Estimation of Defect Volume in Segmental Defects of the Tibia and Femur

Abdollahi, Karim; Kumar, Pradeep; Shepherd, Lane E.; Patzakis, Michael J.

doi:10.1097/00005373-199903000-00010

Cited by 5 publications

(2 citation statements)

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“…It has been calculated that reconstruction of a diaphyseal tibial or femoral defect requires an average of 7 cm 3 of autologous graft per centimeter of defect. If the defect is located in the metaphyseal region, the average amount required increases to 12 cm 3 [20]. Anterior and posterior iliac crests provide an average of 21 and 36 cc of graft, respectively [3].…”

Section: Discussionmentioning

confidence: 99%

Induced membrane technique using enriched bone grafts for treatment of posttraumatic segmental long bone defects

et al. 2019

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BackgroundReconstruction of posttraumatic bone defects represents a difficult challenge. The induced membrane technique is an effective two-stage procedure for bone defect reconstruction. To overcome the problems of autologous bone grafting, different graft substitutes have been investigated. The aim of the present study is to evaluate our clinical experience in reconstruction of critical posttraumatic bone defects using an induced membrane technique based on a combination of autologous graft and allograft (cancellous bone) enriched with platelet-rich plasma (PRP) and bone marrow concentrate aspirate (BMCA).Materials and methodsBetween 2009 and 2014, we reconstructed 18 posttraumatic bone defects in 16 patients. Their average length was 6.4 cm (range 1.6–13.2 cm). The defect location was the femur in nine cases (50%), the tibia in eight (44%) cases, and the humerus in one (6%) case. In all cases, we used a combination of autologous and cancellous allograft graft enriched with PRP and BMCA. Bone fixation was achieved using intramedullary nailing in 2 cases (11%), plating in 15 cases (66%), and external fixation in 1 case (6%).ResultsBoth clinical and radiographic union were achieved in 13 (72%) cases (13 patients). Five (28%) cases (four patients) developed nonunion. Nonunion was observed in two of eight (25%) tibial defects and in three (33%) of nine femoral defects (ns). Three of 4 (75%) double defects had delayed union, whereas 2 of 14 (14%) single defects did not heal (p = 0.016). The average length of the 13 defects that united was 6 cm (range 1.6–11.8 cm), while the length of the 5 defects that did not unite was 10.3 cm (range 6–13.2 cm) (p = 0.009).ConclusionsIn this series using an induced membrane technique based on a combination of autograft and allograft enriched with BMCA and PRP, the healing rate was lower than in other series where autologous bone graft alone was employed. Nonunion was more frequent in longer and double defects. Further research aimed at developing effective alternative options to autogenous cancellous bone graft is desirable.Level of evidence: III

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Section: Discussionmentioning

confidence: 99%

Induced membrane technique using enriched bone grafts for treatment of posttraumatic segmental long bone defects

et al. 2019

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“…Persistent residual pain, superficial infection, haematoma formation and superficial nerve lesion were considered minor complications, whereas fracture, intestinal herniation, deep infection and gait disturbance due to gluteal muscle insufficiency were considered major complications [8,9] . It takes ABGs of 5-7cc/cm and 6-12 cc/cm to replace diaphyseal and metaphyseal defects of the tibia and femur respectively [10] . The amount of available ABG is limited, with averages of 36 cc and 20 cc from the posterior and anterior iliac crest, respectively, and 12 cc from the proximal tibia metaphysis reported by Dawson et al [11] .…”

Section: Autologous Bone Graftsmentioning

confidence: 99%

Regenerative medicine in orthopaedic surgery

2021

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Regenerative medicine includes the use of technologies aimed at repairing or replacing damaged cells, tissues and organs, in order to restore their structure and function. The clinical indications for the use of regenerative medicine in orthopaedic surgery are degenerative diseases (arthritis, aseptic necrosis, osteochondritis), posttraumatic conditions (non-union) and osteoarticular segmental bone loss. The objective of tissue regeneration in orthopaedic surgery can be achieved with minimally invasive techniques or using open surgery with the application of biological or synthetic scaffolds, autologous mesenchymal stem cells, growth factors or specific surgical techniques and new-generation surgical devices. Three-dimensional bioprinting, the new frontier of tissue engineering, is a promising technology for regenerative medicine in orthopaedic surgery. In the present review, all the different techniques of bone tissue regeneration will be described with the aim of highlighting their evidence-based effectiveness and trying to define their specific role in different indications.

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Estimation of tibial shaft defect volume using standard radiographs: Development and validation of a novel technique

Dye

Vagts

Manson

et al. 2015

Injury

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Estimation of Defect Volume in Segmental Defects of the Tibia and Femur

Abstract: This method allows one to estimate the amount of graft required for a defect of the femur and the tibia.

Cited by 5 publications

References 6 publications

Induced membrane technique using enriched bone grafts for treatment of posttraumatic segmental long bone defects

Induced membrane technique using enriched bone grafts for treatment of posttraumatic segmental long bone defects

Regenerative medicine in orthopaedic surgery

Estimation of tibial shaft defect volume using standard radiographs: Development and validation of a novel technique

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