The Effect of Kryptonite Bone Cement combined with a Standard Kirschner Wire on Tibial Bone Fracture in Rats

Objective This study aims to observe whether Kryptonite Bone Cement combined with a standard Kirschner wire, instead of autogenous bone grafts, increases bone healing and mechanical strength in rats with tibia fractures. Methods The study included sixteen rats, which were divided into two groups as a control group (n=8) and an experimental group (n=8). After segmental fractures were made in both groups, intramedullary fixation of tibia procedures were conducted with the use of a Kirschner wire. No additional procedures were performed inthe control group, but Kryptonite Bone Cement was applied in the experimental group. The rats were evaluated clinically, radiologically and histologically4 times; immediately after the operation, and atthe 1st, 3rd, and 6thweeks following surgery. Results One rat from the experimental and one from the control group had both wound dehiscence and wound site infection. No recovery was observed in any rats either in the control or experimental group immediately after surgery. During week 1, callus formation was identified in 5 rats in the experimental group (p=0.0072), and during week 3, fracture lines disappeared in 4 rats in the experimental group (p=0.064); the differences between control and experimental groups were statistically significant. During week 6, no statistical significance was observed in radiological assessments for the control group and experimental group (p=0.71). The rate of non-union was higher in the control group (37.50%) than in the experimental one, while the rate of complete fusion was higher in the experimental group (87.50%) than that in the control group. Conclusion Osteoconductivity and ergonomic qualities of Kryptonite Bone Cement prove helpful in bone repair. Future studies to be conducted in a prospective and randomized manner will be effective on demonstrating the effectiveness of Kryptonite Bone Cement.

Hard and soft tissue augmentation of vertical ridge defects with the “hard top double membrane technique”: introduction of a new technique and a case report

<abstract> <p>Vertical ridge defects (VRD) of the jaws often require both bone and keratinized mucosa (KM) reconstruction. A new staged procedure is proposed to restore both hard and soft tissues in the VRD through a case report. A patient required the lower right second premolar and first molar rehabilitation. The first surgery aimed to restore the bone architecture through the use of a titanium reinforced dense-PTFE (TR-dPTFE) membrane, positioned and stabilized on top of tenting screws. This membrane didn't cover the whole defect, it just created an hard top that avoided the collapse of a collagen membrane that was placed over it. This resorbable membrane was stabilized with tacks and covered the whole defect, protecting a mixture of autogenous bone and porcine xenograft both lingually and buccally. The second surgery was performed after a 5 month healing time either to remove the tenting screws and the TR-dPTFE membrane, and to augment KM with a gingival graft harvested from the palate. Both regenerated hard and soft tissues were left to mature for 7 months before the third surgery. In this last stage implants insertion and healing abutments application were carried out in a straightforward way, since bone and KM had been previously restored. Two bone samples, harvested for histologic evaluation, stated a great amount of new bone formation. This new approach allowed inserting implants in matured and stable regenerated bone and augmented KM, avoiding the hard and soft tissue loss around implant neck that can affect the VRD treatments during healing.</p> </abstract>

Survival Rates of Dental Implants in Autogenous and Allogeneic Bone Blocks: A Systematic Review

Background and Objectives: Preliminary studies emphasize the similar performance of autogenous bone blocks (AUBBs) and allogeneic bone blocks (ALBBs) in pre-implant surgery; however, most of these studies include limited subjects or hold a low level of evidence. The purpose of this review is to test the hypothesis of indifferent implant survival rates (ISRs) in AUBB and ALBB and determine the impact of various material-, surgery- and patient-related confounders and predictors. Materials and Methods: The national library of medicine (MEDLINE), Excerpta Medica database (EMBASE) and Cochrane Central Register of Controlled Trials (CENTRAL) were screened for studies reporting the ISRs of implants placed in AUBB and ALBB with ≥10 participants followed for ≥12 months from January 1995 to November 2021. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed via several scoring tools, dependent on the study design. Means of sub-entities were presented as violin plots. Results: An electronic data search resulted in the identification of 9233 articles, of which 100 were included in the quantitative analysis. No significant difference (p = 0.54) was found between the ISR of AUBB (96.23 ± 5.27%; range: 75% to 100%; 2195 subjects, 6861 implants) and that of ALBB (97.66 ± 2.68%; range: 90.1% to 100%; 1202 subjects, 3434 implants). The ISR in AUBB was increased in blocks from intraoral as compared to extraoral donor sites (p = 0.0003), partially edentulous as compared to totally edentulous (p = 0.0002), as well as in patients younger than 45 as compared to those older (p = 0.044), cortical as compared to cortico-cancellous blocks (p = 0.005) and in delayed implantations within three months as compared to immediate implantations (p = 0.018). The ISR of ALBB was significantly increased in processed as compared to fresh-frozen ALBB (p = 0.004), but also in horizontal as compared to vertical augmentations (p = 0.009). Conclusions: The present findings widely emphasize the feasibility of achieving similar ISRs with AUBB and ALBB applied for pre-implant bone grafting. ISRs were negatively affected in sub-entities linked to more extensive augmentation procedures such as bone donor site and dentition status. The inclusion and pooling of literature with a low level of evidence, the absence of randomized controlled clinical trials (RCTs) comparing AUBB and ALBB and the limited count of comparative studies with short follow-ups increases the risk of bias and complicates data interpretation. Consequently, further long-term comparative studies are needed.

Does Local Vancomycin Powder Impregnated with Autogenous Bone Graft and Bone Substitute Decrease the Risk of Deep Surgical Site Infection in Degenerative Lumbar Spine Fusion Surgery? - an Ambispective Study

Background:Deep surgical site infection (DSSI) is one of the most challenging complications in lumbar fusion surgery. Few investigations examined the effect of vancomycin powder mixed with ABG and bone substitutes on preventing DSSI in degenerative lumbar fusion surgeries as well as any interference with bony fusion. The aim of the study was to investigate the effects of autogenous bone graft (ABG) along with bone substitutes as a local vancomycin delivery system on preventing DSSI in lumbar instrumented fusion and compared with those who did not use vancomycin powder.Methods: From January, 2015 through December, 2015, a one-year prospective study using vancomycin powder mixed with ABG and bone substitute for degenerative lumbar fusion surgeries as vancomycin (V) group, 1 gm vancomycin for 2 and 3-level, and 2 gm for more than 3-level instrumentation. From December, 2013 through December 2014, patients received degenerative lumbar fusion surgeries without using vancomycin before the vancomycin protocol were retrospectively enrolled as non-vancomycin (NV) group. Vancomycin concentration was checked at post-operative days 1 and 3 for both the serum and drainage. Patients’ demographic data, microbiology reports, fusion status and functional outcomes were evaluated. Results:One hundred and ten patients were enrolled prospectively in the V group, and 86 for the NV group. After an average 41 months follow-up (range, 36-54), 3 patients (3.48%) developed postoperative DSSIs in the NV group, thereby requiring revision surgeries and parenteral antibiotics treatment versus no DSSIs (0%, 0/100) in the V group. (p=0.048). The postoperative serum vancomycin levels were undetectable and no vancomycin related side effects was encountered. The mean vancomycin concentration of drainage at postoperative days 1 and 3 were 517.96 ± 174.4 and 220.14 ± 102.3 mg/mL, respectively. At final follow-up, there was no statistical difference observed in terms of clinical and radiologic outcomes. Conclusions: Our vancomycin protocol may reduce the incidence of DSSI in degenerative lumbar fusion surgery without affecting bony fusion.

Distal 3rd Diaphysial Fracture of Humerus Fixed with Dynamic Compression Plate Using Posterior Approach- The Assessment of the Outcome

Objectives: The effectiveness of open reduction and Dynamic Compression Plate (DCP) fixation with or without autogenous bone grafting using the posterior midline approach in the treatment of distal third diaphyseal humeral fractures was assessed. Methods: For humeral nonunion, comminuted fractures, or early failure of conservative therapies, 33 patients (24 men, 9 women; mean age 37 years; range 20 to 60 years) were operated on. The study was carried out at Dhaka Medical College Hospital (DMCH), Dhaka from July 2005 to December 2006. Results: After an average of 17 weeks, all of the patients had union (range 14 to 26 weeks).There was no deep infection, nonunion, malunion, implant failure, or nerve injury in any of the patients. In two cases, transient radial nerve palsy occurred. Minor infections were seen in four of the individuals. All of the patients were pain-free after surgery.The functional outcome was outstanding in all instances and good in 16 patients, yielding 87 % satisfying results. Functional outcomes increased considerably postoperatively compared to preoperatively (p<0.001). In 20 individuals, the range of motion of the shoulders was great. The range of motion at the elbow was considerable in 21 patients and moderate in seven others. More than three-quarters of the patients (75.8%) experienced no problems. Four patients (12.1%) were infected, and two patients (6.1%) developed iatrogenic radial nerve palsy as a result of the surgery. One patient (3%) had a loose screw, while another (3%) needed blood transfusions owing to extensive bleeding at the donor graft site. Conclusion: In distal third humeral fractures, open reduction and posterior DCP fixing, with or without autogenous bone grafting, is a safe and effective treatment option, especially when there is no infection or bony or neurovascular damage. Very few study conducted on distal 3rd diaphysial fracture of humerus fixed with DCP using posterior approach, therefore this study conducted to know the assessment of the outcome.

Graft Tulang Alveolar dan Pemberian Terapi Oksigen Hiperbarik pada Gnatoschizis: Laporan Kasus

Gnatoschizis is a congenital disorder due to complex causes involving many genetic and environmental factors. The shape and complexity of the cleft varies greatly, which will determine the final outcome of the reconstruction. The management involves a multidisciplinary approach including orthodontics, prosthodontics, as well as speech and psychological therapist. Bone grafting materials such as iliac crest (corticocancellous autogenous), bone morphogenetic proteins and recombinant human proteins have shown good long-term results. An additional method that is considered effective in accelerating bone growth is the administration of hyperbaric oxygen therapy (HBOT) which has been reported to increase the accumulation of minerals needed for osteogenesis, such as calcium, magnesium, and phosphorous. We reported a case of a 14-year-old girl with gnatoschizis who underwent an alveolar bone graft surgery and one day after the operation was immediately followed by administration of (HBOT) to improve the bone healing process. cleft location. Autogenous iliac bone graft was used for closure of the bony defect at the site of the cleft. Follow up at day-14 showed a satisfying result. In conclusion, in this patient continuity of upper dental arch was achieved as well as optimal alar basis, no fistula, stabile upper dental arch for orthodontic treatment, and ideal alveolar morphology that supported the ultimate goal of cleft palate treatment - improvement of quality of life.Keywords: gnatoschizis; alveolar bone graft; hyperbaric oxygen therapy Abstrak: Gnatoschizis merupakan kelainan kongenital dengan penyebab kompleks yang meli-batkan banyak faktor genetik dan lingkungan. Bentuk dan kompleksitas sumbing sangat bervariasi, yang akan menentukan hasil akhir rekonstruksi. Tatalaksananya melibatkan pendekatan multi-disiplin termasuk ortodontik, prostodontik, serta terapi wicara dan psikologis. Bahan pencang-kokan tulang seperti krista iliaka (corticocancellous autogenous), protein morfogenetik tulang dan protein manusia rekombinan telah menunjukkan hasil jangka panjang yang baik. Salah satu metode tambahan yang dianggap efektif mempercepat pertumbuhan tulang ialah pemberian terapi oksigen hiperbarik (TOHB) yang telah dilaporkan meningkatkan akumulasi mineral yang dibutuh-kan untuk osteogenesis, seperti kalsium, magnesium, dan fosfor. Kami melaporkan kasus seorang anak perempuan berusia 14 tahun dengan gnatoschizis yang menjalani operasi cangkok tulang alveolar dan satu hari setelah operasi langsung dilanjutkan pemberian TOHB untuk meningkatkan proses penyembuhan tulang. Cangkok tulang iliaka autogenous digunakan untuk penutupan defek tulang di lokasi sumbing. Follow up pada hari ke 14 di poliklinik dengan pemeriksaan fisik pada defek lokasi sumbing mendapatkan hasil yang memuaskan. Simpulan laporan kasus ialah pada pasien ini diperoleh kontinuitas lengkung rahang atas, basis alar yang optimal, fistula dihilangkan, segmen rahang atas yang stabil untuk perawatan ortodontik, dan morfologi alveolar yang ideal yang menyokong tujuan akhir tatalaksana sumbing yaitu perbaikan kualitas hidup.Kata kunci: gnatoschizis; cangkok tulang alveolar; terapi oksigen hiperbarik

A Clinical Study on the Effect of Different Ratios of Recombinant Human Bone Morphogenetic Protein-2 Compound to Autogenous Bone on Cervical Interbody Fusion Based on Smart Healthcare

With an increasing elderly population worldwide, the incidence of spine degenerative diseases with neck and shoulder pain as the main symptom is rising obviously, which has now become one of the important and difficult problems in sociomedical science. This study was to explore the effects of different ratios of recombinant human bone morphogenetic protein-2 (rhBMP-2) compound to the autogenous bone on cervical interbody fusion. 90 cervical degeneration patients with the need of surgical treatment admitted to our hospital from January 2019 to January 2020 were selected as the research objects and equally divided into group A, group B, and group C according to the order of admission, with 30 cases in each group and the ratios of rhBMP-2 compound to autogenous bone being 2 : 1, 1 : 1, and 1 : 2 respectively, and standard anterior cervical diskectomy and fusion (ACDF) treatment was performed to all patients to compare their surgery-related indexes, the Japanese Orthopaedic Association (JOA) score, the visual analog scale (VAS) score, the effect of cervical interbody fusion, and the postoperative complication rate (CR). Compared with group A and group C, group B achieved the significantly better surgery-related indexes ( P < 0.05 ), significantly higher postoperative JOA scores ( P < 0.05 ), significantly lower postoperative neck and upper limb VAS scores ( P < 0.05 ), significantly better effect of cervical interbody fusion ( P < 0.05 ), and significantly lower postoperative CR ( P < 0.05 ). 1 : 1 is the best ratio of rhBMP-2 compound to the autogenous bone, for it can optimize patients’ perioperative indexes, reduce the postoperative pain, lower the possibility of complications, and improve the effect of cervical interbody fusion, which should be promoted and applied in practice.

Efficacy of Ankle Arthodesis with Retrograde Sign Nail

Aim: To evaluate the efficacy of ankle arthrodesis by using Retrograde SIGN Nail. Study Design: Retrospective study. Place and Duration of the Study: Department of Orthopaedic & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore from 1st January 2018 to 30th June 2020. Methodology: Thirty patients were enrolled for arthrodesis by using retrograde nails. Clinical and radiological examination confirmed the severe arthritis of the subtalar joints in all cases. Surgical procedure was initiated by using lateral incision fibula segment of 1.5 cm was excised 6-8 cm proximal to the fibula tip. After adequate exposure, from proximal lateral to distal medial, approximately 5-6 cm transaction of the fibula was made obliquely. Soft tissue was the initiating point of dissection and the portion was placed on the back table for further use as an autogenous bone graft. To expose the medial gutter, approximately 2-3 cm incision was carefully made at medial to the tibialis anterior tendon without indulging saphenous nerve and vein. Results: A weak positive Pearson correlation was found between BMI and FAAM score but a significant (P=0.00001). Conclusion: Retrograde nailing techniques help to achieve the goals of the union. It also assists in the preservation of hind foot alignment. Keywords: Ankle deformity, Ankle arthrodesis, Ankle arthritis, Retrograde nailing