailored for a selective and specific interaction with the target tissue. Abschätzung der biologischen Aktivität von chemisch immobilisiertem rhBMP-2 auf Titanoberflächenin vivo In bisherigen Arbeiten konnte gezeigt werden, dass rekombinantes humanes Bone Morphogenetic Protein (rhBMP-2), welches in vitro aktiv ist, kovalent auf Titanoberflächen immobilisiert werden kann. Es erhebt sich die Frage, ob das in dieser Form immobilisierte rhBMP-2 seine biologische Aktivität in vivo behält. Die Oberfläche von elektropolierten Titanplättchen (10 × 6 × 0.8 mm) wurde durch Behandlung mit Chromschwefelsäure veredelt und die Plättchen wurden anschließend mit einer Gesamtmenge von 150–200 ng rhBMP-2 beschichtet, das mittels rekombinanter DNA-Technologie in E. coli gewonnen wurde. Von der Vorderkante der Tibia erwachsener Kaninchen wurde ein 7 × 20 mm großer Perioststreifen entnommen, die Titanplättchen damit umwickelt und das Komposit dann in den M. gastrocnemius implantiert. Die Experimente wurden in zwei Hauptgruppen aufgeteilt. In der ersten Versuchsgruppe wurden verschiedene Kontrollen in Abwesenheit von rhBMP-2 zusammengefasst (n = 12). In der zweiten Versuchsgruppe wurde die biologische Reaktion auf chemisch immobilisiertes rhBMP-2 (n = 8) mit nicht-immobilisiertem löslichem rhBMP-2 in der Periosttasche (n = 8) verglichen. Die Versuchsdauer betrug 28 Tage. Die quantitative Analyse der Knochenneubildung wurde an Serienschnitten durchgeführt. Während es in der ersten Versuchsgruppe bei Implantaten ohne rhBMP-2 wie zu erwarten nur in 2/12 Fällen zu einer ganz geringen Knochenneubildung kam, zeigte sich eine deutliche Knochenneubildung bei 6/8 Implantaten mit chemisch immobilisiertem rhBMP-2 und bei 8/8 Implantaten mit freiem rhBMP-2. Bei immobilisiertem rhBMP-2 hatte der neugebildete Knochen in allen Fällen einen unmittelbaren Kontakt zur Implantatoberfläche, während bei freiem rhBMP-2 der Knochen in 2 Fällen keinen Kontakt zum Implantat aufwies, sondern von einer Bindegewebsschicht getrennt war. Hinsichtlich Knochenvolumen, Knochenoberfläche und Trabekelzahl ergab sich kein Unterschied zwischen immobilisiertem und freiem rhBMP-2. Die Parameter Osteoidfläche, Osteoidumfang und erodierter Umfang zeigten ebenfalls keine Gruppenunterschiede. Wir schließen, dass im Falle des nicht-immobilisierten rhBMP-2 die Gefahr eines fibrösen Interfaces zwischen Implantat und neugebildetem Knochen und der Induktion von ektopischem Knochen an ungewollter Stelle besteht. Im Gegensatz dazu zeigt kovalent immobilisiertes rhBMP-2 auf Titanoberflächen eine ähnlich hohe biologische Aktivität wie lösliches rhBMP-2 ohne die obengenannten Gefahren. Oberflächen von Biomaterialien können somit durch rhBMP-2 Beschichtungen so verändert werden, dass eine spezifische Interaktion mit dem Zielgewebe induziert wird.
Full-text · Article · Dec 2001 · Materialwissenschaft und Werkstofftechnik
[Show abstract][Hide abstract] ABSTRACT: We compared the motion-stable wire suture by Towfigh (MSWST) with a modified Kessler suture (MKS) by following up flexor tendon repairs (MSWST, n = 21/39 digits; MKS, n = 20/31 digits). For MSWST we found 31 (79.5%) "excellent", 3 (7.7%) "good", and 5 (12.8%) "fair" results, when using the scoring system of Buck-Gramcko. In 3 (14.3%) patients the MSWST had to be removed owing to local irritation. In a further 3 (14.3%) patients, this was done when secondary tenolysis was necessary. The latter was also performed in 4 (20.0%) patients in whom the MKS was used. Here we found 23 (74.2%) excellent, 7 (22.6%) good, and 1 (3.2%) fair result. The statistical evaluation of the data concerning the patients' age, sex, the involved zone, the side, and the functional outcome did not reveal a significant difference (P < 0.05) between both groups and the chosen type of repair. The results of MSWST and MKS are similar, but MSWST allows early motion therapy without a splint or rubber-band protection.
No preview · Article · Feb 2001 · Archives of Orthopaedic and Trauma Surgery
[Show abstract][Hide abstract] ABSTRACT: A concept and methodology were developed for the direct biocoating of implantable metals, like titanium and stainless steel, with bioactive factors such as bone morphoge-netic proteins (BMP) for future application as cementless bone prostheses. Recombinant human BMP-2 (rhBMP-2) was expressed in E. coli and purified in biologically active form. Small electropolished titanium plates were "surface-enhanced" by a novel treatment with chromosulfuric acid and then coated with rhBMP-2. Treatment with chromo sulfuric acid led to a very hydrophilic surface with a five-fold higher binding capacity for protein. In vivo testing was initated employing a periostal flap test model in rabbits. In the animal model it could be shown that the biocoated implants are non-toxic and the overall in vivo biological activity of rhBMP-2 biocoated implants (insoluble BMP-2) is so high that it is comparable to that of soluble rhBMP-2 controls, only that in the latter case the BMP effect is neither limited nor targeted and poses the danger of ectopic bone formation. We conclude that surfaces of biomaterials can be tailored by our method in such a way that a selective and specific interaction ("biological recognition") with the target tissue can be induced by immobilized rhBMP-2 with minimal danger of ectopic bone formation and without eliciting a significant inflammatory response.
[Show abstract][Hide abstract] ABSTRACT: In the treatment of posttraumatic contracture of the elbow joint, arthrolysis is a proven procedure. We used a stepwise operative approach starting laterally and including an additional medial and dorsal incision if needed. A total of 91 patients with arthrolysis of the elbow could be followed-up on average 44 months (range 9-102 months) joint after operative (58, 63.7%) and non-operative (33, 36.3%) fracture treatment. The mean preoperative range of motion (ROM) in flexion/extension was 49 degrees (SD +/- 38 degrees), while in pronation/supination it was 89 degrees (SD +/- 66 degrees). Postoperatively, the ROM was on average 94 degrees (SD +/- 27 degrees) in flexion/extension and 129 degrees (SD +/- 52 degrees) in pronation/supination. Using our own grading system, it became evident that most patients had a functional benefit from the procedure, although the quality of the improvement differed. For example, postoperatively 59.3% of the patients were grade I (> or = 90 degrees) in flexion/extension compared with 16.5% preoperatively. Although the rest also showed improvements, their functional benefit was less. The earlier the release of the joints was performed, the better was the functional outcome (p < 0.05). The importance of an intensive early rehabilitation programme is emphasised while indications for this procedure should only be seen in compliant patients.
No preview · Article · Oct 2000 · Archives of Orthopaedic and Trauma Surgery
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to investigate a systemic induction of bone formation in rats by immunosuppression with FK506 (1 mg/kg body weight intraperitoneally [ip]) in a model of osteoinduction of isogeneic and xenogeneic demineralized bone matrix (DBM) for a period of 28 days. In particular, alterations of in vitro cytokine synthesis and changes of lymphocyte subsets were studied. DBM was implanted intramuscularly in the abdominal wall of Lewis rats (seven per group). Blood was sampled on days -7, 0, 7, and 28 for determination of in vitro tumor necrosis factor a (TNF-alpha) synthesis and lymphocyte subsets by flow cytometry (CD3+, CD4+, CD8+, CD45+, ED9+, and Ia+ antibodies). Ossicles of de novo formed bone and the tibias were removed on day 28 after double tetracycline labeling for histomorphometric analysis. Immunosuppression with FK506 significantly decreased lipopolysaccharide (LPS)-stimulated in vitro cytokine synthesis after 7 days and 28 days (p < 0.05). Compared with control animals FK506 treatment significantly increased the volume of induced bone in isogeneic (2.1 +/- 0.3 mm3 vs. 10.8 +/- 0.9 mm3) and xenogeneic (O mm3 vs. 4.7 +/- 0.8 mm3) DBM. Bone histomorphometry of the tibias revealed that immunosuppression increased both bone formation and bone resorption, accompanied by a significant reduction in the relative trabecular area (Tb.Ar). FK506 caused a decrease in the counts of CD8+ T cells probably because of destruction or dislocation of these cells. This suggests that the amount of CD8+ cells and the degree of T cell activation in terms of mean fluorescence intensity (MFI) may be associated with bone metabolism. In support of this, statistical analysis revealed a significant positive correlation between parameters of bone formation as well as bone resorption and the CD4+/CD8+ ratio. There was a significant negative correlation between parameters of remodeling of the metaphysis of the tibia and induced bone volume (BV), respectively, and MFI values of CD3+/Ia+ cells. These findings suggest an important role of T lymphocytes in bone formation and bone resorption in vivo. FK506 caused a marked increase of bone formation in DBM. However, the conclusion that immunosuppression increases fracture healing warrants further investigation.
Preview · Article · Sep 2000 · Journal of Bone and Mineral Research
[Show abstract][Hide abstract] ABSTRACT: The efficiency of secondary thoracic computed tomography (TCT) in critically ill patients with multiple traumas was assessed by comparison of TCT with chest radiograph findings. The subsequent therapeutic consequences based on the additional information of TCT were evaluated.
A six-bed trauma intensive care unit in a university hospital.
Prospective, descriptive study.
One hundred one computed tomographic (CT) examinations (mean, 2.6 per patient; range, 1-10) were performed in 39 patients, fulfilling the following indications for TCT: a) sepsis with suspected pulmonary focus (n = 41); b) deterioration of pulmonary gas exchange (n = 35); c) guiding the duration of intermittent prone positioning (n = 25). The information provided by TCT was compared with corresponding chest radiographs (CXR). Therapeutic consequences drawn after TCT were compared with the additional diagnostic information of TCT. The change of therapy was documented that would not have been undertaken or may have been delayed had TCT evaluation not been used.
TCT was significantly superior to CXR in detecting pneumothoraces, pleural effusions, and pulmonary abscesses. Furthermore, a significantly higher accuracy regarding pulmonary densities was found. Subsequent therapeutic interventions ensued from 85 (84.2%) CT scans. After TCT, intermittent prone positioning was initiated in 31 patients, chest tubes were inserted in 16 patients, and intermittent prone positioning was terminated in 13 patients and was continued in 12 patients. Eleven thoracotomies were performed because of the TCT findings. The described therapeutic interventions were based on abnormalities seen on CT scans but were not evident in CXR in 58 patients (57.4%). Significant information that influenced therapeutic concepts was obtained in 66% (n = 23) of patients with pulmonary deterioration of gas exchange, in 61% (n = 25) of patients with sepsis, and in 40% (n = 10) of patients to guide the duration of intermittent prone positioning. Thoracotomy and specific drainage by tube thoracostomy was always dependent on the findings of TCT.
Performed under the above displayed defined indications, TCT had an overall efficiency of 57%. It provided an increased sensitivity for intrathoracic lesions and a more comprehensive diagnosis of chest abnormalities.
No preview · Article · May 2000 · Critical Care Medicine
[Show abstract][Hide abstract] ABSTRACT: To evaluate complications and the oncological and intermediate-term functional results in patients with bone and soft tissue tumors of the shoulder girdle who were managed with interscapulothoracic resection (Tikhoff-Linberg procedure).
Case series of 19 consecutive patients during a 10-year period at a mean follow-up of 6.3 years (range, 1-11 years).
University hospital; referral center for musculoskeletal tumor surgery.
The initial diagnosis in this consecutive series of patients with shoulder girdle tumors requiring the Tikhoff-Linberg procedure was chondrosarcoma in 7 patients, Ewing sarcoma in 3 patients, malignant fibrous histiocytoma in 3 patients, solitary metastasis of thyroid carcinoma in 2 patients, osteosarcoma, synovial sarcoma, angiosarcoma, ancd neurofibrosarcoma in 1 patient each. According to the Musculoskeletal Tumor Society staging system, there were 6 in surgical stage IB, 10 in stage IIB, and 3 in stage III. Nine tumors involved the proximal humerus, 8 were located in the scapula or surrounding soft tissues, 1 in the lateral clavicle, and 1 in the acromioclavicular joint.
For reconstruction of the proximal humerus after en bloc tumor resection an isoelastic cemented shoulder tumor prosthesis was inserted in every patient to restore arm length.
Complications, and oncological and intermediate-term functional results.
Twelve patients were alive with no evidence of disease. One of these patients died of nontumorous disease 2 years after surgery. One patient is alive with pulmonary metastases after 12 months. Six patients died of metastases at a mean (SD) interval of 18 months (range, 3-35 months) postoperatively. Two of these patients had additional local recurrence. A deep infection necessitated the explantation of the prosthesis in 1 patient. The mean functional score and SD according to the rating system of the Musculoskeletal Tumor Society was 72%+/-14% (range, 33%-87%) for the 12 surviving patients evaluated. Major complications (1 infection and 2 local recurrences) that may be attributed to the procedure occurred in 3 of the 19 patients.
Despite an overall complication rate of 74% the Tikhoff-Linberg procedure proved to be a valuable surgical procedure for extended tumors of the shoulder girdle for functional and oncological outcome and is superior to forequarter amputation.
No preview · Article · Apr 1999 · Archives of Surgery
[Show abstract][Hide abstract] ABSTRACT: Ninetten consecutive patients with bone and soft tissue tumors of the shoulder girdle were treated with interscapulothoracic resection (Tikhoff-Linberg procedure) over a 10-year period. Twelve patients were alive with no evidence of disease at a mean follow-up of 6.3 (1-11) years and one patient is alive with local recurrence and pulmonary metastases after 15 months. Six patients died due to pulmonary metastases. Despite these complications, the Tikhoff-Linberg procedure proved to be a valuable operation for extended tumors of the shoulder girdle in terms of functional and oncological outcome and is clearly superior to forequarter amputation.
No preview · Article · Feb 1998 · Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
[Show abstract][Hide abstract] ABSTRACT: In 20 Patients - 15 male and 5 female, average age 39 years (range: 25- 68) - a modification of the dynamic skin suture was performed using conventional locks with an integrated membrane. Results were recorded prospectively. There were 15 defects caused by full skin incision, 2 by excision and 3 by a combination of both. Of these defects 5 were located at the lower leg, 12 at the forearm, 2 at the thigh and 1 at the foot. In 14 patients complete skin closure was reached after 5 days (range: 3-9) with adjustement of the sutures' tension once a clay. Of 951 qcm wound area, added from all 20 patients, 850,3 cm2 (89,4%) were covered. In 6 patients meshed skin grafts were needed to close the rest of the wounds. The here introduced modification makes the technique of dynamic skin suture more practicable and allows an infinitely variable adaptation of the skin edge traction to the individual perfusion conditions of the wound.
[Show abstract][Hide abstract] ABSTRACT: In 30 patients (12 male and 18 female) with extensive lesions of the cartilage of the upper and lower ankle joint, controlled partial-loading of the lower extremity was established by means of the load-relieving orthosis by Allgöwer and Wenzl. In these orthoses a hidden step-counter could be integrated. Average patient age was 46 (range 20 to 74) years. The load-relieving orthosis was used on average for 68 (range 22 to 98) days with a mean of 10,756 steps (range: 261 to 30,538); respectively 158 steps per day. Neither age, sex, diagnosis nor the duration of complete postoperative immobilisation correlated with the number-of-steps-per-diem compliance (r > +0.22).
[Show abstract][Hide abstract] ABSTRACT: Pulmonary gas exchange in correlation with condensed lung volume was prospectively studied in 10 patients with multiple injuries and blunt chest trauma. The purpose was to find nomograms that allow the estimation of the extent of pulmonary density from gas exchange parameters. The condensed lung volume was determined planimetrically from serial transverse sections of chest computed tomographic scans. There was no correlation between condensed lung volume and mean pulmonary artery pressure, pulmonary vascular resistance, systemic vascular resistance, or cardiac index and a week negative correlation to the oxygenation index (PaO2/FIO2) (r2 = 0.46) and to the total static lung compliance (r2 = 0.29). A strong correlation between pulmonary density and intrapulmonary shunt fraction (Qs/Qt) (r2 = 0.95) as well as alveoloarterial PO2 difference (P[A-a]O2) (r2 = 0.86) was evident. By using linear regression equations (linear regression line with 95% confidence interval), nomograms were calculated. The extent of pulmonary density can easily be obtained from these nomograms by measuring Qs/Qt or P(A-a)O2. The presented nomograms may be helpful in monitoring the effect of treatment in patients with blunt chest trauma.
No preview · Article · Aug 1997 · The Journal of trauma
[Show abstract][Hide abstract] ABSTRACT: Bei 30 Patienten, die wegen eines erheblichen Knorpelschadens des oberen und/oder unteren Sprunggelenkes einseitig zur postoperativen
Nachbehandlung mit einer dynamischen Teilbelastungsvorrichtung nach Allgöwer/Wenzl versorgt wurden, konnten verdeckte Schrittzähler
in den Gehapparaten installiert werden. Das durchschnittliche Alter der Patienten betrug 46 (Spanne: 20 bis 74) Jahre. Die
Teilbelastungsvorrichtungen wurden im Mittel 68 (Spanne: 33 bis 98) Tage genutzt. Dabei wurde eine mittlere Schrittzahl von
10756 (Spanne: 261 bis 30538) erreicht, das entspricht einer täglichen mittleren Nutzung von durchschnittlich 158 Schritten.
Eine Vorhersage, welcher Patient seine Orthese nutzen wird, ist aufgrund des Alters, des Geschlechtes und der Diagnose der
Patienten nicht möglich. Denn zu diesen Daten und auch zur Dauer der vollständigen postoperativen Entlastung ergab sich bei
der statistischen Gegenüberstellung zur täglichen Schrittzahl keine Korrelation mit r > +0,22.
In 30 patients (12 male and 18 female) with extensive lesions of the cartilage of the upper and lower ankle joint, controlled
partial-loading of the lower extremity was established by means of the load-relieving orthosis by Allgöwer and Wenzl. In these
orthoses a hidden step-counter could be integrated. Average patient age was 46 (range 20 to 74) years. The load-relieving
orthosis was used on average for 68 (range 22 to 98) days with a mean of 10756 steps (range: 261 to 30538); respectively 158
steps per day. Neither age, sex, diagnosis nor the duration of complete postoperative immobilisation correlated with the number-of-steps-per-diem
compliance (r > +0.22).
No preview · Article · Jan 1997 · European Journal of Trauma
[Show abstract][Hide abstract] ABSTRACT: In 30 patients (12 male and 18 female) with extensive lesions of the cartilage of the upper and lower ankle joint, controlled partial-loading of the lower extremity was established by means of the load-relieving orthosis by Allgower and Wenzl. In these orthoses a hidden step-counter could be integrated. Average patient age was 46 (range 20 to 74) years. The load- relieving orthosis was used on average for 68 (range 22 to 98) days with a mean of 10756 steps (range: 261 to 30538); respectively 158 steps per day. Neither age, sex, diagnosis nor the duration of complete postoperative immobilisation correlated with the number-of-steps-per-diem compliance (r > +0.22).
[Show abstract][Hide abstract] ABSTRACT: To investigate and compare the osteogenesis of bone substitute materials.
52 Chbb: ch rabbits were divided into 5 groups. Five different porous biomaterials, including natural bovine hydroxyapatite (Bio-OSS, BK V/1), semi-synthetic coral hydroxyapatite interpore 500, synthetic tricalcium phosphate CEROS 82 and glass POROLITH, were implanted together with free periosteum into the muscle of rabbits for up to 3 and 6 weeks. Undecalcified sections were prepared for microradiography, light and UV microscopy, and morphometry.
Bone ingrowth was present in all such implantats. Bone formation was limited to the periphery of the Ceros blocks, that are lack of pore interconnection, while the other 4 materials with an interconnected porous system were infiltrated by bone into the centrum. Planimetric analyses showed that the specimens were composed of 6.5%-19.0% new bone at the 3rd week and 14.2%-25% at the 6th week respectively. The difference of bone ingrowth was only significant between Bio-OSS and BK V/1 at the 3rd week. No statistically significant difference of bone volume was found within the 6 week groups. There was a positive correlation between the new bone volume and the porosity of the materials.
For the bone ingrowth, the structure of the materials, specifically the pore and pore interconnections, is more impatant than the chemical composition.
No preview · Article · Aug 1996 · Zhonghua yi xue za zhi
[Show abstract][Hide abstract] ABSTRACT: We have used total hip replacement combined with cemented intramedullary nailing to treat a selected group of nine patients with pathological fractures of the proximal femur and impending fractures of the shaft due to metastases. One patient died from cardiopulmonary failure on the third postoperative day, but the others were able to walk within the first week after operation. Complications included one recurrent dislocation of the THR and one fracture of an osteolytic lesion of the femoral shaft during nail insertion. Both were managed successfully. The hybrid osteosynthesis which we describe is an alternative to the use of tumour or long-stem prostheses; it has the advantage of preserving bone stock and muscle attachments.
Preview · Article · Jun 1996 · The Bone & Joint Journal
[Show abstract][Hide abstract] ABSTRACT: From 1981 to 1995, 22 patients received intercalary bone allografts for reconstruction of the extremity after en bloc tumor resection (16 malignant, six benign lesions). Solid union of the graft-host sites within 15 months occurred in 86%. The overall survival rate of patients with high-grade lesions was four of seven and with low-grade lesions eight of nine after 4.5 years. Despite the high complication rate of 42%, intercalary bone allografts provide a valuable solution for reconstruction of the extremity after tumor resection in long bones.
No preview · Article · Feb 1996 · Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
[Show abstract][Hide abstract] ABSTRACT: From 1981 to 1993, 21 patients received intercalary bone allografts for reconstruction of the extremity after en bloc tumor resection (15 malignant and 6 benign tumors). The allografts were collected from multiorgan donors and cryopreserved at -70°C. The mean follow-up was 4.4 (range 1–13) years. The fate of the grafts was followed by conventional radiography, bone scintigraphy, and functional assessment. The overall survival rate of the 7 patients with high-grade malignancies was 86%. Solid union of the graft-host sites in less that 15 months occurred in 85%. An increased isotope uptake of the graft indicates that incorporation at the osteotomies as well as remodelling is still continuing at 9 years after operation. The overall complication rate was 43%; 3 patients had two or more complications. Complications were related to the allograft in 6 (infection or fatigue fracture in 1 and delayed healing in 4 cases) and to the osteosynthesis in 3 patients. The definitive results after treatment of complications show that satisfactory results have been obtained in all but 2 patients: 62% had excellent, 19% good, and 10% fair results. Intercalary allografts therefore provide a valuable solution for large skeletal defects after resection of bone tumors.
No preview · Article · Nov 1995 · Archives of Orthopaedic and Trauma Surgery