Aims

The aim of this study was to assess the safety and clinical outcome of patients with a femoral shaft fracture and a previous complex post-traumatic femoral malunion who were treated with a clamshell osteotomy and fixation with an intramedullary nail (IMN).

Aims

Many authors have reported a shorter treatment time when using trifocal bone transport (TFT) rather than bifocal bone transport (BFT) in the management of long segmental tibial bone defects. However, the difference in the incidence of additional procedures, the true complications, and the final results have not been investigated.

Introduction. Osteochondral defects (OCDs) of the talus are treated initially by arthroscopic bone marrow stimulation. For both large and secondary defects, current alternative treatment methods have disadvantages such as donor site morbidity or two-stage surgery. Demineralized bone matrix (DBM) was published for the treatment of OCDs of rabbit knees. Autologous platelet-rich plasma (PRP) may improve the treatment effect of DBM. We previously developed a goat model to investigate new treatment methods for OCDs of the talus. The aim of the current study was to test whether DBM leads to more bone regeneration than control OCDs, and whether PRP improves the effectiveness of DBM. Methods. A standardized 6-mm OCD was created in 32 ankles of 16 adult Dutch milk goats. According to a randomized schedule, 8 goats were treated with commercially available DBM (Bonus DBM, Biomet BV, Dordrecht, the Netherlands) hydrated with normal saline, and 8 were treated with the same DBM but hydrated with autologous PRP (DBM+PRP). The contralateral ankles (left or right) were left untreated and served as a control. The goats were sacrificed after 24 weeks and the tali were excised. The articular talar surfaces were assessed macroscopically using the international cartilage repair society (ICRS) cartilage repair assessment, with a maximum score of 12. Histologic analysis was performed using 5-μm sections, and histomorphometric parameters (bone% and osteoid%) were quantified on representative areas of the surface, center, and peripheral areas of the OCDs. Furthermore, μCT-scans of the excised tali were obtained, quantifying the bone volume fraction, trabecular number, trabecular thickness, and trabecular spacing in both the complete OCDs and the central 3-mm cylinders. Results. All goats recovered well and were able to bear full weight within 24 hours after surgery. The mean ICRS-score of the ankles treated with DBM was 8.0 ± 1.0, compared to a score of 8.4 ± 1.5 in the contralateral ankle (NS); those treated with DBM+PRP scored 6.9 ± 2.4, compared to 7.4 ± 2.0 in the contralateral ankle (NS). Histologic analysis showed four different patterns of healing, distributed evenly over the treatment and control groups: type 1 (n = 4), almost completely healed; type 2 (n = 11), restoration of the subchondral bone with a cystic lesion underneath; type 3 (n = 14), superficial defect with regeneration from the margins and bottom; type 4 (n = 3), no healing tendency. Histomorphometry and μCT revealed no statistically significant difference between treatment (DBM or DBM+PRP) and contralateral control or between both treatment groups in any of the parameters investigated. Conclusion. No treatment effect of DBM was found compared to control defects, and the addition of PRP was not beneficial

Introduction. We evaluated the osteogenic potential of a novel biomimetic bone paste (DBSint®), made of a combination of a human demineralized bone matrix (hDBM) and a nano-structured magnesium-enriched hydroxyapatite (Mg-HA), in a standardized clinical model of high tibial osteotomy for genu varus. Methods. A prospective, randomized, controlled study was performed and thirty patients were enrolled and assigned to three groups: DBSint® (Group I), nano-structured Mg-HA (SINTlife®) (Group II) and lyophilized-bone-chips (Group III). Six weeks after surgery, computed tomography-guided biopsies of the grafts were performed. Clinical/radiographic evaluation was performed at six weeks, twelve weeks, six months, one and 2 year after surgery, in order to verify if the graft type influenced the healing rate. Results. By histomorphometry, DBSint® was shown able to promote a quick and effective bone tissue regeneration, superior to the healing process occurred in presence of SINTlife® and lyophilized bone chips. At a mean follow up of 32,59 months, no statistical differences between the groups were found, both pre-and post-operatively, according to the Knee Society Scoring System. Mean time of ostointegration was 3,9 months in the DBSint® group, 4,2 months in the lyophilized-bone group and 4,5 in the SINTlife® group. Discussion/conclusion. Orthopedic practice may be adversely affected by an inadequate bone repair that might compromise the success of surgery. Therapy for bone regeneration with DBSint® could be particularly attractive in the treatment of patients with bone defects difficult to heal, where it could shorten the period necessary for bone regeneration, due to the higher osteogenetic potential

Over a five-year period, adult patients with marginal impaction of acetabular fractures were identified from a registry of patients who underwent acetabular reconstruction in two tertiary referral centres. Fractures were classified according to the system of Judet and Letournel. A topographic classification to describe the extent of articular impaction was used, dividing the joint surface into superior, middle and inferior thirds. Demographic information, hospitalisation and surgery-related complications, functional (EuroQol 5-D) and radiological outcome according to Matta’s criteria were recorded and analysed. In all, 60 patients (57 men, three women) with a mean age of 41 years (18 to 72) were available at a mean follow-up of 48 months (24 to 206). The quality of the reduction was ‘anatomical’ in 44 hips (73.3%) and ‘imperfect’ in 16 (26.7%). The originally achieved anatomical reduction was lost in12 patients (25.8%). Radiologically, 33 hips (55%) were graded as ‘excellent’, 11 (18.3%) as ‘good’, one (1.7%) as ‘fair’ and 15 (25%) as ‘poor’. A total of 11 further operations were required in 11 cases, of which six were total hip replacements.

Univariate linear regression analysis of the functional outcome showed that factors associated with worse pain were increasing age and an inferior location of the impaction. Elevation of the articular impaction leads to joint preservation with satisfactory overall medium-term functional results, but secondary collapse is likely to occur in some patients.

Cite this article: Bone Joint J 2013;95-B:230–8.

We reviewed 59 bone graft substitutes marketed by 17 companies currently available for implantation in the United Kingdom, with the aim of assessing the peer-reviewed literature to facilitate informed decision-making regarding their use in clinical practice. After critical analysis of the literature, only 22 products (37%) had any clinical data. Norian SRS (Synthes), Vitoss (Orthovita), Cortoss (Orthovita) and Alpha-BSM (Etex) had Level I evidence. We question the need for so many different products, especially with limited published clinical evidence for their efficacy, and conclude that there is a considerable need for further prospective randomised trials to facilitate informed decision-making with regard to the use of current and future bone graft substitutes in clinical practice.

Cite this article: Bone Joint J 2013;95-B:583–97.

We investigated the stability of seven Schatzker type II fractures of the lateral tibial plateau treated by subchondral screws and a buttress plate followed by immediate partial weight-bearing. In order to assess the stability of the fracture, weight-bearing inducible displacements of the fracture fragments and their migration over a one-year period were measured by differentially loaded radiostereometric analysis and standard radiostereometric analysis, respectively. The mean inducible craniocaudal fracture fragment displacements measured −0.30 mm (−0.73 to 0.02) at two weeks and 0.00 mm (−0.12 to 0.15) at 52 weeks. All inducible displacements were elastic in nature under all loads at each examination during follow-up. At one year, the mean craniocaudal migration of the fracture fragments was −0.34 mm (−1.64 to 1.51).

Using radiostereometric methods, this case series has shown that in the Schatzker type II fractures investigated, internal fixation with subchondral screws and a buttress plate provided adequate stability to allow immediate post-operative partial weight-bearing, without harmful consequences.