Alveolar Ridge Augmentation ; methods ; Humans ; Osteogenesis, Distraction

The management of nonunion with severe bone loss is a challenging task to both surgeons and patients. It often requires prolonged and potentially painful treatments. Moreover, it also represents serious socioeconomic issues for patients. Inadequate fracture stability, disrupted biology, such as blood supply and soft tissue, as well as severe bone loss or presence of infection are possible reasons for nonunion. Several different treatment modalities are available, including nail dynamization, plate osteosynthesis, exchange nailing, and adjuvant alternatives, such as electrical or ultrasound stimulation. Autogenous bone graft remains the standard method to reconstruct small defects. Distraction osteogenesis and induced membrane techniques are contemporary strategies of choice for the reconstruction of larger bony defects. Herein, we attempt to describe the key techniques that may be employed in treating nonunion with severe bone loss.
Biology ; Humans ; Membranes ; Methods ; Osteogenesis, Distraction ; Surgeons ; Transplants ; Ultrasonography

OBJECTIVETo explore a methods of 3-Dimension expansion of zygomatic suture in a goat model.

METHODSSeven goats were used in this study. The 3-D extensive applicator was designed and used to extend the zygomatic suture of the goats by placing it in the zygomatic bone through an infraorbital incision. Ten days after the first operation, it was gradually extended on a speed of 0.09 cm/d for 7 days. The zygomatic movement and the osteogenesis of the suture was evaluated in two weeks.

RESULTSThe zygomatic bone was extended for 0.6 cm long in average, and the osteogenesis was also shown significantly in the suture.

CONCLUSIONThe above mentioned technique could be a safe and effect method to be applied for the zygomatic extension.

Animals ; Cranial Sutures ; Goats ; Humans ; Osteogenesis, Distraction ; instrumentation ; methods ; Zygoma

Segmental bone defects are very severe in open fractures of the lower extremity. Traditional treatment requires skeletal stabilization, usually by external fixation, followed by free tissue transfer for soft tissue coverage, and vascularized or nonvascularized bone grafting for the skeletal defect. The bone transport distraction osteogenesis is a new method for treating bone defects. The range of bone loss for which bone transport is indicated 3 to 12 cm. The method required only small bone grafts to stimulate healing at the bone defect site, whereas patients in the conventionally treated group needed a larger volume of cancellous bone graft. Donor site morbidity was less in the method, and no free-tissue transfers were required. Disadvantages of the method was a complex, time-consuming reconstruction. In the appropriately selected patient, when the surgeon is experienced in the technique, treatment by bone transport distraction osteogenesis offers unique advantages for certain cases of the bone defect.
Bone Transplantation ; Fractures, Open ; surgery ; Humans ; Osteogenesis, Distraction ; methods

Humans ; Mandible ; surgery ; Osteogenesis, Distraction ; methods ; Reconstructive Surgical Procedures

OBJECTIVEThe aim of this study was to explore ultrastructural characters of the newly formed bone in the correction of cleft palate (CP) bone defect by distraction osteogenesis (DO).

METHODSThe CP experimental animal models (12 cats) were established surgically, and were divided randomly into the experimental group (10 cats), in which the hard palate bone defects were corrected with DO procedure at the rate of 0.4 mm x 2/day. The specimen retrieval with euthanasia was carried out at 2, 4, 6, 8, 12 weeks after completion of distraction. Ultrastructural study was then performed; the experimental control group (2 cats) was kept for 6 weeks before euthanasia without any correction, the other extra 2 cats were used as the negative control.

RESULTSNew bone formation appeared in early 2 weeks. Exclusively intramembranous bone formation was observed in all specimens. The remodeling activities were keep observed throughout the period of study, and the bone structure matured gradually till 12 weeks after the completion of DO. No repair was observed in experimental control group.

CONCLUSIONThe reconstruction of CP bone defect by means of DO could get active intramembranous bone formation and remodeling, which adapted to normal functional activities.

Animals ; Bone Regeneration ; Cats ; Cleft Palate ; pathology ; surgery ; Osteogenesis ; Osteogenesis, Distraction ; methods ; Palate, Hard ; ultrastructure

OBJECTIVEThe purpose of this experimental study was to investigate the histomorphological changes of tubular bone following widening distraction osteogenesis.

METHODSTwelve Chinese mountain goats were subjected to the study. After the procedure of vertical and horizontal osteotomy, two widening distraction osteogenesis devices were put in each goat's left tibiae. After an 8-day latency period, nine tibiae were widening distracted; another three tibiae served as sham control group. Every three animals from the experimental group were sacrificed in different consolidated periods including 1-month, 2-month, and 3-month. Radiography, tetracycline double labeling, histomorphology, as well as biomechanics were used to evaluate the quality and quantity of new generated bone in different consolidated period after distraction osteogenesis.

RESULTSAfter a distraction period, the average width of the tibiae is increased 7.83mm. From the end of distraction to 3-month after the consolidation period, radiography demonstrated that the distraction gaps gradually became vague. Tetracycline double labeling showed that the double labeling brands were rarely seen in normal cortex bone, but strongly increased in the distracted callus. Mineralization rates (MR) has a significant difference (P < 0.05) within distracted callus region compared with control cortex bone. Histomorphological study shows that there was a different result in two sides of vertical distracted gaps. The non-exposure side had a good bone formation, while a non-union of bone occurred at the exposure side. Three months after consolidation period, part of the gap in exposure side was filled with dense connection tissue, whereas the distracted callus had been remodeled and become lamellar bone in non-exposure side. The control group showed normal fracture healing procedure.

CONCLUSIONSThere was a different outcome in two sides distraction gaps of tubular bone following widening distraction osteogenesis. A viable and well-perfused soft-tissue envelope in the area of distraction osteogenesis is important for creation of sufficient amount of new bone during distraction osteogenesis.

Animals ; Biomechanical Phenomena ; Bone Regeneration ; Goats ; Osteogenesis ; Osteogenesis, Distraction ; methods ; Radiography ; Tibia ; diagnostic imaging ; physiology

The Ilizarov technique for gradual distraction osteogenesis was developed in the 1950s. A correctly performed osteotomy is essential to the success of distraction osteogenesis and prepares for limb lengthening. Between Sept. of 1991 and 1994, thirty-four patients were treated by Ilizarov technique at St. Benedict Hosp. and Gang-Dong Hosp.. And then assigned to two separate groups : a corticotomy group (group A) and osteotomy group (group B; osteotomy with Gigli saw or osteotomy with multiple drill holes and osteotome). The regenerate segments were evaluated weekly for the first six weeks after operation. After the initial six-week evaluation period, observations of these segments were continued through a series of monthly radiographs. Distraction began on postoperative day seven in group A and on day eleven in group B; and continued at a rate of 1 mm/day and a frequency of 4 times/day. Group A displayed new bone formation earlier than group B: group A's mean was 16.5 ± 4.9 days, while B's mean was 25.3 ± 4.6 days. The first bridging callus occurred earlier in group A than it did in group B: A's mean was time of 36.7 ± 9.9 days, while B's mean was 44.0 ± 7.9 days. There was no significant difference between groups A & B in terms of first cortical formation : A's mean was 86.9 ± 24.0 days, and B's mean was 100.6 ± 25.2 days. There was no significant difference between groups A & B in terms of the bone healing index : A's mean was 41.6 ± 13.5 days and B's mean was 41.15 ± 8.10 days.
Bony Callus ; Extremities ; Humans ; Ilizarov Technique ; Methods ; Osteogenesis ; Osteogenesis, Distraction ; Osteotomy

Distraction osteogenesis (DO) is widely used for bone tissue engineering technology. Immune regulations play important roles in the process of DO like other bone regeneration mechanisms. Compared with others, the immune regulation processes of DO have their distinct features. In this review, we summarized the immune-related events including changes in and effects of immune cells, immune-related cytokines, and signaling pathways at different periods in the process of DO. We aim to elucidated our understanding and unknowns about the immunomodulatory role of DO. The goal of this is to use the known knowledge to further modify existing methods of DO, and to develop novel DO strategies in our unknown areas through more detailed studies of the work we have done.
Bone Regeneration/physiology* ; Bone and Bones ; Osteogenesis/physiology* ; Osteogenesis, Distraction/methods* ; Tissue Engineering

OBJECTIVETo explore a new technique for repair of alveolar cleft by sutural distraction osteogenesis.

METHODSNine 8-weeks mongrel dogs were used in this study, three being in the control group, six in the experimental group. Alveolar cleft model was created surgically in all animals. Two weeks later, a U-shaped distractor made of Ni-Ti memory alloy wire was insterted into the premaxilla to distract the mid-premaxillary suture. When the premaxilla of the cleft side approached the ipsilateral maxilla, periosteoplasty of the alveolar cleft was performed. The distractor was removed at two weeks after periosteoplasty. The results were evaluated clinically, radiographically, morphologically and histologically.

RESULTSThe cleft model in dogs was stable and similar to the human alveolar cleft. In experimental dogs, the premaxilla was moved gradually toward the maxilla so that the cleft was closed. The distracted mid-premaxillary suture showed a gradually widened traingle, with its tip being posterior. The density of the distracted traingle suture was increased gradually. Bony repair was achieved completely at the cleft three months post-periosteoplasy. The morphology of the mid-premaxillary suture was restored.

CONCLUSIONThe alveolar cleft could be repaired by the technique of mid-premaxilla suture distraction.

Alveoloplasty ; methods ; Animals ; Dogs ; Maxilla ; surgery ; Models, Animal ; Osteogenesis, Distraction ; methods