Donor site morbidity with reamer-irrigator-aspirator (RIA) use for autogenous bone graft harvesting in a single centre 204 case series

Qvick, Lars M.; Ritter, Christopher; Mutty, Christopher E.; Rohrbacher, Bernhard J.; Buyea, Cathy; Anders, Mark J.

doi:10.1016/j.injury.2013.06.008

Cited by 47 publications

(34 citation statements)

References 46 publications

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“…It may result in loss of large volumes of blood during harvest. Lowering of 2 to 3 g of Hb levels are known6061 after RIA harvest. This precludes its use in anemic patients.…”

Section: Masquelet-induced Membrane Techniquementioning

confidence: 99%

Infected nonunion of tibia

Chaudhary¹

2017

IJOO

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Infected nonunions of tibia pose many challenges to the treating surgeon and the patient. Challenges include recalcitrant infection, complex deformities, sclerotic bone ends, large bone gaps, shortening, and joint stiffness. They are easy to diagnose and difficult to treat. The ASAMI classification helps decide treatment. The nonunion severity score proposed by Calori measures many parameters to give a prognosis. The infection severity score uses simple clinical signs to grade severity of infection. This determines number of surgeries and allows choice of hardware, either external or internal for definitive treatment. Co-morbid factors such as smoking, diabetes, nonsteroidal anti-inflammatory drug use, and hypovitaminosis D influence the choice and duration of treatment. Thorough debridement is the mainstay of treatment. Removal of all necrotic bone and soft tissue is needed. Care is exercised in shaping bone ends. Internal fixation can help achieve union if infection was mild. Severe infections need external fixation use in a second stage. Compression at nonunion site achieves union. It can be combined with a corticotomy lengthening at a distant site for equalization. Soft tissue deficit has to be covered by flaps, either local or microvascular. Bone gaps are best filled with the reliable technique of bone transport. Regenerate bone may be formed proximally, distally, or at both sites. Acute compression can fill bone gaps and may need a fibular resection. Gradual reduction of bone gap happens with bone transport, without need for fibulectomy. When bone ends dock, union may be achieved by vertical or horizontal compression. Biological stimulus from iliac crest bone grafts, bone marrow aspirate injections, and platelet concentrates hasten union. Bone graft substitutes add volume to graft and help fill defects. Addition of rh-BMP-7 may help in healing albeit at a much higher cost. Regeneration may need stimulation and augmentation. Induced membrane technique is an alternative to bone transport to fill gaps. It needs large amounts of bone graft from iliac crest or femoral canal. This is an expensive method physiologically and economically. Infection can resorb the graft and cause failure of treatment. It can be done in select cases after thorough eradication of infection. Patience and perseverance are needed for successful resolution of infection and achieving union.

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“…It may result in loss of large volumes of blood during harvest. Lowering of 2 to 3 g of Hb levels are known6061 after RIA harvest. This precludes its use in anemic patients.…”

Section: Masquelet-induced Membrane Techniquementioning

confidence: 99%

Infected nonunion of tibia

Chaudhary¹

2017

IJOO

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“…The gold standard therapy for fracture non‐union remains the implantation of bone autograft . However, its use is associated with problems including limited accessibility, formation of haematoma, bleeding, infection, and harvest‐related pain . The use of autograft substitutes, such as allograft scaffolds provides a valid alternative, particularly when these scaffolds are loaded with autologous bone marrow (BM) aspirates, growth factors or their combination .…”

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confidence: 99%

Collagen‐containing scaffolds enhance attachment and proliferation of non‐cultured bone marrow multipotential stromal cells

El‐Jawhari

Sanjurjo‐Rodríguez

Jones

et al. 2015

Journal Orthopaedic Research

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Large bone defects are ideally treated with autografts, which have many limitations. Therefore, osteoconductive scaffolds loaded with autologous bone marrow (BM) aspirate are increasingly used as alternatives. The purpose of this study was to compare the growth of multipotential stromal cells (MSCs) from unprocessed BM on a collagen‐containing bovine bone scaffold (Orthoss® Collagen) with a non‐collagen‐containing bovine bone scaffold, Orthoss®. Another collagen‐containing synthetic scaffold, Vitoss® was included in the comparison. Colonization of scaffolds by BM MSCs (n = 23 donors) was evaluated using microscopy, colony forming unit‐fibroblast assay and flow‐cytometry. The number of BM MSCs initially attached to Orthoss® Collagen and Vitoss® was similar but greater than Orthoss® (p = 0.001 and p = 0.041, respectively). Furthermore, the number of MSCs released from Orthoss® Collagen and Vitoss® after 2‐week culture was also higher compared to Orthoss® (p = 0.010 and p = 0.023, respectively). Interestingly, collagen‐containing scaffolds accommodated larger numbers of lymphocytic and myelomonocytic cells. Additionally, the proliferation of culture‐expanded MSCs on Orthoss® collagen and Vitoss® was greater compared to Orthoss® (p = 0.047 and p = 0.004, respectively). Collectively, collagen‐containing scaffolds were superior in supporting the attachment and proliferation of MSCs when they were loaded with unprocessed BM aspirates. This highlights the benefit of collagen incorporation into bone scaffolds for use with autologous bone marrow aspirates as autograft substitutes. © 2015 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 34:597–606, 2016.

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“…Qvich et al [50] evaluated donor site morbidity and complication rate associated with the RIA system for intramedullary, nonstructural autogenous bone graft harvesting: the complication rate in 204 RIA procedures in 184 patients was 1.96% (N = 4).…”

Section: Discussionmentioning

confidence: 99%