OBJECTIVE: To compare treatment effect of monolateral and circular external fixator in infectious tibial nonunion and to explore external fixation structure with better osteogenic ability and fewer complications. METHODS: A retrospective analysis was performed on 150 patients with infectious tibial nonunion admitted from January 2010 to December 2014. Patients who met the inclusion and exclusion criteria were divided into monolateral fixator group and circular fixator group according to the type of external fixation. Demographic and perioperative data of the two groups were collected. New bone quality was assessed by pixels ratio, treatment effect was assessed by complications. Notes for treatment was explored by case analysis. RESULTS: A total of 64 patients with infectious mid-tibial nonunion were included, 26 in monolateral fixator group and 38 in circular fixator group. There was no difference in demographic data between two groups. The pixel ratio of new bone between two groups was from 0.91 to 0.97 with an average of (0.94±0.03), and from 0.93 to 0.97 with an average of(0.95±0.02), respectively, with no statistical significance (P>0.05). The external fixation index was from 34.1 to 50.6 with an average of (42.3±8.3) days /cm in monolateral fixator group and from 44.5 to 56.1 with an average of (45.8±10.3) days/cm in the circular fixator group, and the difference was not statistically significant (P>0.05). There were 7 cases (26.9%) of complications in monolateral fixator group and 5 cases (13.2%) in circular fixator group, the difference was not statistically significant (P>0.05), but 5 cases of foot ptosis in monolateral fixator group and none in circular fixator group. The time of weight bearing in monolateral fixator group was later than that in circular fixator group, and the difference was statistically significant (P<0.05). CONCLUSION Monolateral and circular fixators can achieve equivalent bone formation in the treatment of infected tibial nonunion. Circular fixator is recommended for patients with severe osteoporosis or concomitant medical diseases requiring early weight bearing. Hydroxyapatite coated screws are recommended if a monolateral external fixator is selected when the expected enlarged length is long and the fixation time is long and close monitoring of the ankle movement is required to avoid foot droop.
Humans ; Tibial Fractures/surgery* ; Retrospective Studies ; External Fixators ; Tibia/surgery* ; Treatment Outcome ; Hydroxyapatites

BACKGROUND: Absorbable plates are widely used in open reduction and internal fixation surgeries for facial bone fractures. Absorbable plates are made of polyglycolic acid (PGA), polylactic acid (PLA), polydioxane (PDS), or various combinations of these polymers. The degradation patterns of absorbable plates made from different polymers and clinical courses of patients treated with such plates have not been fully identified. This study aimed to confirm the clinical courses of facial bone fracture patients using absorbable plates and compare the degradation patterns of the plates. METHODS: A retrospective chart review was conducted for 47 cases in 46 patients who underwent open reduction and internal fixation surgery using absorbable plates to repair facial bone fractures. All surgeries used either PLA/PGA composite-based or poly-L-lactic acid (PLLA)/hydroxyapatite (HA) composite-based absorbable plates and screws. Clinical courses were confirmed and comparisons were conducted based on direct observation. RESULTS: There were no naturally occurring foreign body reactions. Post-traumatic inflammatory responses occurred in eight patients (nine cases), in which six recovered naturally with conservative treatment. The absorbable plates were removed from two patients. PLA/PGA composite-based absorbable plates degraded into fragments with non-uniform, sharp surfaces whereas PLLA/HA composite-based absorbable plates degraded into a soft powder. CONCLUSION: PLA/PGA composite-based and PLLA/HA composite-based absorbable plates showed no naturally occurring foreign body reactions and showed different degradation patterns. The absorbable plate used for facial bone fracture surgery needs to be selected in consideration of its degradation patterns.
Absorbable Implants ; Bone Plates ; Facial Bones ; Foreign Bodies ; Humans ; Hydroxyapatites ; Polyglycolic Acid ; Polymers ; Retrospective Studies

Unsintered hydroxyapatite (u-HA) and poly-L-lactide (PLLA) composites (u-HA/PLLA) are osteoconductive and biodegradable. Screw (Super-Fixsorb MX30) and plate (Super-Fixsorb MX40 Mesh) systems made of u-HA/PLLA are typically used in small bones in maxillofacial surgeries. After the resection of bone tumors in larger bones, reconstructions with β-tricalcium phosphate (β-TCP) implants of strong compression resistance have been reported. After a resection, when the cavity is hemispheric- or concave-shaped, stabilization of the implanted β-TCP block is necessary. In the current series, u-HA/PLLA were used to stabilize the mechanically strong implanted low-porous β-TCP blocks in six bone tumor cases, including three giant cell tumors of bone, and one case each of chondroblastoma, chondrosarcoma, and parosteal osteosarcoma. The mean age of patients at the time of surgery was 31.3 years (range, 19 to 48 years). The bones involved were two ilia (posterior), a femur (diaphysis to distal metaphysis), and three tibias (proximal epiphysis, proximal metaphysis to epiphysis, and distal metaphysis to epiphysis). Neither displacement of the implanted β-TCP block nor any u-HA/PLLA-related complications were observed. The radiolucent character of the u-HA/PLLA did not hinder radiological examinations for potential signs of tumor recurrence. The method of using u-HA/PLLA components for the stabilization of β-TCP blocks makes the procedure easy to perform and reliable. It can extend the application of β-TCP blocks in reconstruction surgery.
Bone Neoplasms ; Chondroblastoma ; Chondrosarcoma ; Durapatite* ; Epiphyses ; Femur ; Giant Cell Tumors ; Humans ; Hydroxyapatites ; Methods ; Osteosarcoma ; Reconstructive Surgical Procedures ; Recurrence ; Tibia

PURPOSE: The purpose of this study is to investigate the effect of the titanium implant soaked in saline after RBM and acid etched surface treatment on the initial osseointegration by comparing the removal torque and the surface analysis compared to the titanium implant with only RBM and acid etched surface treatment. MATERIALS AND METHODS: The control group was RBM and acid etched surface treated implants (RBM + HCl), and the test group was implants soaked in saline for 2 weeks after RBM and acid etched surface treatment (RBM + HCl + Sal). The control and test group implants were placed in the left and right tibiae of 10 rabbits, respectively, and at the same time, the insertion torque (ITQ) was measured. After 10 days, the removal torque (RTQ) was measured by exposing the implant site. FE-SEM, EDS, Surface roughness and Raman spectroscopy were performed for the surface analysis of the new implant specimens used in the experiments. RESULTS: There was significant difference in insertion torque and removal torque between control group and experimental group (P = 0.014 < 0.05). Surface roughness of experimental group is higher than control group. CONCLUSION: Saline soaking after RBM and acid etched surface treatment of titanium implants were positively affect the initial osseointegration as compared to titanium implants with only RBM and acid etched surface treatment.
Hydroxyapatites ; Immersion ; Osseointegration ; Rabbits ; Sodium Chloride ; Spectrum Analysis, Raman ; Tibia ; Titanium ; Torque

Nonthermal atmospheric plasma has been studied for its many biomedical effects, such as tooth bleaching, wound healing, and coagulation. In this study, the effects of dentinal tubules occlusion were investigated using fluoride-carboxymethyl cellulose (F-CMC) gel, nano-sized hydroxyapatite (n-HA), and nonthermal atmospheric plasma. Human dentin specimens were divided to 5 groups (group C, HA, HAF, HAP, and HAFP). Group HA was treated with n-HA, group HAF was treated with n-HA after a F-CMC gel application, group HAP was treated with n-HA after a plasma treatment and group HAFP was treated with n-HA after a plasma and F-CMC gel treatment. The occlusion of dentinal tubules was investigated using scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDS), which shows Ca/P ratio. In the EDS results, a higher Ca/P ratio was shown in the groups including n-HA than in the control group. The specimens of group HAP and HAFP had a higher Ca/P ratio in retentivity. In the SEM results, there was not a significant difference in the amount of times applied. Therefore, this study suggests F-CMC gel and n-HA treatment using nonthermal atmospheric plasma will be a new treatment method for decreasing hypersensitivity.
Carboxymethylcellulose Sodium ; Cellulose ; Dentin Sensitivity ; Dentin ; Durapatite ; Fluorides ; Humans ; Hydroxyapatites ; Hypersensitivity ; Methods ; Microscopy, Electron, Scanning ; Plasma Gases ; Plasma ; Spectrometry, X-Ray Emission ; Tooth Bleaching ; Wound Healing

PURPOSE: The purpose of this study is to investigate the effect of the titanium implant soaked in saline after RBM surface treatment on the initial osseointegration by comparing the removal torque and the surface analysis compared to the titanium implant with only RBM surface treatment. MATERIALS AND METHODS: The control group was RBM surface treated implants (RBM), and the test group was implants soaked in saline for 2 weeks after RBM surface treatment (RBM+Sal). The control and test group implants were placed in the left and right tibiae of 10 rabbits, respectively, and at the same time, the insertion torque (ITQ) was measured. After 10 days, the removal torque (RTQ) was measured by exposing the implant site. FE-SEM, EDS, Surface roughness and Raman spectroscopy were performed for the surface analysis of the new implant specimens used in the experiments. RESULTS: There was no significant difference in insertion torque and removal torque between RBM surface treated titanium implants and saline-soaked titanium implants after RBM surface treatment. CONCLUSION: Saline soaking after RBM surface treatment of titanium implants did not positively affect the initial osseointegration as compared to titanium implants with only RBM surface treatment.
Hydroxyapatites ; Osseointegration ; Rabbits ; Sodium Chloride ; Spectrum Analysis, Raman ; Tibia ; Titanium ; Torque

BACKGROUND: Recombinant human bone morphogenetic proteins (rhBMPs) have been widely used in regenerative therapies to promote bone formation. The production of rhBMPs using bacterial systems such as Escherichia coli (E. coli) is estimated to facilitate clinical applications by lowering the cost without compromising biological activity. In clinical practice, rhBMP-2 and osteoconductive carriers (e.g., hydroxyapatite [HA] and bovine bone xenograft) are used together. This study examined the effect of E. coli-derived rhBMP-2 combined with porous HA-based ceramics on calvarial defect in rabbits. METHODS: Six adult male New Zealand white rabbits were used in this study. The experimental groups were divided into the following 4 groups: untreated (NC), bovine bone graft (BO), porous HA (HA) and porous HA with rhBMP-2 (HA-BMP). Four transosseous defects of 8 mm in diameter were prepared using stainless steel trephine bur in the frontal and parietal bones. Histological and histomorphometric analyses at 4 weeks after surgery revealed significant new bone formation by porous HA alone. RESULTS: HA-BMP showed significantly higher degree of bone formation compared with BO and HA group (P<0.05). The average new bone formation % (new bone area per total defect area) of NC, BO, HA, and HA-BMP at 4-week after surgery were 12.65±5.89%, 29.63±6.99%, 28.86±6.17% and 49.56±8.23%, respectively. However, there was no statistical difference in the bone formation between HA and BO groups. CONCLUSIONS: HA-BMP promoted more bone formation than NC, BO and HA alone. Thus, using E. coli-derived rhBMP-2 combined with porous HA-based ceramics can promote new bone formation.
Adult ; Bone Morphogenetic Proteins ; Ceramics* ; Durapatite ; Escherichia coli ; Escherichia* ; Humans* ; Hydroxyapatites ; Male ; Osteogenesis ; Parietal Bone ; Rabbits* ; Stainless Steel ; Transplants

BACKGROUND: To augment cement-bone fixation, Dr. Hironobu Oonishi attempted additional physicochemical bonding through interposition of osteoconductive crystal hydroxyapatite (HA) granules at the cement-bone interface in 1982. He first used the interface bioactive bone cement (IBBC) technique in 12 selected patients (12 hips) in 1982 (first stage) and followed them for 2 years. In 1985, the technique was applied in 25 total hip arthroplasty (THA) patients (second stage) and the effects were investigated by comparing the side with the IBBC technique and the other side without the IBBC technique. He has employed this technique in all THA patients since 1987 (third stage). METHODS: In the IBBC technique, HA granules (2 to 3 g) were smeared on the bone surface just before the acetabular and femoral components were cemented. In the first stage, 12 hips were operated using the IBBC technique in 1982. In the second stage, THA was performed without the IBBC technique on one side and with the IBBC technique on the other side within 1 year in 25 patients. In the third stage, THA was performed with the IBBC technique in 285 hips in 1987. RESULTS: In the first stage patients, implant loosening was not detected at 30 years after operation. In the second stage patients, revision was required in 7 hips without the IBBC technique due to cup loosening (5 hips) and stem loosening (2 hips), whereas no hip was revised after THA with the IBBC technique at 26 years after operation. In the third stage patients, the incidence of radiolucent lines and osteolysis was very few at 25 years after operation. CONCLUSIONS: The long-term follow-up of THA performed around the inception of the IBBC technique has revealed low incidences of radiolucent lines, osteolysis, and revision surgery.
Adult ; Aged ; Aged, 80 and over ; *Arthroplasty, Replacement, Hip/adverse effects/instrumentation/methods ; *Bone Cements/adverse effects/therapeutic use ; Bone-Implant Interface/physiology ; Follow-Up Studies ; Hip/diagnostic imaging/surgery ; Humans ; Hydroxyapatites/therapeutic use ; Middle Aged ; Young Adult

To produce bionic bone material that is consistent with human bone in chemical composition and molecular structure using rat tail tendon collagen type Ⅰ.The type Ⅰcollagen derived from rat tail was extracted by acetic acid to form collagen fibers. The reconstructed collagen fibers were placed in the mineralized solution to mimic bone mineralization for 2-6 days. Bone mineralization was observed by transmission electron microscopy and electron diffraction.Collagen fibers with characteristic D-Band structure were reconstructed by using rat tail tendon collagen type Ⅰ extracted with acid hydrolysis method. Transmission electron microscopy and electron diffraction showed that calcium hydroxyapatite precursor infiltrated into the collagen fibers, and the collagen fibers were partially mineralized after 2 days of mineralization; the collagen fibers were completely mineralized and bionic bone material of typeⅠ collagen/calcium hydroxyapatite was formed after 6 days of mineralization.The collagen type Ⅰ can be extracted from rat tail tendon by acid hydrolysis method, and can be reformed and mineralized to form the bionic bone material which mimics human bone in chemical composition and the molecular structure.
Animals ; Biocompatible Materials ; chemical synthesis ; Bone Matrix ; chemistry ; growth & development ; Bone Substitutes ; chemical synthesis ; Bone and Bones ; anatomy & histology ; chemistry ; Calcification, Physiologic ; Collagen Type I ; biosynthesis ; chemistry ; ultrastructure ; Humans ; Hydroxyapatites ; chemistry ; Rats ; Tail ; Tendons ; chemistry ; ultrastructure ; Tissue Engineering ; methods

OBJECTIVE: The aim of this study was to compare the clinical and radiological outcomes associated with the use of hydroxyapatite (HA) spacer and allogeneic bone (AB) spacer in laminoplasty. METHODS: From January 2006 to July 2014, 79 patients with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament underwent cervical laminoplasty. The radiologic parameters were obtained from plain radiography and three-dimensional computed tomography. All images were taken before and after surgery. Cervical lordosis, spinal canal dimension, fusion between lamina and spacer, and resorption of spacer were checked. Clinical outcomes were assessed using visual analog scale and Japanese Orthopedic Association. RESULTS: Double-door laminoplasty was performed on 280 levels : 182 in the HA group and 98 in the AB group. The mean follow-up was 23.1 months (range : 4–69 months). Similar fusion rates were found in these groups (p=0.3). The resorption rate between lamina and spacer was lower in the HA group (p<0.001). During the immediate postoperative period, the canal dimension of both groups increased compared with the results in the preoperative period. However, the canal dimension of the AB group decreased over time compared with that of the HA group (p<0.001). CONCLUSION: Double-door laminoplasty improved the clinical outcomes of both groups. However, the spinal canal dimension in the AB group showed a greater degree of reduction than in the HA group at the final postoperative follow-up. Therefore, we suggest that surgeons consider the use of larger-sized AB spacers in double-door laminoplasties.
Allografts ; Animals ; Asian Continental Ancestry Group ; Durapatite* ; Follow-Up Studies ; Humans ; Hydroxyapatites ; Laminoplasty* ; Longitudinal Ligaments ; Lordosis ; Orthopedics ; Ossification of Posterior Longitudinal Ligament ; Postoperative Period ; Preoperative Period ; Radiography ; Spinal Canal ; Spinal Cord Diseases ; Spinal Fusion ; Surgeons ; Visual Analog Scale