“…Its placement causes minimal soft-tissue disruption and is easily reproducible. 7 Although a blade plate and TTC screw construct was shown to be biomechanically superior to an IM nail construct in a previous study, the IM nail construct did not include the TTC screw. 4 That construct also did not include posterior-to-anterior interlocking screws, which have subsequently been shown to be biomechanically superior to lateral-to-medial interlocking screws.…”
“…Its placement causes minimal soft-tissue disruption and is easily reproducible. 7 Although a blade plate and TTC screw construct was shown to be biomechanically superior to an IM nail construct in a previous study, the IM nail construct did not include the TTC screw. 4 That construct also did not include posterior-to-anterior interlocking screws, which have subsequently been shown to be biomechanically superior to lateral-to-medial interlocking screws.…”
“…The authors did not find a study available in the literature involving more patients that underwent TTCA. 1,2,5,7,9,12 A literature search furthermore only produced two prospective studies of nailed TTCA in which the AOFAS system was used. 7,7…”
Section: Discussionmentioning
confidence: 99%
“…Non-union mainly occurred in the subtalar joint. 9,9 If one considers also TTCA studies that did not use the AOFAS score for the assessment of their patients, 1,2,6,7,10,12,13,16,19,20,27,28 the mean non-union rate was 12% (range, 0% to 43%).…”
Compared with the literature, the data obtained in this study show a good outcome and a high rate of bony union, with comparable complication rates. Patient satisfaction was good. However, the patients still had limitations. The clinical benefit of the nail used was confirmed.
“…Depending on where the initial bone is harvested from, in the autogenous graft procedure, various complications are known to develop which can compromise the health of the patient. Minor complications that have been reported are persistent donor-site pain (Summers and Eisenstein, 1989 ; Goulet et al, 1997 ; Schnee et al, 1997 ; Ebraheim et al, 2001 ), superficial injury of nerves (Smith et al, 1984 ), the formation of hematomas or seromas (Arrington et al, 1996 ; Westrich et al, 2001 ) and infection (Banwart et al, 1995 ; Arrington et al, 1996 ; Westrich et al, 2001 ). Major complications that can arise when using autograft protocols are the formation of deep hematomas, which lead to deep infections (Banwart et al, 1995 ; Arrington et al, 1996 ; Goulet et al, 1997 ; Sasso et al, 1998 ) and necrosis of harvest site when a large graft is utilized for transplantation (Barth, 1893 ).…”
A paradigmatic shift in the way of thinking is what bone tissue engineering science requires to decrypt the translation conundrum from animal models into human. The deductive work of Urist (1965), who discerned the principle of bone induction from the pioneering works of Senn, Huggins, Lacroix, Levander, and other bone regenerative scientists, provided the basis that has assisted future bone tissue regenerative scientists to extend the bone tissue engineering field and its potential uses for bone regenerative medicine in humans. However, major challenges remain that are preventing the formation of bone by induction clinically. Growing experimental evidence is indicating that bone inductive studies are non-translatable from animal models into a clinical environment. This is preventing bone tissue engineering from reaching the next phase in development. Countless studies are trying to discern how the formation of bone by induction functions mechanistically, so as to try and solve this enigmatic problem. However, are the correct questions being asked? Why do bone inductive animal studies not translate into humans? Why do bone induction principles not yield the same extent of bone formation as an autogenous bone graft? What are bone tissue engineering scientists missing? By critically re-assessing the past and present discoveries of the bone induction field, this review article attempts to re-discover the field of bone formation by induction, identifying some key features that may have been missed. These include a detailed library of all proteins in bones and their arrangement in the 3D superstructure of the bone together with some other important criteria not considered by tissue engineering scientists. The review therefore not only re-iterates possible avenues of research that need to be re-explored but also seeks to guide present and future scientists in how they assess their own research in light of experimental design and results. By addressing these issues bone formation by induction without autografts might finally become clinically viable.
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