OBJECTIVETo introduce a technique pertaining to S2 iliosacral screw insertion.

METHODSThe screw pathway was first measured on the preoperative pelvic CT scan or the standard sacral lateral radiograph to make sure the existence of the "safe zone" in the S2 segment for screw insertion. Under general anesthesia, patients were positioned supine or prone, depending on the injury pattern of pelvic ring or associated injuries requiring concomitant operation. The operation field was routinely sterilized using iodine and subsequent alcohol solution and draped. The tip of a guide wire was inserted through a stab wound to the posterior outer iliac table, manipulated in the "safe zone" being enclosed by the anterior aspect of the S2 nerve root tunnel, the anterior aspect of the sacral vertebrae, and the inferior aspect of the S1 foramen under the guidance of the standard sacral lateral fluoroscopy, and then the tip was hammered one to two millimeters into the iliac cortex. The guide wire progressed along the trajectory between the inferior aspect of the S1 foramen and the superior aspect of the S2 foramen on the pelvic outlet fluoroscopic view, and then along the posterior to the anterior aspect of the S2 sacral vertebrae and alae on the pelvic inlet fluoroscopic view with a predetermined length. At that moment, in order to ensure the safety, another standard sacral lateral view was imaged to detect the guide wire's tip which should locate posterior to the anterior aspect of the sacral vertebrae and anterior to the anterior aspect of the S2 nerve root tunnel. Subsequently, the depth was measured, the trajectory was drilled and tapped, and the screw was inserted. Following the removal of the guide wire, the wound was irrigated and sutured.

RESULTSUtilizing this insertion technique, there were 30 S2 iliosacral screws in total being placed to stabilize the injured and unstable posterior pelvic ring in 27 patients. Each S2 screw was accompanied by an ipsilateral S1 screw. The S2 screw location was completely intraosseous in all patients, which was verified by postoperative pelvic outlet and inlet radiographs and CT scans. The insertion accuracy was 100 percent in the present series.

CONCLUSIONThe S2 iliosacral screw insertion technique is safe and reproducible to guide the placement of the S2 screw, enhancing the stability for the compromised posterior pelvic ring.

Adult ; Bone Screws ; Female ; Fractures, Bone ; surgery ; Humans ; Ilium ; injuries ; surgery ; Male ; Sacrum ; injuries ; surgery

OBJECTIVETo evaluate the feasibility and outcomes of chimeric deep circumflex iliac artery perforator flap (DCIAPF) applied in the simultaneous reconstruction of the oromandibular defect.

METHODSSix patients underwent simultaneous oromandibular reconstruction using DCIAPF following segmental mandibulectomy in Xiangya Hospital from March 2014 to July 2014. The skin paddle was designed to be centered on the pre-operative perforator mapping. Retrograde dissection was performed through the underlying abdominal wall to raise the skin paddle. The pedicle was isolated from the groin, and the iliac crest was cut. The deep iliac circumflex vessels were dissected until the skin paddle was reached. Finally, the donor site was strictly sutured layer by layer to avoid ventral hernia.

RESULTSThe skin paddles ranged from 3.5 cmx5.0 cm to 7.0 cmx 10.0 cm. The length of the bone components was 5.0 cm to 11.0 cm. All donor sites closed primarily without skin grafting. DCIAPF was harvested successfully in five patients, except for one patient whose perforator originated from the superficial iliac circumflex vessels. An additional pair of anastomoses was performed. All iliac flaps survived. However, slight skin-edge necrosis and exfoliation caused by flap thinning occurred in one patient and healed after pruning and dressing change. The heights of all alveolar ridges were significantly restored, and no serious donorsite complication was observed during the three to six months' follow-up.

CONCLUSIONDCIAPF is a reconstructive option for mandibular defects because of its adequate bone tissue and rich blood supply. Satisfactory alveolar ridge restoration greatly facilitates future denture retention. DCIAPF also has a great degree of mobility between the skin paddle and the bone component when appliedin composite oromandibular defect reconstruction.

Humans ; Iliac Artery ; Ilium ; Mandible ; surgery ; Maxillofacial Abnormalities ; surgery ; Perforator Flap ; Reconstructive Surgical Procedures ; methods ; Skin

OBJECTIVETo investigate the anatomical features of iliac bone grafts used for mandibular reconstruction and dental implantation.

METHODSSixteen cadavers were dissected. The length, width, height and cortical thickness of the iliac bone were measured with respect to points determined by the relative dimensions of the bone.

RESULTSThe length of iliac bone graft was (77.2 ± 6.1) mm. The height was from (38.2 ± 4.2) mm to (41.9 ± 4.7) mm. The width decreased from iliac crest to base line. The least width 10 mm and 15 mm away from iliac crest were (8.4 ± 2.2) mm and (6.5 ± 2.1) mm respectively. The greatest mean cross-sectional cortical thickness at the intermediate line of the iliac crest was (3.4 ± 0.8) mm.

CONCLUSIONSAnatomical features of iliac bone are suitable for designing bone grafts for mandibular reconstruction followed by dental implantation.

Bone Transplantation ; Dental Implantation, Endosseous ; methods ; Humans ; Ilium ; anatomy & histology ; transplantation ; Mandible ; surgery ; Mandibular Reconstruction ; methods

OBJECTIVETo explore clinical curative effects of bilateral bone plate with autogenous iliac bone graft for the treatment of Schatzker IV-VI complex tibial plateau fractures.

METHODSFrom December 2011 to December 2013,32 patients with complex tibial plateau fractures (Schatzker IV-VI) were operated by bilateral bone plate with autogenous iliac bone graft. Among them,including 20 males and 12 females with an average age of 37.4 years old ranged from 19 to 54 years old; 14 cases on the left side and 18 cases on the right side; the time from injury to operation ranged from 5 h to 9 d with an average of 3.5 d. According to Schatzker classification, 8 cases were type IV, 16 cases were type V and 8 cases were type VI; according to Oestern closed fracture classification, 5 cases were type I , 19 cases were type II, 7 cases were type III and 1 case was type IV. Postoperative complications were observed and Lysholm scoring were used to evaluate functional assessment.

RESULTSThirty-two patients were followed up from 10 to 23 months with an average of 14 months. According to Lysholm scoring, totall score was 88.91 ± 8.41, 20 cases got excellent results, 9 moderate and 3 poor. One patient occurred postoperative wound infection and exposure of tibia,while healed after dressing changing and skin flap transplantation. All patients were removed internal fixation ranged from 12 to 18 months without fracture non-union.

CONCLUSIONBilateral bone plate with autogenous iliac bone graft for the treatment of Schatzker IV-VI complex tibial plateau fractures has advantages of clear exposure, stable fixation, less trauma to the intraoperative blood supply and good fracture healing.

Adult ; Bone Plates ; Female ; Humans ; Ilium ; transplantation ; Male ; Middle Aged ; Tibial Fractures ; surgery ; Transplantation, Autologous

Masquelet technique is one of the modalities for the treatment of long bone defect. Using cancellous bone graft to fill the bone defect is always a concern in children due to the small size of their iliac crest and open growth plate. We reported a case of 13-year-old male who presented with gap non-union of middle third of tibia. We applied a modified Masquelet technique by using only the cortical fibular graft instead of cancellous bone to fill the space surrounded by induced membrane. Fibula was used as a nonvascularized strut graft and matched stick graft to achieve complete union. We concluded that nonvascularized fibula grafting is an easy and effective option to fill the bone defect in children in the second stage of Masquelet technique.
Male ; Child ; Humans ; Adolescent ; Fracture Healing ; Bone Transplantation/methods* ; Fibula/transplantation* ; Tibia/surgery* ; Ilium/transplantation*

Objective: To explore the clinical effects of proximal ulnar artery perforator flap combined with iliac bone graft in the reconstruction of subtotal thumb or finger defects. Methods: A retrospective observational study was conducted. From August 2016 to August 2019, 7 patients with thumb or finger defects caused by mechanical damage who met the inclusion criteria were admitted to Ruihua Affiliated Hospital of Soochow University, including 6 males and 1 female, aged 46 to 58 years. Their length of fingers was repaired with iliac bone, with length of 2.0 to 3.0 cm. After the bone graft, the skin defect area of the affected finger ranged from 2.8 cm×2.2 cm to 6.0 cm×3.2 cm. Then the free proximal ulnar artery perforator flap with area of 3.0 cm×2.4 cm to 6.5 cm×3.5 cm was used to cover the wounds. The wounds in donor sites of iliac crest and flap were directly sutured. The survival of flap in one week post surgery and the donor site wound healing in 2 weeks post surgery were observed, respectively. During the follow-up, the appearance and sensory function of the affected finger, bone healing, and scar hypertrophy of wound in the donor site were observed and evaluated. At the last follow-up, the functional recovery of the affected finger was evaluated with trial standard for the evaluation of functions of the upper limbs of the Hand Surgery Society of Chinese Medical Association. Results: In one week post surgery, all the flaps survived. In 2 weeks post surgery, the iliac bone and the wounds in forearm donor site healed. During the follow-up of 5 to 13 months, the flap was good in appearance, without obvious pigmentation; the sensory recovery reached level S₂ in 5 patients and S₀ in 2 patients; all the grafted iliac bones were bony union without obvious resorption; the wounds in donor site healed well, with only mild scar formation. At the last follow-up, the shape of the reconstructed finger was close to the healthy finger, and the functional evaluation results were excellent in 3 cases and good in 4 cases. Conclusions: The use of proximal ulnar artery perforator flap combined with iliac bone graft to reconstruct subtotal thumb or finger can partially restore part of the appearance and function, with less damage to the donor site. It is a good choice for patients who have low expectations of appearance and function for the reconstructed finger.
Male ; Humans ; Female ; Soft Tissue Injuries/surgery* ; Perforator Flap/transplantation* ; Skin Transplantation/methods* ; Thumb/surgery* ; Plastic Surgery Procedures ; Ulnar Artery/surgery* ; Cicatrix/surgery* ; Ilium/surgery* ; Treatment Outcome

OBJECTIVETo study the feasibility and authenticity of repairing alveolar defects in alveolar cleft patients with osteoinduction active material (OAM) in clinic.

METHODSTwenty-seven cases of alveolar defect chosen from clinic were divided into two groups (test group and control group). For test group (12 cases), OAM was transplanted to repair the alveolar cleft. For control group (15 cases), autogenous ilium cancellous bone were transplanted into the defect region to repair alveolar cleft. At 6 months after operation, CT and three-dimensional reconstruction were used to observe alveolar appearance, and the effect and clinical success rate of recover alveolar cleft by using different repair material were compared.

RESULTSIn the 27 cases, all the maxillary continuity was restored except two of test group and two of control group. There was no significant difference between test group and control group regarding the clinical success rate of the alveolar cleft repair (P = 1.000).

CONCLUSIONOAM was used to repair the alveolar cleft that can result in new bone formations and the burgeon of canines from the bone grafted areas. There is no significant difference between OAM and autogenous ilium cancellous bone regarding the effect of the alveolar cleft repair.

Alveolar Process ; pathology ; surgery ; Biocompatible Materials ; therapeutic use ; Bone Regeneration ; Bone Transplantation ; Cleft Palate ; surgery ; Humans ; Ilium ; transplantation

Although ultrasound has not been used to clarify bone lesions because of their high acoustic impendence and attenuation coefficient, aneurysmal bone cyst of the pelvis was imaged with ultrasound. Dual fluid levels and multiple loculations were discovered by ultrasound imaging through thin cortical bone. Ultrasonography is a simple, non-invasive method which can be utilized to detect bony lesions of an expansile nature and reveal characteric findings in an aneurysmal bone cyst.
Adolescent ; *Blood ; Bone Cysts/*diagnosis/surgery ; Case Report ; Female ; Human ; *Ilium/pathology/surgery ; Tomography, X-Ray Computed

Adult ; Bone Neoplasms ; diagnosis ; surgery ; Humans ; Ilium ; Magnetic Resonance Imaging ; Male ; Osteoma, Osteoid ; diagnosis ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo retrospectively compare the therapeutic effects of simple Pemberton's ilium osteotomy and combined unter-trochanter derotation-varisation osteotomy for developmental dysplasia of the hip (DDH).

METHODSClinical data of 141 DDH patients who received either simple Pemberton's ilium osteotomy (n=57; 12 male and 45 female; age range 3-8 years) or combined unter-trochanter derotation-varisation osteotomy (n=84; 15 male and 69 female; age range 4-9 years) from January 2004 to January 2009 were collected. Postoperative complications, Severin's radiological outcomes and therapeutic outcomes as evaluated by Mcay criteria were compared between the two groups 2 years after operation.

RESULTSThe patients in simple Pemberton group were followed-up for 30-52 months (mean 38 months) and the patients in the combination group were followed-up for 32-51 months (mean 37 months). There were 7 cases of dislocation, 4 cases of avescular necrosis of femoral head and 5 cases of joint stiffness in simple Pemberton group vs 0 case of dislocation, contraction of the limb and ANFH,2 cases of joint stiffness in the combination group. Two years after surgery, the result as evaluated by McKay criteria was excellent in 27 cases, good in 18 cases and fair in 12 cases in simple Pemberton group vs. 52, 25 and 7 cases in the combination group. The overall clinical outcome in the combination group was better than that in simple Pemberton group. Severin X-ray evaluation showed excellent in 27 cases, good in 15 cases and fair in 15 cases in simple Pemberton group vs. 53, 22 and 9 cases in the combination group,indicating that the overall result in the combination group was better than that in simple Pemberton group.

CONCLUSIONThe overall clinical outcome of the combination group is better than that of simple Pemberton group in the treatment of pediatric DDH, especially in reducing postoperative complications and functional recovery. The patients in the combination group reported a higher postoperative satisfaction as compared with those in simple Pemberton group.

Bone Diseases, Developmental ; etiology ; surgery ; Child ; Child, Preschool ; Female ; Femur ; surgery ; Hip Dislocation, Congenital ; complications ; surgery ; Humans ; Ilium ; surgery ; Male ; Osteotomy ; methods