The iliosacral joint in lizards: an osteological and histological analysis.

The development of the iliosacral joint (ISJ) in tetrapods represented a crucial step in the evolution of terrestrial locomotion. This structure is responsible for transferring forces between the vertebral column and appendicular skeleton, thus supporting the bodyweight on land. However, most research dealing with the water-to-land transition and biomechanical studies in general has focused exclusively on the articulation between the pelvic girdle and femur. Our knowledge about the contact between the pelvic girdle and vertebral column (i.e. the ISJ) at a tissue level is restricted so far to human anatomy, with little to no information available on other tetrapods. This lack of data limits our understanding of the development and evolution of such a key structure, and thus on the pattern and processes of the evolution of terrestrial locomotion. Therefore, we investigated the macro- and microanatomy of the ISJ in limb-bearing squamates that, similar to most non-mammalian, non-avian tetrapods, possess only two sacral ribs articulating with the posterior process of the ilium. Using a combination of osteology, micro-computed tomography and histology, we collected data on the ISJ apparatus of numerous specimens, sampling different taxa and different ontogenetic stages. Osteologically, we recorded consistent variability in all three processes of the ilium (preacetabular, supracetabular and posterior) and sacral ribs that correlate with posture and locomotion. The presence of a cavity between the ilium and sacral ribs, abundant articular cartilage and fibrocartilage, and a surrounding membrane of dense fibrous connective tissue allowed us to define this contact as a synovial joint. By comparison, the two sacral ribs are connected to each other mostly by dense fibrous tissue, with some cartilage found more distally along the margins of the two ribs, defining this joint as a combination of a syndesmosis and synchondrosis. Considering the intermediary position of the ISJ between the axial and appendicular skeletons, the shape of the articular surfaces of the sacral ribs and ilium, and the characteristics of the muscles associated with this structure, we argue that the mobility of the ISJ is primarily driven by the movements of the hindlimb during locomotion. We hypothesize that limited torsion of the ilium at the ISJ happens when the hip is abducted, and the joint is likely able to absorb the compressional and extensional forces related to the protraction and retraction of the femur. The mix of fibres and cartilage between the two sacral ribs instead serves primarily as a shock absorber, with the potential for limited vertical translation during locomotion.

Adipocyte lineage differentiation potential of MSCs isolated from reaming material.

Mesenchymal stem cells (MSCs) obtained from various sources have been used for different therapeutic applications including tissue regeneration. Reamer/irrigator/aspirator (RIA) has been increasingly used in recent years for the derivation of MSCs. Here in this investigation we have comparatively analyzed MSCs obtained from iliac crest bone marrow (ICBM) and RIA for their morphology, cluster determinant (CD) markers, and adipogenic differentiation capacity. MSCs were isolated, cultured, and purified from both sources and then flow cytometric studies were performed to study their characteristics. The differentiation potential of RIA and ICBM was examined by an Oil Red O staining protocol. Moreover, the tissue-specific markers related to adipogenesis were analyzed by real-time polymerase chain reaction (RT-PCR). The cells were cultured in the relevant induction medium and then adipogenic lineage differentiation was tested and confirmed for all MSC preparations. Additionally, analysis by flow cytometer was indicative of RIA derived MSCs (RIA-MSCs) having a more homogenous population than ICBM derived MSCs. The RIA-MSCs differentiation toward adipogenic lineage was more efficient compared with ICBM-MSCs. Direct comparative analysis of RIA to ICBM-MSCs indicated that the RIA-MSCs had a higher potential toward adipocyte lineage differentiation compared with ICBM-MSCs.

Exercise-induced loading increases ilium cortical area in a selectively bred mouse model.

OBJECTIVES: Little is known about how ilium cortical bone responds to loading. Using a mouse model, this study presents data testing the hypothesis that iliac cross-sectional properties are altered in response to increased activity. MATERIALS AND METHODS: The sample derives from lines of High Runner (HR) mice bred for increased wheel-running activity. Four treatment groups of female mice were tested: non-selected control lines housed without (N = 19) and with wheels (N = 20), and HR mice housed without (N = 17) and with wheels (N = 18) for 13 weeks beginning at weaning. Each pelvis was µCT-scanned, cross-sectional properties (cortical area-Ct.Ar, total area-Tt.Ar, polar moment of area, and polar section modulus) were determined from the ilium midshaft, and robusticity indices (ratio of the square root of Ct.Ar or Tt.Ar to caudal ilium length) were calculated. Mixed models were implemented with linetype, wheel access, and presence of the mini-muscle phenotype as fixed effects, replicate line nested within linetype as a random effect, and body mass as a covariate. RESULTS: Results demonstrate that the mouse ilium morphologically resembles a long bone in cross section. Body mass and the mini-muscle phenotype were significant predictors of iliac cross-sectional properties. Wheel access only had a statistically significant effect on Ct.Ar and its robusticity index, with greater values in mice with wheel access. DISCUSSION: These results suggest that voluntary exercise increases cortical area, but does not otherwise strengthen the ilium in these mice, corroborating previous studies on the effect of increased wheel-running activity on femoral and humeral cross-sectional properties in these mice.

Iliac and mandible osteoblasts exhibit varied responses to LMHF vibration.

The facial and long bones have distinct developmental origins, structures, and cellular compositions. This study aimed to compare the in vitro responses of human mandible and long bone osteoblasts to low-magnitude, high-frequency (LMHF) mechanical vibration in terms of expression of mediators of bone remodeling. Osteoblast-like cell cultures were prepared from iliac crest and mandibular bone specimens from three individuals and cultured in osteogenic induction media. Induction of mature osteoblastic phenotypes was confirmed by analysis of DNA content, alkaline phosphatase activity and gene expression every 3 days for 27 days. Based on gene expression, mature osteoblasts formed by day 15 of induction culture. After 15 days of culture in induction media, mature osteoblasts were subjected to vibration (0, 30, or 60 Hz) for 30 min every 24 h. After 48 h, RANKL, OPG, IL-1ß, IL-6 and TGF-ß gene, and protein expression were determined by real-time PCR analysis of total cellular mRNA and ELISAs of the cell supernatants. Both iliac and mandible osteoblasts responded to LMHF vibration: IL-1ß and RANKL mRNA were downregulated and IL-6 mRNA was upregulated. However, TGF- ß mRNA was unaltered and OPG mRNA was upregulated in iliac osteoblasts, whereas both TGF-ß and OPG mRNA were downregulated in mandible osteoblasts. As a result, LMHF reduced the RANKL/OPG mRNA ratio in iliac osteoblasts but did not alter the RANKL/OPG mRNA ratio in mandible osteoblasts. This study suggests mature iliac osteoblasts exhibit a more potent anti-resorptive response to vibration, while this tendency was not obviously apparent in mature mandible osteoblasts.

The dynamic role of the ilio-sacral joint in jumping frogs.

A striking feature among jumping frogs is a sharp pelvic bend about the ilio-sacral (IS) joint, unique to anurans. Although this sagittal plane hinge has been interpreted as crucial for the evolution of jumping, its mechanical contribution has not been quantified. Using a model based on Kassina maculata and animated with kinematics from prior experiments, we solved the ground contact dynamics in MuJoCo enabling inverse dynamics without force plate measurements. We altered the magnitude, speed and direction of IS extension (leaving remaining kinematics unaltered) to determine its role in jumping. Ground reaction forces (GRFs) matched recorded data. Prior work postulated that IS rotation facilitates jumping by aligning the torso with the GRF. However, our simulations revealed that static torso orientation has little effect on GRF due to the close proximity of the IS joint with the COM, failing to support the 'torso alignment' hypothesis. Rather than a postural role, IS rotation has a dynamic function whereby angular acceleration (i) influences GRF direction to modulate jump direction and (ii) increases joint loading, particularly at the ankle and knee, perhaps increasing tendon elastic energy storage early in jumps. Findings suggest that the pelvic hinge mechanism is not obligatory for jumping, but rather crucial for the fine tuning of jump trajectory, particularly in complex habitats.

Relationships between age and microarchitectural descriptors of iliac trabecular bone determined by microCT.

AIM: Estimation of age at death is a major issue in anthropology. The main anthropological histological methods propose studying the architecture of cortical bone. In bone histomorphometry, researches on metabolic bone diseases have provided normative tables for trabecular bone volume (BV/TV) according to age and gender of individuals on trans-iliac bone biopsies. We have used microCT, a non-destructive tool for measuring bone volume and trabecular descriptors to compare the French tables to a series of forensic anthropological population and if the two iliac bones could be used interchangeably. METHODOLOGY: Coxal bone of a personal forensic collection whose age and gender were known (DNA identification) were used. Bone samples, centered on the same area than bone biopsy. MicroCT (pixel size: 36µm) was used to measure BV/TV and morphometric trabecular parameters of microarchitecture. An adjusted Z-score was calculated for BV/TV to compare with normative tables and a right/left comparison of trabecular parameters was provided. RESULTS: Twenty-seven iliac bones, which 20 forming 10 complete pelvises, aged between 24 and 73y.o. (average of 47.7 y.o.) were used. All adjusted Z-score were within normal values. There was a strong positive correlation between right and left sides for Tb.Th, Tb.N and Tb.Sp, but an insignificant correlation was obtained for BV/TV. CONCLUSION: Normative tables between age and BV/TV are valid and therefore usable in anthropology. They may represent an alternative to determine the age at death. Nevertheless, it requires a precise technique that could be a drawback in current practice.

Development and performance analysis of Si-CaP/fine particulate bone powder combined grafts for bone regeneration.

BACKGROUND: Although autogenous bone grafts as well as several bone graft substitute material have been used for some time, there is high demand for more efficient and less costly bone-substitute materials. Silicon-substituted calcium phosphates (Si-CaP) and fine particulate bone powder (FPBP) preparations have been previously shown to individually possess many of the required features of a bone graft substitute scaffold. However, when applied individually, these two materials fall short of an ideal substitute material. We investigated a new concept of combining Si-CaP with FPBP for improved performance in bone-repair. METHODS: We assessed Si-CaP/FPBP combined grafts in vitro, by measuring changes in pH, weight loss, water absorption and compressive strength over time. RESULTS: Si-CaP/FPBP combined grafts was found to produce conditions of alkaline pH levels compared to FPBP, and scaffold surface morphology conducive to bone cell adhesion, proliferation, differentiation, tissue growth and transport of nutrients, while maintaining elasticity and mechanical strength and degradation at a rate closer to osteogenesis. CONCLUSION: Si-CaP/FPBP combined grafts was found to be superior to any of the two components individually.

Preservation of bone mass and structure in hibernating black bears (Ursus americanus) through elevated expression of anabolic genes.

Physical inactivity reduces mechanical load on the skeleton, which leads to losses of bone mass and strength in non-hibernating mammalian species. Although bears are largely inactive during hibernation, they show no loss in bone mass and strength. To obtain insight into molecular mechanisms preventing disuse bone loss, we conducted a large-scale screen of transcriptional changes in trabecular bone comparing winter hibernating and summer non-hibernating black bears using a custom 12,800 probe cDNA microarray. A total of 241 genes were differentially expressed (P < 0.01 and fold change >1.4) in the ilium bone of bears between winter and summer. The Gene Ontology and Gene Set Enrichment Analysis showed an elevated proportion in hibernating bears of overexpressed genes in six functional sets of genes involved in anabolic processes of tissue morphogenesis and development including skeletal development, cartilage development, and bone biosynthesis. Apoptosis genes demonstrated a tendency for downregulation during hibernation. No coordinated directional changes were detected for genes involved in bone resorption, although some genes responsible for osteoclast formation and differentiation (Ostf1, Rab9a, and c-Fos) were significantly underexpressed in bone of hibernating bears. Elevated expression of multiple anabolic genes without induction of bone resorption genes, and the down regulation of apoptosis-related genes, likely contribute to the adaptive mechanism that preserves bone mass and structure through prolonged periods of immobility during hibernation.

Age-related changes in iliac crest cortical width and porosity: a histomorphometric study.

Although age-related changes in cancellous bone structure in human are relatively well characterized, few studies have addressed changes in cortical bone. We have investigated age-related changes in iliac crest bone biopsy specimens from 54 normal subjects, 23 men and 31 women, aged 18-90 years. A significant decrease in cortical width and area was seen (P =0.002 and <0.001 respectively), with no difference between sexes. Haversian canal density increased significantly with age by approximately 9% per decade (P = 0.032) but Haversian canal area tended to be lower, resulting in no overall age-related difference in cortical porosity. Haversian canal area was significantly higher in the endosteal section than in the periosteal section of the cortex (P = 0.019) but the Haversian canal density was lower, resulting in similar overall porosity in the two sections. In conclusion, our results demonstrate an age-related decrease in iliac crest cortical width in men and women and an increase in Haversian canal density, but no overall change in cortical porosity.

Interposition of a reversed jejunal segment enhances intestinal adaptation in short bowel syndrome: an experimental study on pigs.

BACKGROUND: Interposition of a reversed intestinal segment as a factor facilitating intestinal adaptation has been experimentally investigated. Controversy exists about its efficacy in terms of body weight improvement, direction of luminal changes, and underlying mechanisms. This study aims to provide a comprehensive approach. METHODS: The pigs were randomly allocated to two groups: (1) short bowel (SB) group (n=8) and (2) short bowel reverse jejunal segment (SB-RS) group (n=8). On postoperative d 3, 30, and 60, intestinal transit time was measured; body weight and serum albumin were measured on baseline, as well as on postoperative d 30 and 60. After sacrifice, histopathologic and immunohistochemical (PCNA, activated caspase-3) evaluation followed. RESULTS: Transit time was numerically longer in SB-RS group at all time points; the difference reached statistical significance on d 60. No statistically significant differences were observed concerning body weight or serum albumin. In the SB-RS group, a statistically significant increase in muscle thickness, crypt depth, villus height, and PCNA immunostaining, and a decrease in caspase-3 positive (+) cell count were documented both at the jejunal and ileal level. CONCLUSIONS: The reversed jejunal segment seemed able to enhance intestinal adaptation at a histopathologic level, as well as to favorably modify transit time. These putatively beneficial actions were not reflected upon body weight. The decrease in apoptosis was caspase-3-dependent.

Sonographic evaluation of apophyseal ossification of the iliac crest in forensic age diagnostics in living individuals.

Due to the requirement to minimise exposure to radiation, it is desirable to develop non-ionising imaging procedures for the analysis of skeletal maturation for forensic age diagnostics in living individuals. The present pilot study analyses the applicability of ultrasound examinations for the evaluation of apophyseal ossification of the iliac crest. With reference to the sonographic staging of clavicular ossification, the maturation stages of the iliac crest apophysis of 23 male and 16 female subjects, aged 11-20 years, were determined. Ossification stage I occurred in the male subjects at a minimum age of 15.7 years. Ossification stage II was diagnosed in boys at a minimum age of 14.1 years and in girls at a minimum age of 11.7 years. The earliest observation of ossification stage III was at a chronological age of 16.2 years in males and 15.2 years in females. The earliest age of occurrence of ossification stage IV was at least 18.0 years in male test persons and at least 17.1 years in female test persons. The results obtained should be reassessed in a larger number of cases. It is to be expected that sonographic examination of the iliac crest apophysis will become established as a valid and efficient method for forensic age diagnostics in living individuals.

Fast tool for evaluation of iliac crest tissue elastic properties using the reduced-basis methods.

Computationally expensive finite element (FE) methods are generally used for indirect evaluation of tissue mechanical properties of trabecular specimens, which is vital for fracture risk prediction in the elderly. This work presents the application of reduced-basis (RB) methods for rapid evaluation of simulation results. Three cylindrical transiliac crest specimens (diameter: 7.5 mm, length: 10-12 mm) were obtained from healthy subjects (20 year-old, 22 year-old, and 24 year-old females) and scanned using microcomputed tomography imaging. Cubic samples of dimensions 5×5×5 mm(3) were extracted from the core of the cylindrical specimens for FE analysis. Subsequently, a FE solution library (test space) was constructed for each of the specimens by varying the material property parameters: tissue elastic modulus and Poisson's ratio, to develop RB algorithms. The computational speed gain obtained by the RB methods and their accuracy relative to the FE analysis were evaluated. Speed gains greater than 4000 times, were obtained for all three specimens for a loss in accuracy of less than 1% in the maxima of von-Mises stress with respect to the FE-based value. The computational time decreased from more than 6 h to less than 18 s. RB algorithms can be successfully utilized for real-time reliable evaluation of trabecular bone elastic properties.

Proliferation and osteoblastic differentiation of bone marrow stem cells: comparison of vertebral body and iliac crest.

Bone marrow stem cells (BMSCs) can be obtained from the vertebral body (VB) and iliac crest (IC) for augmenting spinal arthrodesis. However, it is still not evaluated, which of the two sites would have a better BMSCs potential on Proliferation and osteoblastic differentiation is still not evaluated. Fourteen patients (10 men and 4 women) undergoing posterolateral lumbar arthrodesis and pedicle screw instrumentation were involved. The mean age was 54.7 years (range 31-75 years). Bone marrow aspirates were obtained from the vertebral body through the bilateral pedicle and were quantified relative to matched, bilateral aspirates from the iliac crest that were obtained from the same patient and at the same time. The mononuclear cell count and concentration of BMSCs were calculated and compared. Proliferation and osteoblastic differentiation of each of the BMSCs were characterized using biochemical and molecular biology techniques. Concentration (cells/mL) of BMSCs from VB and IC were 3.73 × 10(3) and 3.19 × 10(3), respectively (P > 0.05). VB and IC exhibited similar proliferation pattern at 3, 5 and 7 days, but BMSCs from the VB exhibited an increased mineralization staining with Alizarin Red S at 14 days. BMSCs from both anatomic sites expressed comparable levels of CD29, CD34, CD44, CD90 and CD105. VB and IC displayed similar levels of expression of ALP, type I collagen and osterix, but VB expressed higher level of osteocalcin and Runx-2, especially at 14 and 21 days. Our studies show that BMSCs from VB have osteogenic differentiation potential similar to IC. Based on these findings, we suggest that BMSCs from VB would be comparable candidates for osseous graft supplementation especially in spinal fusion procedures.

Iliac cortical thickness in the neonate - the gradient effect.

Recent studies of the neonatal ilium are beginning to reveal that a recognizable structural patterning of trabecular bone is present in the absence of any direct stance-related weight transfer. However, little is known about the organization of compact bone in the ilium and the way in which it is laid down during the earliest stages of development. This study investigates cortical bone thickness across both gluteal and pelvic iliac shells in the human neonatal ilium. Measurements of specific regions of interest on the iliac cortices were recorded using reconstructed micro-computed tomography scans from 30 neonatal ilia. Analysis of gluteal and pelvic cortical thicknesses revealed a distinctive patterning consistent with the expected bone distribution achieved through early bone modelling and remodelling. The analysis of this pattern is important for understanding the relationship between trabecular bone patterning and cortical bone structure in the earliest stages of pelvic development prior to locomotive influences and its response to the specific functional forces acting during this period.

Anticipating bipedalism: trabecular organization in the newborn ilium.

Trabecular bone structural organization is considered to be predominantly influenced by localized temporal forces which act to maintain and remodel the trabecular architecture into a biomechanically optimal configuration. In the adult pelvis, the most significant remodelling forces are believed to be those generated during bipedal locomotion. However, during the fetal and neonatal period the pelvic complex is non-weight bearing and, as such, structural organization of iliac trabecular bone cannot reflect direct stance-related forces. In this study, micro-computed tomography scans from 28 neonatal ilia were analysed, using a whole bone approach, to investigate the trabecular characteristics present within specific volumes of interest relevant to density gradients highlighted in a previous radiographic study. Analysis of the structural indices bone volume fraction, trabecular thickness, trabecular spacing and trabecular number was carried out to quantitatively investigate structural composition. Quantification of the neonatal trabecular structure reinforced radiographic observations by highlighting regions of significant architectural form which grossly parallel architectural differences in the adult pattern but which have previously been attributed to stance-related forces. It is suggested that the seemingly organized rudimentary scaffold observed in the neonatal ilium may be attributable to other non-weight bearing anatomical interactions or even to a predetermined genetic blueprint. It must also be postulated that whilst the observed patterning may be indicative of a predetermined inherent template, early non-weight bearing and late stance-related locomotive influences may subsequently be superimposed upon this scaffolding and perhaps reinforced and likely remodelled at a later age. Ultimately, the analysis of this fundamental primary pattern has core implications for understanding the earliest changes in pelvic trabecular architecture and provides a baseline insight into future ontogenetic development and bipedal capabilities.

Teriparatide following bisphosphonates: initial and long-term effects on microarchitecture and bone remodeling at the human iliac crest.

Since the approval of teriparatide for clinical application, a number of iliac crest studies have focused on increases in bone volume or changes in structural parameters with microCT and numerical changes in histomorphometry. This investigation is based on individual histopathological observations related to early and late effects of teriparatide treatment in humans. A total of 44 (18 paired) iliac crest biopsies (ICB) from 41 patients receiving teriparatide (10 months +/- 6 months) following bisphosphonate (BP) treatment were investigated for hematopoietic changes, bone turnover, and description of microarchitectural changes using histology and selective microCT. Fully 71% of the ICB showed a normal or high bone turnover; 56% of the paired ICB presented an increase in bone turnover following teriparatide treatment. Early teriparatide stimulation (<1 month) resulted in peritrabecular fibroblast-like formations. Rare findings (<9%) included reactive hematopoietic changes, osteoidosis, endosteal fibrosis, microcallus, or woven bone. Round mast cells were frequently observed within marrow spaces. A total of 14% had an increase in cortical porosity, approximately 20% demonstrated signs of intratrabecular resorption sites. Teriparatide treatment resulted in an increase in remodeling units as early as 1 week after the first application with a continuous stimulation up to 18 months of rhPTH treatment despite previous BPs. Subgroups of patients developed increased cortical and/or intratrabecular resorption pattern, with unclear biomechanical significance. This mechanism could potentially result in new trabecular structures with an increase in trabecular number. Some individuals presented histological findings (e.g., fibrosis) that may require adjustment of treatment that could be of importance for clinical efficacy.

Iliac bolt fixation: an anatomic approach.

STUDY DESIGN: An illustrative technique display and discussions. OBJECTIVES: Review of traditional and new "anatomic" techniques for placement of iliac-spinal fixation. SUMMARY OF BACKGROUND DATA: Placement of iliac fixation traditionally has been performed using offset connectors, devascularizing the iliac muscles, in addition to the posterior iliac spine. The technique reviewed provides for the screw heads to be placed in a more anatomic position, allowing rods to be laid parallel without the detachment of the erector spinous muscles. METHODS: Utilization of anatomic models and discussion of present surgical technique for iliac bolt fixation (traditional) compared and contrasted to newer technique using the anatomic landmarks and structures of the iliac crest. RESULTS: The anatomic models illustrate and support the utilization of an anatomic technique for fixation due to the lessening of muscle trauma, alignment of the rod systems, and preservation of the cortical surfaces. CONCLUSIONS: The anatomic placement of iliac bolts provides for improved alignment of constructs while addressing spinal deformities. It may also increase screw pullout and construct strength.

The effect of screw length and bone cement augmentation on the fixation strength of iliac screws: a biomechanical study.

STUDY DESIGN: Comparison of the biomechanical fixation strengths offered by 3 iliac screw fixation techniques: short screw, short screw augmented with cement, and long screw. OBJECTIVE: Evaluate the effect of screw length and bone cement augmentation on the fixation strength of iliac screw upon fatigue loading. SUMMARY OF BACKGROUND DATA: Iliac screws have been used in treating spinal disorders such as spinal deformity, spondylolisthesis, and sacral tumor. In clinical practices, both short screws and long screws are being used. It has been reported that short iliac screws have a higher rate of loosening. Therefore, short iliac screws are being used with bone cement augmentation to improve fixation. To date, no biomechanical study has compared the strengths of these 3 different iliac screw fixation techniques. METHOD: Fresh, frozen human cadaveric pelvis specimens (n = 18, 12 males, 6 females, average age 61 y) were used. Bone density was measured to characterize bone quality. The specimens were randomly divided into 2 groups. In group 1 (n = 8), short screws of 7.0-mm diameter and 70 + or - 4 mm length (as the length of exceeding over ischial notch) and long screw of 7.0-mm diameter and 120 + or - 4 mm length were placed on either side of the pelvis (left and right). In group 2 (n = 10), short iliac screws were placed after augmentation with polymethyl methacrylate bone cement on 1 side of the pelvis and long iliac screw were placed on the other side (left and right). Cyclic loading ranging from 20 to 200 N was applied to each screw at a frequency of 2 Hz up to 5000 cycles. Pullout tests were then conducted at the rate of 5 mm/min after the fatigue test, and the maximum pullout strength for each screw was recorded and analyzed. RESULTS: The maximum pullout strength of the long screw and short screw groups after fatigue conditioning were 2386 + or - 1470 and 833 + or - 681 N respectively. Significant difference was found between the 2 groups (P < 0.05). The short iliac screw had a higher loosening rate. The pullout force of the short screw fixation with augmentation and the long screw fixation after cyclic loading were 2436 + or - 915 and 2529 + or - 1055 N, respectively. No significant difference was found between the 2 groups (P > 0.05). CONCLUSIONS: Short iliac screws are susceptible to loosening after cyclic loading. Bone cement augmentation of short screws has demonstrated a significant increase in the fixation strength of short screws to an extent similar to that of long iliac screws. Thus, short iliac screw fixation after augmentation with bone cement will be a viable clinical option for spino-pelvic reconstruction.

Iliac crest fresh frozen homografts used in pre-prosthetic surgery: a retrospective study.

In the case of severe jaw atrophy several options are available to restore the alveolar crest. Aim of the present study was to evaluate the resorption over time of homologous fresh frozen bone used to restore the alveolar ridge. Specifically factors influencing (1) graft survival, (2) type, and (3) degree of bone resorption were evaluated. One hundred and thirteen maxillae and 27 mandibles were grafted. The surgical techniques used were 102 inlay, 27 onlay, and 11 veneer. Measurements were taken on pre-operative, post-operative, and follow-up radiographs. Data were processed by using three statistical methods: Kaplan-Meier algorithm, Cox regression, and curve estimation. As regards graft survival, Cox regression output showed a statistically significant effect only on surgical technique (P = 0.0312) and Kaplan-Meier algorithm demonstrated a worse outcome for veneer surgical technique (Log rank test = 0.0242). The Curve estimation demonstrated an inverse correlation between degree of bone resorption over time, with a progressive decrease. In conclusion FFB is a reliable material for alveolar bone restoration with a predicable average of resorption.

Total knee replacement in the fixed valgus deformity using a lateral approach: role of the automatic iliotibial band release for a successful balancing.

The purpose of this work was to document eleven years of experience in knee replacement for fixed knee valgus through a lateral approach with special emphasis on the balancing procedures. At a mean follow-up of seven years, only one revision for sepsis was required in this series of 63 knee replacements. The mean knee score improved from 37 (range 20-45) to 91 (range 65-100) at the last review (p < 0.01) while the function score increased from 29.5 (range 0-50) to 78.7 (range 10-100) (p = 0.01). The mean mechanical axis (HKA) was 14.7 degrees of valgus preoperatively and 1 degrees of valgus postoperatively. After the iliotibial band was automatically released in the approach, only four of 63 knees required additional release for tightness in extension. These results underline the appeal of the lateral approach with the automatic release of the iliotibial band. If required, additional ligament release is recommended step-by-step after bone section to avoid postoperative instability.