Induced membrane technique using beta-tricalcium phosphate for reconstruction of clavicle bone defect after fracture related infection - A case report.

The induced membrane technique (IMT) is among the most innovative reconstructive methods for clavicle defects after fracture-related infection (FRI). Herein, we report a case in which a clavicle bone defect after FRI was reconstructed with an autogenous cancellous bone graft mixed with ß-tricalcium phosphate (ß-TCP) in the second stage of the IMT. A 62-year-old male patient with left clavicle fracture underwent open reduction and internal fixation. Refracture occurred immediately after the implant was removed. The patient was diagnosed with FRI after reopen reduction and internal fixation and was then referred to our hospital. The surgery was performed using the IMT. In the second stage of the IMT, the bone defect was filled with an autogenous cancellous bone mixed with wool-type ß-TCP. At 8 months after surgery, the nonunion area had fused, and the patient had no restrictions in activities of daily living. The IMT with ß-TCP can be a reconstructive method for bone defects after clavicular nonunion.

Induced membrane technique using an equal portion of autologous cancellous bone and ß-tricalcium phosphate provided a successful outcome for osteomyelitis in large part of the femoral diaphysis - Case report.

BACKGROUND: No report has yet described good prognosis following the induced membrane technique (IMT) for bone defects over 200 mm. CASE PRESENTATION: A 46-year-old male developed osteomyelitis over a large portion of the right femoral diaphysis, which had an unknown infection route, and subtrochanteric fracture during the waiting period of the planed IMT. Around 3 days after the pathological fracture, the first stage was performed. Aggressive debridement resulted in large segmental bone defect, which was treated with internal fixation using intramedullary nailing and insertion of an antibiotic-impregnated polymethylmethacrylate (PMMA) spacer. Postoperative radiographs showed a radiographic apparent bone gap of 221 mm. A subsequent culture of the debrided bone test identified Corynebacterium as the causative organism, with blood examination indicating normal C-reactive protein, white blood cell count, and erythrocyte sedimentation rate following 4 weeks of intravenous antibiotic administration. Around 7 weeks after the first stage, the second stage was initiated. After removing the PMMA spacer, grafting was performed by filling the bone defect with a combination of autologous cancellous bone harvested from the posterior iliac crest and ß-tricalcium phosphate (ß-TCP), which were mixed in approximately equal proportions. Routine postoperative radiographs confirmed a sequential healing process and callus formation in three out of four cortices 3 years after surgery. CONCLUSIONS: In the present case, IMT was able to successfully treat the osteomyelitis-induced large segmental bone defect of the femoral shaft exceeding 200 mm. Had autologous cancellous bone alone been applied during the second stage, the possible amount of bone defect covered by the IMT would have been limited. However, this limitation can be addressed by applying ß-TCP. Further expansion of IMT indications may help address challenges in the treatment of extensive bone defects.

Irreducible Chronic Volar Dislocation of the Distal Radioulnar Joint After Surgery for Distal Radius Fracture: A Case Report.

CASE: We report a case of irreducible chronic volar dislocation of the distal radioulnar joint (DRUJ) after surgery for distal radius fracture. The patient underwent volar locking plate fixation for distal radius fracture. Despite the satisfactory alignment of the distal radius, irreducible volar dislocation of the DRUJ was discovered at 5 weeks after the initial surgery. DRUJ reconstruction at 9 weeks after injury using the Adams-Berger procedure resulted in a stable and functional DRUJ and wrist. CONCLUSION: To prevent postoperative DRUJ instability or dislocation, the DRUJ should be evaluated for stability immediately after fracture fixation.

Clinical and radiological assessment of the induced membrane technique using beta-tricalcium phosphate in reconstructive surgery for lower extremity long bone defects.

AIMS: To clarify the effectiveness of the induced membrane technique (IMT) using beta-tricalcium phosphate (ß-TCP) for reconstruction of segmental bone defects by evaluating clinical and radiological outcomes, and the effect of defect size and operated site on surgical outcomes. METHODS: A review of the medical records was conducted of consecutive 35 lower limbs (30 males and five females; median age 46 years (interquartile range (IQR) 40 to 61)) treated with IMT using ß-TCP between 2014 and 2018. Lower Extremity Functional Score (LEFS) was examined preoperatively and at final follow-up to clarify patient-centered outcomes. Bone healing was assessed radiologically, and time from the second stage to bone healing was also evaluated. Patients were divided into ≥ 50 mm and < 50 mm defect groups and into femoral reconstruction, tibial reconstruction, and ankle arthrodesis groups. RESULTS: There were ten and 25 defects in the femur and tibia, respectively. Median LEFS improved significantly from 8 (IQR 1.5 to 19.3) preoperatively to 63.5 (IQR 57 to 73.3) at final follow-up (p < 0.001). Bone healing was achieved in all limbs, and median time from the second stage to bone healing was six months (IQR 5 to 10). Median time to bone healing, preoperative LEFS, or postoperative LEFS did not differ significantly between the defect size groups or among the treatment groups. CONCLUSION: IMT using ß-TCP provided satisfactory clinical and radiological outcomes for segmental bone defects in the lower limbs; surgical outcomes were not influenced by bone defect size or operated part. Cite this article: Bone Joint J 2021;103-B(3):456-461.

Conservative Treatment of an Intra-Articular Shear Fracture of the Ulnar Head.

Background Isolated intra-articular fracture of the ulnar head is rare. Case Description A 59-year-old woman experienced an ulnar head fracture involving the distal radioulnar joint after a fall at ground level. The intra-articular fragment of the ulnar head was rotated into anatomical alignment with an above-elbow cast in 90° of supination for 4 weeks. A below-elbow night splint was retained for 2 additional weeks. Twelve months post-injury, full active motion and bone union were achieved. Literature Review Only three studies have reported treatment of isolated intra-articular ulnar head fractures, and in all cases open reduction and internal fixation were performed. Clinical Relevance Our report demonstrated good results for the conservative treatment of an intra-articular ulnar head shear fracture, with early recovery of forearm rotation and wrist function.