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*

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

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 investigate the influences of experimental osteoporosis (OP) on bone healing of autologous iliac crest graft around dental implants in rabbits.

METHODSTwenty Japanese rabbits were randomly divided into two groups. Bilaterally ovariectomy was performed on experimental group and control group received sham-operation. Twelve weeks later, femoral bones were examined for bone mineral density (BMD) to verify OP status. Then bone defects were made in the proximal metaphysis of the tibiae and autologous iliac crest grafts with simultaneous implant placement were performed. The animals were killed at 8 and 12 weeks after bone graft surgery. Undecalcified sections were prepared and examined histologically and histomorphometrically.

RESULTSOsteoporotic status caused by ovariectomy was verified by significantly decreased BMD in experimental group (P < 0.001). At 8 and 12 weeks after bone graft surgery, osseointegration was observed in both groups. However, thickness of cortical bone (TCB), bone volume in cancellous area (BVC), implant-bone contact rate (IBCR) at bone graft area all significantly decreased in experimental group when compared with control group (P < 0.01). Newly formed bone was also less in experimental group than that in control group.

CONCLUSIONAlthough experimental OP may not delay osseointegration of dental implants in autologous iliac crest graft, it certainly promotes resorption of bone grafts, decreases cancellous bone volume and implant-bone contact rate. Therefore it may be an important risk factor for patients receiving autologous bone graft with simultaneous implant placement.

Animals ; Bone Transplantation ; Dental Implants ; Female ; Ilium ; transplantation ; Osseointegration ; Osteoporosis ; pathology ; Ovariectomy ; Rabbits

PURPOSE: There are no reports about bone graft and cell therapy for the osteonecrosis of femoral head (ONFH). We prospectively evaluated the clinical results of auto-iliac cancellous bone grafts combined with implantation of autologous bone marrow cells for ONFH. MATERIALS AND METHODS: Sixty-one hips in 52 patients with ONFH treated with bone graft and cell therapy were enrolled, and the average follow-up of the patients was 68 (60-88) months. Necrotic lesions were classified according to their size by the Steinberg method and location of necrosis. RESULTS: At the last follow-up, the percentage of excellent or good results was 80% (12/15 hips) in the small lesion group, 65% (17/26 hips) in the medium size group, and 28% (6/20 hips) in the large size group. The procedures were a clinical success in 4 of 5 hips (80%) of stage I, 23 of 35 hips (65.7%) of stage II, 7 of 18 hips (38.9%) of stage III, and 1 of 3 hips (33.3%) of stage IV grade, according to the Association Research Circulation Osseous grading system. Among the 20 cases with large sized necrotic lesions, 17 cases were laterally located and this group showed the worst outcomes, with 13 hips (76.5%) having bad or failed clinical results. CONCLUSION: The results of the present study suggested that patients who have a large sized lesion or medium sized laterally located lesion would not be good candidates for the head preserving procedure. However, for medium sized lesions, this procedure generated clinical results comparable to those of other head preserving procedures.
Autografts/radiography ; *Bone Transplantation ; Femur Head Necrosis/radiography/*therapy ; Humans ; Ilium/transplantation ; *Mesenchymal Stem Cell Transplantation ; Transplantation, Autologous ; Treatment Outcome

OBJECTIVETo explore the feasibility of transplantation of frozen autogenous mandible with delayed implantation.

METHODSOperations were performed to create two defects in the bilateral mandible of 16 dogs. The left defect was grafted by composite transplantation of frozen autogenous mandible (immersed in -196 degrees C liquid nitrogen) with fresh cancellous ilium (composite transplantation group, CTG). The right defect was grafted by fresh ilium (iliac transplantation group, ITG). Three months after transplantation one IMZ TPS dental implant was placed into the graft of each side. At 3, 6, 9, 12 weeks postoperatively, 4 animals were sacrificed respectively and the grafts with dental implant were harvested for gross observation, X-Ray examination and histological evaluation to compare peri-implant bone healing between composite transplantation group and iliac transplantation group.

RESULTSThere was no absorbing bone density reducing image of peri-implant at each stage. The quantified X-Ray gray extent displayed obvious variation of interfacial bone density between two kinds of grafts at 3 weeks, 6 weeks and 9 weeks after implantation. The composite transplantation group obviously surpassed the iliac transplantation group. At 12 weeks after the implantation, there was no significant difference between the peri-implant bones of both sides. There was satisfactory osseointegration between the implants and the two kinds of grafts. The healing style of peri-implant bone was similar.

CONCLUSIONSGood osseointegration was performed between the implant and the composite transplantation of frozen autogenous mandible following delayed implantation.

Animals ; Bone Transplantation ; Dental Implantation, Endosseous ; methods ; Disease Models, Animal ; Dogs ; Ilium ; transplantation ; Male ; Mandible ; transplantation ; Transplantation, Autologous

OBJECTIVETo evaluate the clinical outcome of reconstruction of maxillary defects with vascularized iliac crest flap and simultaneous osseointegrated implant embedding.

METHODSDuring September to October 2003, two patients with maxillary defects from tumor resection underwent microsurgical reconstruction. The free iliac osteomuscular flap transferring and simultaneous osseointegrated implant embedding were performed to repair the defects. Three months after the reconstructive surgery, an abutment operation was preformed and denture was applied in both cases.

RESULTSThe flaps survived well. Postoperative follow-up for 8 to 9 months showed that the patients obtained good zygomaxillary appearance, normal occlusion, and satisfactory pronunciation, without oronasal fistula or other serious complications.

CONCLUSIONSThe free iliac crest osteomuscular flap with simultaneous osseointegrated implant embedding is an ideal, effective and cosmetically acceptable method for maxilla reconstruction.

Adult ; Bone Transplantation ; methods ; Female ; Humans ; Ilium ; transplantation ; Male ; Maxilla ; surgery ; Middle Aged ; Transplantation, Homologous ; Treatment Outcome

OBJECTIVETo study the effect of allograft compound vertebra on vertebral reconstruction in rabbits so as to provide biomechanical direction for manufacturing and selecting vertebral reconstruction materials.

METHODSTwenty-five healthy New Zealand white rabbits were divided randomly into three groups: normal group (Group A, n equal to 5),iliac bone graft group (Group B, n equal to 10) and allograft compound vertebra group (Group C, equal to 10). After C4 was resected, iliac bone implantation and allograft bone cage transplantation were fulfilled in Group B and Group C, respectively. Every 5 rabbits from Group B and Group C were selected to test the biomechanical strength and biological activity one and two months postoperatively.

RESULTSNo significant statistical difference was found between Group A and Group C one and two months postoperatively (P larger than 0.05). The biomechanical strength of Group B was much weaker than that of Group A and Group C one month postoperatively (P less than 0.05), but at two months postoperatively, no statistical difference was found among the three groups. The biological activity and vertebral moulding ability of Group C were better than those of Group B at one and two months postoperatively.

CONCLUSIONSCompound vertebra, which is made up of allograft cortical bone cage and autogenous cancellous bone, shows instantaneous and permanent biomechanical stability and biological activity, therefore, it is an ideal material for vertebral reconstruction.

Animals ; Biomechanical Phenomena ; Bone Substitutes ; Bone Transplantation ; Ilium ; transplantation ; Models, Animal ; Rabbits ; Reconstructive Surgical Procedures ; Spinal Neoplasms ; surgery ; Transplantation, Homologous

OBJECTIVETo investigate the effect of vascularized composite flap with iliac crest and nternal oblique muscle of abdomen for half mandibular reconstruction.

METHODSFrom July 2009 to Sept. 2013, 14 cases with half mandibular defect after tumor resection were treated with composite flap of iliac crest and internal oblique muscle of abdomen pedicled by deep circumflex iliac vessels. During operation, one group performed tumor resection and got the recipient area vessels ready for anastomosis. The other group performed harvesting of composite flap. Then the flap was trimmed and fixed to construct the defect with vessel anastomosis.

RESULTSAll the 14 composite flaps survived with local infection only in 1 case. The size of harvested iliac crest ranged from 6 cm x 3 cm to 9 cm x 3 cm. The size of harvested internal oblique muscle of abdomen ranged from 5 cm x 4 cm to 7 cm x 5 cm. The patients were followed up for 6 months to 26 months (mean, 13 months) with satisfactory results and no complication. Mandibular panoramic radiographs showed new bone formation and good union.

CONCLUSIONSVascularized composite flap with iliac crest and internal oblique muscle of abdomen has the advantages of abundant bone volume, as well as soft tissue reconstruction in one stage. The reconstructed mandible can attain normal function and appearance.

Abdominal Muscles ; transplantation ; Abdominal Wall ; Humans ; Ilium ; transplantation ; Mandibular Reconstruction ; methods ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply ; transplantation

OBJECTIVETo analyze the stress and displacement distribution of 3D-FE models in three conjunctive methods of vascularized iliac bone graft for established mandibular body defects.

METHODSUsing computer image process technique, a series of spiral CT images were put into Ansys preprocess programe to establish three 3D-FE models of different conjunctions.

RESULTSThe three 3D-FE models of established mandibular body defects by vascularized iliac bone graft were built up. The distribution of Von Mises stress and displacement around mandibular segment, grafted ilium, plates and screws was obtained.

CONCLUSIONIt may be determined successfully that the optimal conjunctive shape be the on-lay conjunction.

Bone Transplantation ; Finite Element Analysis ; Humans ; Ilium ; Imaging, Three-Dimensional ; Mandible