Background:
Little is known about the volumetric changes of grafted bone over time when using the induced membrane technique. This study investigates the volumetric changes of bone graft using serial computed tomographic (CT) scans following the induced membrane technique.
Methods:
Patients with critical-sized bone defects had serial CT scans after undergoing bone-grafting using the induced membrane technique. CT scans to evaluate the volume of bone graft were obtained immediately postoperatively and at 6 and 12 months. The change in the volume of bone graft was determined at 6 and 12 months postoperatively. Patient demographic characteristics, the location and composition of the bone graft, and the type of fixation construct were analyzed.
Results:
Forty patients met inclusion criteria. There were 27 tibiae and 13 femora with a mean size defect of 8.6 cm (range, 2.5 to 20.6 cm). Of these patients, 21 received autograft with cancellous bone graft and 19 received mixed autogenous bone with demineralized bone matrix (DBM) at a mean time of 17 weeks after the membrane formation. For the first 6 months, there was an overall osseous resorption of −9.9%. The overall graft volume from 6 to 12 months demonstrated an increase of osseous volume by +1.6%. For the entire 12-month period, there was a mean graft volume resorption of −8.3%. A correlation was found between the early volumetric changes of grafted bone and the percentage of DBM in the graft mixture. A correlation was also found between the late volumetric changes and the location of defect or the type of fixation.
Conclusions:
At 1 year after use of the induced membrane technique for the treatment of a critical-sized bone defect, resorption of the grafted bone averaged −8.3%. The volumetric changes were influenced by the property of the grafted bone, the fixation construct, and the location of the defect.
Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Background
Open pelvic fractures are associated with pelvic-perineal soft tissue injuries and pelvic infections as late complications. The study aimed to analyse and compare the clinical results and medical costs of the conventional and modified instillation negative-pressure wound therapy (cNPWT and m-iNPWT, respectively).
Methods
This retrospective study compared the outcomes of cNPWT and m-iNPWT for soft tissue management in patients with open pelvic fractures. We analysed the Injury Severity Score (ISS), hospital stay, medical costs, number of NPWT, time required to reach definite wound coverage, and occurrence of complications.
Results
Seventeen patients with open pelvic fractures were treated with NPWT. The median ISS (interquartile range) for m-iNPWT and cNPWT were 40 (26–48) and 43 (35–43), respectively. The numbers of NPWT changes were 6 (3–8) for m-iNPWT and 21 (20–32) for cNPWT. The time to wound coverage for patients who underwent m-iNPWT and cNPWT was 30 and 49 days, respectively. The overall medical costs of m-iNPWT and cNPWT were 80076 and 248395 USD. The hospital and intensive care unit (ICU) stay was 53 (41–70) and 12 (5–26) days for m-iNPWT and 167 (107–284) and 43 (23–151) days for cNPWT. One patient receiving cNPWT died of pelvic sepsis during ICU treatment.
Conclusions
Our study findings indicate that m-iNPWT would be a feasible method for complex pelvic soft tissue infection in open pelvic fractures to reduce complication rates, hospital stay, and medical costs.
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