Viability of Free Bone Graft in Combination With Free Tissue Transfer and Post-Operative RT in Orbital Floor Reconstruction.

OBJECTIVES/AIM: Orbital floor reconstruction post cancer ablation is challenging especially when associated with extensive soft tissue defects. Due consideration is to be given to the possible toxicities of adjuvant radiotherapy as well. Free bone-soft tissue flaps are ideally suited in such situations. However, a single flap may fall inadequate for large defects. Using two free flaps in combination increases operating time and donor site morbidities. Non-vascularized bone grafts combined with large soft tissue flaps harbor the risk of bone resorption and osteo-radio necrosis. Alloplastic implants can lead to exposure and infection. We conducted a study researching the outcome of non-vascularized cortico-cancellous iliac bone graft (NVCIBG) used in orbital floor reconstruction along with free anterolateral thigh (FALT) flap in subjects undergoing extensive surgical ablation and adjuvant radiotherapy. MATERIALS AND METHODS: Ten consecutive subjects who underwent maxillo-mandibular resection with or without skin were included in the study. The parameters assessed were diplopia, ectropion, bone viability, and osteointegration. Subjects were assessed in the immediate post-operative period, 1 month after surgery, and after 1 year of radiotherapy. RESULTS: The size of iliac bone harvested ranged from 3 to 5.5 cm (mean 4.8 cm). Forty percent subjects complained of binocular diplopia in the initial post-operative period which subsided subsequently. Thirty percent subjects developed ectropion all of whom required external skin reconstruction. None developed osteoradionecrosis. CONCLUSION: NVCIBG along with FALT flap is an excellent reconstructive option for orbital floor defects. It can withstand the toxicities of adjuvant radiotherapy and avoids the need for double free flap reconstruction. LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.

Comparison between Metal Mesh and Iliac Bonegraft in the Reconstruction of Orbital Floor Fracture-A Clinical Study.

Background: After face trauma, orbital floor fractures are often experienced, leading to both functional and cosmetic deficits. There are several methods for reconstructing the orbital floor, such as iliac bone grafting and metal mesh. There are not many comparison studies available, nevertheless, to help surgeons choose the best method. Methods: Fifty patients with orbital floor fractures were enrolled in this prospective, randomized clinical investigation. They were randomly allocated to receive either an iliac bone transplant (n = 25) or metal mesh (n = 25). Over the course of six months, postoperative complications such as diplopia and enophthalmos were assessed regularly. A statistical study was conducted to compare the two groups' results. Results: There was no discernible difference in postoperative complications between the two groups when it came to the reconstruction of orbital floor fractures using either metal mesh or iliac bone transplant. In contrast to the metal mesh group, the iliac bone graft group did, however, exhibit a somewhat decreased incidence of diplopia and enophthalmos. Conclusion: In conclusion, metal mesh and iliac bone graft are both reliable methods for reconstructing the orbital floor, and their rates of surgical complications are similar. However, there could be little benefit to iliac bone grafting in terms of lower rates of enophthalmos and diplopia. Based on the preferences of the surgeon and patient-specific criteria, the procedure should be selected individually.

A matching and localization study of iliac bone graft for repair of talar cartilage injury secondary to lateral ankle instability.

Background: To investigate the search for an Iliac-Talar Grafts on the iliac bone that is morphologically matched to a multiplanar injury lesion of the talus; while utilizing a bone-harvesting guide to ensure precise positioning of the Iliac-Talar Grafts. Methods: A total of twenty-two cases with both talar CT data and iliac CT data were collected from January 2019 to June 2023. One case each of talar deformity injury and bone disease were excluded, resulting in a selection of 20 cases. The medial and lateral target repair areas of the talus were formulated, and virtual surgery was performed by using digital orthopedic technology to locate an iliac-talar restoration on the iliac bone that matched the morphology of the multiplanar injury lesion of the talus. 3D chromatographic deviation analysis was used to assess the accuracy of Iliac-Talar Grafts in terms of morphometric matching and positioning, while personalized iliac bone extraction guides were designed to ensure accurate positioning of the Iliac-Talar Grafts. Results: The best fitting point for repairing the medial talar lesion is determined to be medial to the anterior iliac crest, specifically 2.935 ± 0.365 cm posterior to the anterior superior iliac spine, and 2.550 ± 0.559 cm anterior to the valgus-iliac crest point (VICP). Similarly, for the repair of the lateral talar lesion, the ideal position is found to be lateral to the posterior iliac crest, approximately 2.695 ± 0.640 cm posterior to the valgus-iliac crest point (VICP). Utilizing bone extraction guides enables precise positioning for iliac bone extraction. Conclusion: This study utilizes virtual surgery, 3D chromatographic deviation analysis, and guide plate techniques in digital orthopedics to precisely locate the Iliac-Talar Graft on the iliac bone, matching the morphology of the talar lesion; it provides a new solution for cutting the iliac bone implant that matches the the multifaceted talar lesion to be repaired.

Conversion Total Hip Arthroplasty After Pedicled Peri-Hip Bone Flap Grafting: The Chinese Experience.

BACKGROUND: This study investigated the perioperative outcomes of patients undergoing conversion total hip arthroplasty (THA) after failed peri-hip bone flap grafting (PBFG) and compared them with those patients undergoing primary THA for osteonecrosis of the femoral head (ONFH). METHODS: From January 2010 to December 2021, 163 Chinese patients (163 hips) were treated by conversion THA after failed PBFG (containing 94 patients who had pedicled vascularized iliac bone flap grafting and 69 patients who had pedicled vascularized greater trochanter bone flap grafting), and 178 Chinese patients were treated by primary THA. The preoperative baseline data and perioperative indicators in both groups were compared. RESULTS: In the conversion group, patients had significantly greater blood loss, a longer length of stay, and greater changes in serum hemoglobin than those in the primary THA group (P < 0.05). The operative room time, transfusion volume, calculated blood loss, changes in serum hematocrit, and increased superficial infection (P > 0.05) in the conversion group were greater compared with the primary cohort; however, the difference was not statistically significant. The mean postoperative Harris Hip Scoring system (HHS) of the PBFG group at the 1-month follow-up was 81, and the control group had a score of 82. Importantly, subgroup analysis of the PBFG group indicated that there was no significant difference between patients who had prior pedicled vascularized iliac bone flap grafting and pedicled vascularized greater trochanter bone flap grafting (P > 0.05), except for the operative room time (P = 0.032). CONCLUSIONS: Hip-sparing surgery of ONFH did not make THA more difficult or lead to more perioperative complications, but increased blood loss and extended hospital stay from a prior PBFG are still notable problems in clinical practice. Thus, it is necessary for surgeons to focus attention on the improvement of the preoperative condition and prepare for any specific intraoperative challenges.

Modified Atlantoaxial Arthrodesis Technique for Atlantoaxial Instability via Intraarticular Autografting Using Structural Iliac Bone: Technical Nuances and Case Series.

OBJECTIVE: The present study described a modified technique of atlantoaxial arthrodesis in patients with atlantoaxial instability (AAI) along with the postoperative clinical and radiological results. METHODS: Five patients underwent this method for their AAI concurrent with C1 arch hypoplasia and/or the development of odontoid pannus causing myelopathy. After thorough exposure of the posterior surface of the C1-2 complex, the bilateral C2 nerve roots were sectioned to allow for easier access to the C1/2 facet joints. To prepare a suitable grafting bed, the C1/2 facet capsule was opened, and then the articular cartilaginous and synovial tissues were thoroughly removed. After being properly fashioned to match the gap between the C1/2 facet joint spaces, the structural bone grafts from the iliac crest were directly inserted into the facet joint spaces. To alleviate cord compression caused by concomitant odontoid pannus and/or hypoplastic C1 arch, C1 laminectomy was necessitated in all cases. Subsequently, posterior screw-rod instrumental fixation was conducted. RESULTS: All 5 patients underwent this procedure successfully. Clinical and radiological follow-up data of all patients indicated favorable relief of clinical symptoms and early rigid C1-2 stability. The sequelae of C2 nerve resection were not remarkable. No other neural or vascular damage associated with this technique was observed. CONCLUSIONS: Modified atlantoaxial arthrodesis via intraarticular autografting using the structural iliac bone combined with posterior instrumentation appears to be an efficient alternative treatment method for AAI patients with concurrent pathologies, even when the C1-2 posterior arches are unavailable for the grafting bed.

Comparison of SHD-IBG and PVIBGT in ONFH including mechanical and pathological analysis of failure cases.

Currently, there is a lack of relevant research on the efficacy difference between SHD combined with IBG and PVIBGT in the treatment of osteonecrosis of the femoral head(ONFH). Firstly, this study intends to compare the effectiveness of surgical hip dislocation combined with impacting bone grafts (SHD-IBG) and pedicled vascularised iliac bone graft transfer (PVIBGT) in treating ONFH. And the study investigates patients who suffered from hip preservation failures from both groups to better comprehend failure reasons. 30 patients (34 hips) with ARCO stage IIIA femoral head necrosis were selected between January 2012 and July 2022. They were divided into group A(SHD-IBG) and group B (PVIBGT) according to different surgical methods. Firstly, compared the 1-year effect between SHD-IBG and PVIBGT at 1 year postoperatively; Secondly, assessed the medium and long-term efficacy of SHD-IBG hip preservation treatment; Lastly, based on study of the femoral head removed from patients with hip preservation failure in the two groups, the reasons for the failure of hip preservation were comprehensively analyzed in the two groups. Group A: 11 males (13 hips), 4 females (4 hips);Group B: 9 males (11 hips), 6 females (6 hips).Firstly, the average Harris scores of the two groups at 1 year after surgery: preoperative: 70.7, 1 year after surgery: 78.9 in group A; preoperative: 69.5, 1 year after surgery: 81.5 in group B. The differences were statistically significant (P < 0.05).Compared to the preoperative period, quantitative analysis by DCE-MRI showed an increase in perfusion in the necroticarea and an improvement in hyperperfusion in the repair-responsive area one year after the surgery. Secondly, in group A, the hip preservation rate was 88.2% at 2.5-11 (average of 77 months) years of follow-up, and the mean Harris score at the last follow-up was 73.2.Semi-quantitative analysis of postoperative DCE-MRI showed that the perfusion curves of necrotic and repaired areas were similar to those of the normal area. This suggests the instability within the femoral head had been effectively improved, and the perfusion had partially recovered. Thirdly, according to Micro-CT and pathologica studies of patients with hip preservation failure in these two groups, all these patients' femoral head was significantly collapsed and deformed. Their trabeculae was thin and partially disorganized, with fractures in the subchondral bone and separation of the cartilage from the subchondral bone. The necrotic areas had sparse trabeculae, disorganized arrangement, loss of continuity, and disappearance of cells in the trabecular traps. The necrotic area was covered with fibrous tissue, and partial restoration was observed in the repair area. Mechanical finite element analysis showed that the maximum equivalent force was observed in the weight- bearing area and the cortical bone surrounding the shaft of femurand. The result of DCE-MRI showed that the repair reaction area exhibited abnormal hyperperfusion. In this study, the efficacy of SHD-IBG and PVIBGT was compared at 1 year after operation, and the long-term follow-up of SHD-IBG was 2.5-11 (mean 77 months) years, combined with DCE-MRI results, we found that the short-term effect of PVIBGT was more significant than that of SHD-IBG. SHD-IBG can achieve satisfactory hip preservation in the medium and long term follow-up.

A study on the morphology of iliac crest based on the objectives of jaw bone defect reconstruction.

OBJECTIVES: to understand the morphological characteristics of iliac crest and provide advice and assistance for jaw bone reconstruction with iliac bone flap by evaluating the thickness and curvature of iliac crest. MATERIALS AND METHODS: 100 patients who had taken Spiral CT of the Abdominal region before surgeries between 2020 and 2022 were included in this study. 3D reconstruction images of the iliac bones were created. 5 vertical planes perpendicular to the iliac crest were made every 2 cm along the centerline of the iliac crest (VP2 ~ VP10). On these vertical planes, 4 perpendicular lines were made every 1 cm along the long axis of the iliac crest (D1 ~ D4). The thicknesses at these sites, horizontal angle (HA) of iliac crest and the distance between inflection point and the central point of anterior superior iliac spine (DIA) were measured. RESULTS: The thickness of iliac bone decreased significantly from D1 ~ D4 on VP6 ~ VP10 and from VP2 ~ VP10 on D3 and D4 level (P<0.05). HA of iliac crests was 149.13 ± 6.92°, and DIA was 7.36 ± 1.01 cm. Iliac bone thickness, HA and DIA had very weak or weak correlation with patient's age, height and weight. CONCLUSIONS: The average thicknesses of iliac crest were decreased approximately from front to back, from top to bottom. The thickness and curvature of the iliac crest were difficult to predict by age, height and weight. CLINICAL RELEVANCE: Virtual surgical planning is recommended before jaw bone reconstruction surgery with iliac bone flap, and iliac crest process towards alveolar process might be a better choice.

A comparison of anterior reconstruction of spinal defect using nano-hydroxyapatite/polyamide 66 cage and autologous iliac bone for thoracolumbar tuberculosis: a stepwise propensity score matching analysis.

Purpose: Previous studies have confirmed the advantages and disadvantages of autogenous iliac bone and nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cage. However, there is no conclusive comparison between the efficacy of the two implant materials in spinal tuberculosis bone graft fusion. The aim of this study was to analyze the mid-to long-term clinical and radiologic outcomes between n-HA/PA66 cage and autogenous iliac bone for anterior reconstruction application of spinal defect for thoracolumbar tuberculosis. Methods: We retrospectively reviewed all patients who underwent anterior debridement and strut graft with n-HA/PA66 cage or iliac bone combined with anterior instrumentations between June 2009 and June 2014. One-to-one nearest-neighbor propensity score matching (PSM) was used to match patients who underwent n-HA/PA66 cage to those who underwent iliac bone. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) and visual analogue score (VAS). Radiographic evaluations included cage subsidence and segmental angle. Results: At the end of the PSM analysis, 16 patients from n-HA/PA66 cage group were matched to 16 patients in Iliac bone group. The C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values in the n-HA/PA66 group decreased significantly from 33.19 ± 10.89 and 46.63 ± 15.65 preoperatively, to 6.56 ± 2.48 and 9.31 ± 3.34 at the final follow-up, respectively (p < 0.001). There were no significant differences in the CRP and ESR values between the two groups at the final follow-up. The VAS and JOA scores in the iliac bone and n-HA/PA66 group were significantly improved at the 3-month follow-up postoperatively (both p < 0.001). Then, improvements of VAS and JOA scores continue long at final follow-up. However, there were no significant differences in the VAS and JOA scores at any time point between the two groups (p > 0.05). Although the segmental angle (SA) significantly increased after surgery in both groups, there was no significant difference at any time point after surgery (p > 0.05). There were no significant differences in the cage subsidence and fusion time between the two groups. Conclusion: Overall, our data suggest that the n-HA/PA66 cage outcomes are comparable to those in the autogenous iliac bone, with a similar high fusion rate as autogenous iliac bone.

Consecutive Bilateral Iliac Stress Fracture in an Adult Male Runner.

Iliac stress fractures (ISF) are uncommon in sports, particularly among runners, and are attributed to repetitive loading and other predisposing factors. ISF poses diagnostic challenges due to nonspecific symptoms and the limited sensitivity of conventional imaging procedures. The reported case is about a 51-year-old male marathon runner with consecutive bilateral ISF. Initial symptoms included mechanical pain in the right buttock, leading to a diagnosis confirmed via pelvic MRI. Conservative management with eight weeks rest from sport activity was indicated with symptom resolution and return to sport. However, 20 days after returning to sport, the patient developed left-sided symptoms post-resumption of running, with MRI confirming a new ISF. An additional eight weeks of rest was prescribed, allowing the patient to resume sport at preinjury levels. ISF should be considered in runners presenting with gluteal pain, emphasizing the importance of early diagnosis. MRI emerges as a valuable tool for accurate diagnosis, guiding appropriate management strategies. Conservative management focusing on rest is paramount for favorable outcomes and optimizing runners' health and performance.

Analysis of risk factors for the recurrence of osteomyelitis of the limb after treatment with antibiotic-loaded calcium sulfate and autologous bone graft.

Objective: We aimed to evaluate the efficacy of antibiotic-loaded calcium sulfate combined with autologous iliac bone transplantation in the treatment of limb-localized osteomyelitis (Cierny-Mader type III) and analyze the causes and risk factors associated with infection recurrence. Methods: Clinical data of 163 patients with localized osteomyelitis of the extremities treated with antibiotic-loaded calcium sulfate combined with autologous iliac bone transplantation in Xi'an Honghui Hospital from January 2017 to December 2022 were retrospectively analyzed. All patients were diagnosed with localized osteomyelitis through clinical examination and treated with antibiotic-loaded calcium sulfate combined with autologous iliac bone. Based on the infection recurrence status, the patients were divided into the recurrence group and the non-recurrence group. The clinical data of the two groups were compared using univariate analysis. Subsequently, the distinct datasets were included in the binary logistic regression analysis to determine the risk and protective factors. Results: This study included 163 eligible patients, with an average age of 51.0 years (standard deviation: 14.9). After 12 months of follow-up, 25 patients (15.3%) experienced infection recurrence and were included in the recurrence group; the remaining 138 patients were included in the non-recurrence group. Among the 25 patients with recurrent infection, 20 required reoperation, four received antibiotic treatment alone, and one refused further treatment. Univariate analysis showed that education level, smoking, hypoproteinemia, open injury-related infection, and combined flap surgery were associated with infection recurrence (p < 0.05). Logistic regression analysis showed that open injury-related infection (odds ratio [OR] = 35.698; 95% confidence interval [CI]: 5.997-212.495; p < 0.001) and combined flap surgery (OR = 41.408; 95% CI: 5.806-295.343; p < 0.001) were independent risk factors for infection recurrence. Meanwhile, high education level (OR = 0.009; 95% CI: 0.001-0.061; p < 0.001) was a protective factor for infection recurrence. Conclusion: Antibiotic-loaded calcium sulfate combined with autologous iliac bone transplantation is an effective method for treating limb-localized osteomyelitis. Patients without previous combined flap surgery and non-open injury-related infections have a relatively low probability of recurrence of infection after treatment with this surgical method. Additionally, patients with a history of smoking and hypoproteinemia should pay attention to preventing the recurrence of infection after operation. Providing additional guidance and support, particularly in patients with lower education levels and compliance, could contribute to the reduction of infection recurrence.

Anatomical Basis for Preservation of Cartilaginous Apophysis in Pediatric Patients Undergoing Iliac Crest Bone Graft Harvest: A Cohort Study.

Background The anterior iliac crest is the workhorse for the harvest of cancellous bone in children undergoing cleft alveolar bone grafting. However, the complexity of the anatomy makes the process of harvesting graft technique sensitive. The aim was to describe the outcomes of the medially based trap door method of graft harvest in pediatric patients undergoing cleft alveolar bone grafting. Methods A cohort study was conducted, including all the patients in the age group of 8-12 years. Alveolar bone grafting was performed after harvesting a cancellous graft from the iliac crest bone grafting (ICBG) using a medially based trap door approach. Intraoperative time, average blood loss, and postoperative outcomes, including pain score, paresthesia, and gait disturbances, were recorded. Results A total of 28 patients were included in the study based on the inclusion and exclusion criteria. The volume of cancellous bone harvested was between 4-9 cc. The mean intraoperative time was 42 minutes, with an average blood loss of 36 to 48 ml. The average visual analog scale (VAS) score in the postoperative period was 3.5, 6, and 4 on the first, third, and seventh postoperative days. All the patients were ambulated on the second postoperative day, and none of them reported paresthesia. Long-term evaluation of the anterior illum revealed intact crestal morphology with a bone refill on the posterior-anterior (PA) pelvic X-ray. Conclusion A medially based modified trap door approach is more efficacious and less morbid for the harvest of ICBG in pediatric patients.

Three-dimensional comprehensive evaluation of unilateral alveolar cleft bone grafting with iliac bone and chin bone blocks.

In this study, we aimed to provide guidance for selecting bone grafting materials in cases of alveolar clefts. Twenty-nine patients with unilateral complete alveolar clefts were categorized into three groups based on the bone grafting material used: Group A (iliac bone block grafts), Group B (iliac cancellous bone grafts), and Group C (chin bone block grafts). Cone-beam computed tomography (CBCT) data were analyzed using Mimics 19.0 software. Results showed that Group A had the highest bone formation rate, with significant differences observed between Groups A and B, as well as between Groups B and C. Group A and Group C had the highest proportion of Type I in volume assessment, while Group B had the highest proportion of Type III, Significant differences were observed in the distribution of volume assessment scores among the three groups. Bone height measurement results indicated that buccal-side measurement points had a higher proportion of Type I bone height than palatal-side measurement points. Bone width measurement results showed that Type I bone width was highest in Group C, while Type IV bone width was highest in Group B. Significant differences were observed in the distribution of implanted bone width among the three groups. Total grafting scores indicated that Types A and D were predominant in Groups A and C, while Group B had the highest proportion of Type D. Significant differences were observed in the distribution of total grafting scores among the three groups. The comprehensive evaluation method provides accurate assessment of alveolar cleft bone grafting outcomes and is applicable in clinical settings. Based on the results, we consider both iliac bone blocks and chin bone blocks as suitable materials for alveolar cleft bone grafting. Grafting material selection should consider preoperative gap volume measured using CBCT, required bone quantity, donor site complications, and overall clinical needs.

Tuberculosis of the Iliac Bone and Acetabulum With Iliopsoas, Obturator Internus, and Obturator Externus Abscesses in an Immunocompetent Indian Female: An Extremely Rare Case.

Skeletal tuberculosis is a rare form of extrapulmonary tuberculosis. Due to non-specific clinical features, these cases are often diagnosed very late, ultimately affecting treatment outcomes. The present case is a very rare case of tuberculosis of the iliac bone and acetabulum with iliopsoas, obturator internus, and obturator externus abscesses in an Indian female. She reported pain in her right hip and a limp. It was a difficult diagnosis, especially due to the rare involvement of bones and muscles in the absence of any lesions in the lungs. Nevertheless, the diagnosis was achieved by a detailed radiometric and laboratory workup. She was initiated on antituberculous treatment per her weight for 12 months.

[Comparison of talonavicular-cuneiform joint fusion with bone grafting and without bone grafting in treatment of Müller-Weiss disease].

Objective: To compare the effectiveness of talonavicular-cuneiform joint fusion with iliac bone grafting and without bone grafting in the treatment of Müller-Weiss diseases (MWD). Methods: The clinical data of 44 patients (44 feet) with MWD who received talonavicular-cuneiform joint fusion between January 2017 and November 2022 and met the selection criteria was retrospectively analyzed. Among them, 25 patients were treated with structural iliac bone grafting (bone grafting group) and 19 patients without bone grafting (non-bone grafting group). There was no significant difference ( P>0.05) in age, gender composition, body mass index, disease duration, affected side, Maceira stage, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, anteroposterior/lateral Meary angle, and Pitch angle between the two groups. Operation time, operation cost, and postoperative complications were recorded in the two groups. AOFAS and VAS scores were used to evaluate the function and pain degree of the affected foot. Meary angle and Pitch angle were measured on the X-ray film, and the joint fusion was observed after operation. The difference (change value) of the above indexes before and after operation was calculated for comparison between groups to evaluate the difference in effectiveness. Results: The operation was successfully completed in both groups, and the incisions in the two groups healed by first intention. The operation time and cost in the bone grafting group were significantly more than those in the non-bone grafting group ( P<0.05). All patients were followed up. The median follow-up time was 41.0 months (range, 16-77 months) in the non-bone grafting group and 40.0 months (range, 16-80 months) in the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case, internal fixation stimulation in 2 cases, and pain at the iliac bone harvesting area in 1 case of the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case and muscle atrophy of the lower limb in 1 case of the non-bone grafting group. There was no significant difference in the incidence of complications between the two groups ( P>0.05). At last follow-up, the AOFAS scores of the two groups significantly improved when compared with those before operation, while the VAS scores significantly decreased, the anteroposterior/lateral Meary angle and Pitch angle significantly improved, and the differences were significant ( P<0.05). There was no significant difference in the change values of outcome indicators between the two groups ( P>0.05). There was no delayed bone union or bone nonunion in both groups, and joint fusion was achieved at last follow-up. Conclusion: In the treatment of MWD, there is no significant difference in effectiveness and imaging improvement of talonavicular-cuneiform joint fusion combined with or without bone grafting. However, non-bone grafting can shorten the operation time, reduce the cost, and may avoid the complications of bone donor site.

Enhancing surgical outcomes of posterior iliac bone harvesting through a pivotal modification.

Traditionally, patients are positioned in the prone position to access the donor site during the posterior iliac bone graft harvesting procedure. However, this well-established method is associated with complications such as pressure injuries, displacement of the endotracheal tube and intravenous catheter, and blindness. Moreover, the process of turning patients 180° between the supine and prone positions is both laborious and time consuming. However, no updates have been made in the approaches published in the literature to counteract these problems. Therefore, to overcome these challenges and improve patient outcomes, we proposed a pivotal modification: change prone position to the lateral decubitus position. This approach allowed us to effectively avoid the aforementioned complications. In addition, this modification offered significant advantages, including ease of implementation and timesaving benefits. The article presented results of the modification and a comprehensive evaluation of clinical and anesthetic considerations comparing the two methods.

Clinical and radiological outcomes of non-window-type bioactive glass-ceramic cage in single-level ACDF versus PEEK cage filled with autologous bone.

Bioactive glass-ceramic (BGC) cage is a substitute for polyether ether ketone (PEEK) cages in anterior cervical discectomy and fusion (ACDF). Only a few comparative studies exist using PEEK and non-window-type BGC cages (CaO-SiO2-P2O5-B2O3) in single-level ACDF. This study compared PEEK cages filled with autologous iliac bone grafts and BGC cages regarding clinical safety and effectiveness. A retrospective case series was performed on 40 patients who underwent single-level ACDF between October 2020 and July 2021 by a single orthopedic spine surgeon. The spacers used in each ACDF were a PEEK cage with a void filled with an autologous iliac bone graft and a non-window-type BGC cage in 20 cases. The grafts were compared pre-operatively and post-operatively at 6 weeks and 3, 6, and 12 months. Post-operative complications were investigated in each group. Clinical outcome was measured, including Visual Analog Scale (VAS) scores of neck and arm pains, Japanese Orthopedic Association score (JOA), and Neck Disability Index (NDI). Dynamic lateral radiographs were used to assess the inter-spinous motion (ISM) between the fusion segment and subsidence. The fusion status was evaluated using a computed tomography (CT) scan. Overall, 39 patients (19 and 20 patients in the PEEK and BGC groups, respectively) were recruited. Eighteen (94.7%) and 19 (95.0%) patients in the PEEK and BGC groups, respectively, were fused 12 months post-operatively, as assessed by ISM in dynamic lateral radiograph and bone bridging formation proven in CT scan. The PEEK and BGC groups showed substantial improvement in neck and arm VAS, JOA, and NDI scores. No substantial difference was found in clinical and radiological outcomes between the PEEK and BGC groups. However, the operation time was considerably shorter in the BGC group than in the PEEK group. In conclusion, a non-window-type BCG cage is a feasible substitute for a PEEK cage with an autologous iliac bone graft in single-level ACDF.

Primary Aneurysmal Bone Cyst in the Iliac Bone: A Case Report.

Introduction: Aneurysmal bone cysts (ABCs) are non-neoplastic expansile, vascular, osteolytic benign tumors in the long bone, spine, and sternum. The location in the pelvis is sparse. Case Report: A 12-year-old female presented with pain in her left pelvis for 6 months. On radiological examination, we found an expansile balloting lytic lesion involving almost the whole ilium and sparing the hip joint. There were multiple fluid levels seen on magnetic resonance imaging. The initial biopsy suggested ABC. Curettage and bone grafting were done along with electrocauterization and chemical cauterization. At 1-year follow-up, she is doing well without any complaints. Conclusion: This case report demonstrates a rare ABC of the ilium that was managed with curettage and bone grafting.

Medial Trap Door Technique to Harvest a Cancellous Bone Graft From the Anterior Iliac Crest.

Alveolar bone grafting (ABG) in cleft lip and palate patients allows for the facilitation of eruption of the canine and sometimes eruption of the lateral incisor. It provides bony support to the cleft raising the alar base of the nose and also facilitates the closure of an oro-nasal fistula. Many report at a time when late alveolar bone grafting is the only option to overcome the bony defect mainly due to their socioeconomic concern. Autologous bone graft for alveolar bone grafting harvested from the anterior iliac crest using the medial trap door technique has many advantages over other techniques of harvesting bone graft from the anterior iliac crest. In this case report we have discussed a case of bone graft harvesting from the anterior iliac crest using the medial trap door technique for late secondary alveolar bone grafting.

Alveolar cleft reconstruction using iliac bone graft: a clinical case report.

Introduction and importance: Alveolar clefts are frequently occurring congenital anomalies that can significantly impact both the functional and aesthetic aspects of an individual's life. Thus, reducing the quality of life. These clefts can give rise to difficulties in feeding, speech, and dental development. Furthermore, the presence of a gap in the alveolar ridge can disrupt the proper alignment and eruption of permanent teeth. Various techniques have been developed to effectively repair these defects and restore oral function and rehabilitation. Case presentation: An 18-year-old girl is presented with unilateral alveolar cleft which was successfully repaired by utilizing iliac bone grafting and augmenting the defect to restore proper bone architecture and gain suitable support for dental prostheses. Therefore, enhancing oral health by closing the oronasal fistula and improving aesthetics and functional abilities including speech. Clinical discussion: Having an alveolar cleft can lead to challenges which may require a multidisciplinary approach, including surgical intervention, orthodontic treatment, and dental rehabilitation. The primary goal is to close the cleft, restore normal speech and feeding functions, and promote proper dental development. Conclusion: Patients who suffer from alveolar clefts need appropriate treatment. This case report suggests a surgical technique of utilizing the combination of hard and soft tissue management to fix the problem for such individuals and achieve improved oral health, speech, and overall enhancement in quality of life.

Comparison of vertical bone resorption following various types of autologous block bone grafts.

BACKGROUND: This study aims to measure and compare the differences in vertical bone resorption after vertical augmentation using different types of autologous block bone. METHODS: Data were collected from 38 patients who had undergone vertical ridge augmentation using an autologous block bone before implant insertion. The patients were divided into three groups based on the donor sites: ramus bone (RB), chin bone (CB), and iliac crestal bone (IB). RESULTS: The surgical outcome of the augmentation was evaluated at the follow-up periods up to 60 months. In 38 patients, the mean amount of vertical bone gain was 8.36 ± 1.51 mm in the IB group, followed by the RB group (4.17 ± 1.31 mm) and the CB group (3.44 ± 1.08 mm). There is a significant difference in vertical bone resorption between the groups (p < 0.001), and the RB group demonstrated significantly lower resorption than the CB and IB groups (p = 0.011 and p < 0.001, respectively). The most common postoperative complications included neurosensory disturbance in the CB graft and gait disturbance in the IB graft. Out of the 92 implants inserted after augmentation, four implants were lost during the study period, resulting in an implant success rate of 95.65%. CONCLUSIONS: The RB graft might be the most suitable option for vertical augmentation in terms of maintaining postoperative vertical height and reducing morbidity, although the initial gain was greater with the IB graft compared to other block bones.