Bone grafts in craniofacial surgery

Bone grafting or bone replacement is an integral part of craniofacial surgery. Most craniofacial surgeons prefer the use of autogenous bone; however, there are exceptions to this, because some plastic surgeons prefer the use of alloplastic implants for replacement of parts or missing segments in the craniomaxillofacial skeleton. Inlay bone grafts are useful in osteotomies because they show little resorption. Onlay bone grafts contour and balance the face aesthetically and enable the surgeon to obtain refinement and fine-tuning in all types of craniofacial reconstruction. These grafts demonstrate more resorption than inlay grafts. However, the use of onlay grafts coupled with soft-tissue shifts of galea and muscle enable the craniofacial surgeon to achieve superior results over those of surgeons primarily concerned with jaw- or tooth-related movements that do not utilize primary bone grafting as a method of augmentation. Superior results today are obtained with various methods and techniques of bone grafting, some of which have been described in this article.     

Bone allografts in orthopedic surgery: current concepts

In the last decade, indications for bone allografting in orthopedic surgery have progressively increased, related to, on the one part, treatment of benign or malignant tumors, but, on another (major) part, to treatment of major bone defects due to loosening of hip or knee total prostheses. In France, legislation and control concerning donated human tissues, safety precautions, and the uses for human tissues have been greatly modified over the last few years. The authors describe the various obligations implicated by these activities and the consequences for tissue banks and surgeons; They describe different processes for bone inactivation and their action on allograft mechanical properties, or the biological capability for integration to the host bone. The authors then discuss different current techniques for bone stock reconstruction and the results in prosthetic or tumoral surgery, as well as their consequences on current surgical indications. In conclusion, they emphasize the optimal conditions for the success of allografts in orthopedic use: stability of the host bone-graft junction, vitality of the bone support, and a favourable mode of constraint of the graft, which have to be protected by osteosynthesis, but should not, however, miss partial bearing.     

Bone grafts and bone substitutes in hip and knee surgery.

Bone grafts and bone substitutes are an essential part of the armamentarium of orthopedic surgeons. This article presents the current knowledge about bone replacements and reviews the available sources, techniques, and indications of the various types of autograft, allograft, and synthetic agents that are used in contemporary hip and knee replacement surgery.     

Tourniquets in orthopedic surgery

Tourniquets are commonly used in limb surgeries, be it orthopedic or plastic surgeries. But the inflation pressures, the duration, and release guidelines are still not clear. According to a survey, majority of orthopedic surgeons inflate the tourniquet to fixed pressures for the upper and the lower limbs without considering the baseline blood pressure of the patient on whom the tourniquets are being applied. This review was designed to recall and review the safe use of tourniquets and the various techniques that can be employed to minimize the complications of tourniquet use. Google, science direct, and pubmed were searched for appropriate literature and relevant articles were identified.     

Thromboprophylaxis in orthopedic surgery

More than 2 million people undergo major orthopedic surgery each year, and this rate is expected to continue rising as our population ages. Our patients are at particularly high risk for deep vein thrombosis (DVT) and pulmonary embolism. The latest guidelines from the American College of Chest Physicians recommend thromboprophylaxis for high-risk orthopedic surgery patients. Although specific recommendations vary by type of surgery, low-molecular-weight heparin, fondaparinux, warfarin, and sometimes low-dose unfractionated heparin are effective alone or with mechanical prophylaxis. Goals of treatment are to prevent proximal and distal DVT, pulmonary death, chronic pulmonary hypertension, and postthrombotic syndrome.     

手术机器人在骨科领域中的应用及发展

手术机器人作为外科医生的一项新工具,目前已经逐步进入骨科领域。前期由于技术有限、设备笨重、成本高昂、市场需求不大等,骨科机器人的发展进入了很长时间的停滞期。近十年来随着人工智能技术在各行各业中的发展,研发经费的投入,生产成本的降低及对精准医疗、个体化医疗的需求,各种各样新颖而巧妙的机器人系统被提出、原型化并商业化,参与...     

Bone dysplasias in orthopedic practice.

The paper presents a review of rare but important orthopedic diseases--osteochondrodysplasias. The authors stress both the clinical and radiological variety of these deformations. Some kinds of osteochondrodysplasia are clearly defined clinical entities, while in other cases the clinical presentation is so variable that it is very difficult to make a diagnosis. Accurate diagnosis is very important in order to assess the inheritance pattern, clinical course and possible complications. Clinical and radiological examination are the cornerstones in making a diagnosis. The paper contains a list of radiograms necessary for a correct diagnosis. In many cases the diagnostic process must include highly specific biochemical and genetic tests.