Coralline hydroxyapatite bone graft substitutes in a canine diaphyseal defect model: radiographic features of failed and successful union

Radiographic and densitometric evaluation of a new type of bone graft substitute derived from reef-building sea coral via a hydrothermal chemical exchange process was undertaken in a canine diaphyseal defect model. Comparably sized blocks of this material and autogenous iliac cortical-cancellous graft were implanted into the respective radial diaphyses of seven dogs. Qualitative and quantitative radiographic assessment was performed during the immediate postoperative period and at 3 months following surgery. Significant complications were observed radiographically in over half of the coralline implanted limbs, including failed union, graft fracture, and loosening of internal fixation hardware. No significant difference was noted in degree of native osseous ingrowth between the implants and the autografts, and the latter exhibited a higher success rate. Radiographic film densitometry was found not to be reliably predictive of coralline implant behavior in the individual case. It is concluded that coralline hydroxyapatite bone graft substitutes appear to offer no particular advantage over autogenous grafts in the management of diaphyseal defects, although further investigation is warranted since other factors may be responsible for the unfavorable findings in this study.This work has been presented at the 34th Annual Meeting of The Association of University Radiologists. Hartford, Connecticut, May 4–9, 1986     

Coralline hydroxyapatite bone-graft substitutes in a canine metaphyseal defect model. Radiographic-histometric correlation

Radiographic and histometric evaluation of a new form of bone-graft substitute derived from reef-building sea coral was performed in a canine metaphyseal defect model. Blocks of this material were implanted into the proximal tibial metaphyses of eight dogs, with radiographic densitometry and harvesting performed at two, four, six, and 12 months. Histometric analysis demonstrated progressive apposition of host compact bone at the margins and trabecular bone at the interior of the implants with time following surgery. Corrected transmission density determinations correlated significantly with degree of osseous ingrowth (R = -0.78), void volume fraction (R = 0.88), and postoperative interval (R = 0.88). These results support the successful early application of coralline hydroxyapatite bone-graft substitutes as an alternative to autogenous grafting in the clinical setting, and indicate that the course of incorporation into host bone can be noninvasively monitored using densitometric techniques.     

Coralline hydroxyapatite bone graft substitutes: preliminary report of radiographic evaluation

A new bone graft substitute made by conversion of the calcium carbonate exoskeleton of reef-building sea coral into hydroxyapatite has recently become clinically available. The normal radiographic appearance of two forms of this material is described. In the immediate postoperative period, the exoskeletal architecture of these implants is readily appreciated. With graft incorporation over the ensuing months, their intrinsic structure is gradually lost in association with poor marginal definition. Evolving radiographic findings reflect the biocompatible nature of these implants, which provides the potential for ingrowth of native bone with preservation of the coralline scaffold, resulting in enhanced biomechanical properties.     

Pasteurized intercalary autogenous bone graft: radiographic and scintigraphic features

Objective. Pasteurized autogenous bone graft sterilized at a low temperature (60°C) is one option for reconstruction after resection of bone and soft tissue tumors. The purpose of this investigation was to assess the normal and abnormal radiographic and scintigraphic findings of pasteurized intercalary autogenous bone graft after resection of bone and soft tissue sarcomas. Design. This was a retrospective evaluation of the radiography and bone scintigraphy findings in patients after treatment of bone and soft tissue sarcomas using an intercalary pasteurized autogenous bone graft. Patients. Among 10 consecutive patients, eight had intercalary grafts, and they constitute the subjects of this study. All available radiography and bone scintigraphy findings were reviewed for the healing process and the possibility of complications. Results and conclusions. Healing and incorporation of the graft were observed in five patients during the follow-up, but the other three did not heal satisfactorily. Rapid incorporation of pasteurized autogenous bone graft can be demonstrated by means of radiography and bone scintigraphy. Received: 21 December 1999 Revision requested: 16 February 2000 Revision received: 9 March 2000 Accepted: 14 March 2000     

MR imaging of avascular scaphoid nonunion before and after vascularized bone grafting

Objective To investigate the magnetic resonance (MR) imaging appearances of chronic nonunion of the scaphoid with proximal pole avascular necrosis before and after insertion of a vascularized bone graft, using computed tomography (CT) as the imaging gold standard.Design and patients A retrospective study was performed involving MR imaging (n=26), CT scans (n=37) and radiographs (n=52) of 13 men (mean age 29 years, age range 20–38 years) with avascular scaphoid nonunion. Avascular necrosis of the scaphoid proximal pole was confirmed intraoperatively (n=13). MR images were acquired preoperatively and following placement of a vascularized bone graft. Scaphoid MR signal characteristics were assessed for evidence of vascular bone graft incorporation and revascularization of the bone marrow of the proximal pole of the scaphoid and compared with the gold standard of CT. Surgical and clinical notes were reviewed with a minimum 3 year imaging and clinical follow-up in all patients.Results Graft incorporation with revascularization of the proximal pole of the scaphoid was documented in 9 patients (69%). Graft failure with persistent pseudoarthrosis and avascular necrosis of the scaphoid was seen in 4 patients (31%).Conclusions MR imaging is useful to determine whether vascularized bone graft incorporation and revascularization of the proximal pole of the scaphoid has occurred in the setting of avascular scaphoid nonunion.Paper presented at ESSR, European Society of Skeletal Radiology, Aarhus, Denmark, 14 June 2003. Awarded first prize for the ESSR award for Scientific PresentationsPaper presented at ISS, Closed Scientific Session, Malta, 3 October 2004 as part of the above prize     

Pasteurized autogenous bone graft for reconstruction after resection of malignant bone and soft tissue tumors: imaging features

Our experimental study revealed that pasteurization was sufficient for killing all tumor cells in any massive bone and that the osteoinductivity and mechanical strength of pasteurized bone were about same as that of a fresh bone graft and better than boiled or autoclaved bone. We have performed reconstruction surgery using pasteurized autogenous bone graft since 1990. Resected bone was warmed for 30 minutes in a homeothermal heater set at 60 degrees C and then placed back to the original anatomic site. The graft was fixed with a plate or intramedullary nail with or without bone cement. Based on our experience in 31 patients, no local recurrence was seen in the grafts. Among 24 patients who can be adequately evaluated, incorporation of graft was complete in 17 cases and partial in 4 cases. In 18 of 21 patients, uptake of radionuclide in the grafted pasteurized bone was detected on bone scintigraphy approximately 6 months after surgery, and the uptake increased gradually, which suggested revascularization and remodeling of grafted bone.     

Different fibrovascularization rate between coralline hydroxyapatite and high density porous polyethylene (Medpore) measured by 99mTc-MDP bone scintigraphy 6 months after intraorbital implantation

Many materials and types of implant have been used to achieve a cosmetic effect and prosthesis motility in the anophthalmic socket. Hydroxyapatite remains the implant material of choice for producing the most natural prosthesis motility while porous polyethylene shows promising characteristics as another useful material. The aim of this study was to compare the fibrovascular ingrowth rates of orbital implants between coralline hydroxyapatite and high density porous polyethylene (Medpore). The fibrovascularization rate is determined by bone imaging using 99mTc methylene diphosphonate (99mTc-MDP) 6 months after implantation. Our study included 29 patients with coralline, and nine patients with Medpore implants. Our results showed that groups with coralline implants appearing to achieve complete fibrovascularization at a much more rapid rate than those with Medpore. The differences in rate were statistically significant.     

A case of recurrent ameloblastoma developing in an autogenous iliac bone graft 20 years after the initial treatment

A case of recurrent ameloblastoma developing in an autogenous iliac bone graft 20 years after radical resection of primary mandibular ameloblastoma is presented. This case showed extensive bony resorption extending throughout the auto-grafted bone. Seeding to the graft bone was suspected as a cause of the recurrence in the iliac bone graft because wide destruction of the graft bone was observed without any prior signs and symptoms of intraoral mucosa. Consequently, extensive resection of bone as well as adjacent soft tissue was performed. Persistent follow-up examination is essential for management of ameloblastoma.     

Dynamic contrast-enhanced MR imaging assessment of vascularized free fibular grafts

Magnetic resonance (MR) imaging may be a noninvasive method for assessing perfusion of vascularized bone grafts placed for treatment of avascular necrosis. One proximal femur of seven beagles was devascularized, with insertion of a vascularized fibular graft. MR imaging at 1 week (seven dogs) and 6 weeks (five dogs) after surgery included pre- and postcontrast spin-echo sequences, unenhanced twodimensional time-of-flight (TOF) vascular imaging, and dynamic gradient-echo imaging during infusion of gadolinium. Relative signal intensity values of selected regions obtained from the dynamic gradientecho images were plotted as percent enhancement versus time. In the operated hip, MR imaging did not show enhancement in six of seven femoral heads and greater trochanters at 1 week after surgery, with similar results after 6 weeks. MR imaging of fibular grafts 6 weeks after surgery showed an initial rapid increase in enhancement and a subsequent slower increase in five of five dogs, although no enhancement was seen in six of seven dogs at 1 week. These findings contrasted with a rapid initial increase in enhancement followed by slow decline in non-operated hips. Two-dimensional TOP imaging did not show the vascular pedicle of the graft in any dog. Findings of radionuclide bone scanning performed 1 week after surgery were consistent with devascularization of the operated femur and fibular graft. However, tetracycline distribution and histologic findings confirmed the viability of five of five grafts within the devascularized femurs 6 weeks after surgery. Thus, dynamic contrast-enhanced MR imaging at 6 weeks after surgery is valuable for assessing vascular bone graft perfusion, while similar imaging at 1 week may suggest otherwise.     

开放性植骨联合VSD在感染性胫骨骨缺损治疗中的临床应用

目的探讨开放性植骨联合负压封闭引流(VSD)在感染性胫骨骨缺损治疗中的临床疗效。方法 2012年8月~2014年6月安徽省中西医结合医院创伤骨科收治胫骨感染性骨缺损11例,男性7例,女性4例;年龄25~56岁,平均37.5岁;均为GustiloⅢ型胫骨开放性骨折伴软组织不同程度损伤。受伤原因:道路交通伤8例,重物压砸伤3例。患者入院后常规行清创骨折内外固定,出院后定期随访,患肢表现为骨折不愈合,骨坏死形成,创区反复渗液、流脓,胫骨平均缺损长度为(4.5±1.5)cm。先行感染病灶清除术,术后应用负压封闭引流(VSD)覆盖创面,待创面稳定后再行自身髂骨植骨加负压封闭引流(VSD),最后根据植骨创面大小及肉芽生长情况选择植皮或皮瓣修复术闭合创面。结果 11例患者获得随访6~24个月,平均12个月,均获得骨性愈合;术后骨折愈合时间平均6个月(4~12个月)。肉芽组织覆盖植骨区的平均时间为18d(15~35d)。11例中2例植骨区创面直接拉拢缝合,3例予以植皮手术,其余6例中随意筋膜皮瓣修复4例,皮神经营养皮瓣修复2例。所有植皮及皮瓣均成活良好。结论开放性植骨联合负压封闭引流(VSD)在感染性胫骨骨缺损治疗中操作相对简单,可有效控制创面感染,缩短骨折愈合时间,疗效肯定。     

VSD技术序贯背阔肌皮瓣游离移植治疗胫腓骨严重开放性骨折骨外露

目的探讨应用负压封闭引流(VSD)技术序贯背阔肌皮瓣游离移植治疗胫腓骨严重开放性骨折骨外露的临床效果。方法 2002年2月~2012年6月,应用VSD技术序贯背阔肌皮瓣游离移植修复19例GustiloⅢB和ⅢC型胫腓骨骨折骨外露患者,男性13例,女性6例;年龄17~68岁,平均37.3岁。其中GustiloⅢB型11例,GustiloⅢC型8例,骨外露创面面积16cm×13cm~25cm×17cm。所有患者入院后先行清创,VSD覆盖创面,抗感染治疗,待创面清洁无感染后行背阔肌皮瓣游离移植修复骨外露。结果术后随访12~36个月,平均22个月。本组19例移植肌皮瓣均成活,2例出现皮瓣尖端坏死,1周后行坏死组织清除并植皮修复,其余小腿创面均Ⅰ期愈合,术后无感染及血管危象发生。19例中13例骨折于术后8~21个月达到骨性愈合;4例胫骨缺损者于术后3个月行取自体髂骨植骨并更换为钢板内固定,9~14个月骨折愈合;2例胫骨骨折术后3~6个月X线摄片示骨折局部骨质吸收,骨折端萎缩,无骨痂生长,于术后6个月时行取髂骨植骨并钢板内固定,分别于10、13个月达骨性愈合。5例因皮瓣臃肿,影响日常生活,后期给予皮瓣修整术后明显改善;5例吻合神经的皮瓣感觉功能有不同程度恢复。膝关节功能活动基本正常,6例踝关节功能部分受限,主要表现为背曲受限,与胫前肌群损伤有关。结论应用VSD技术序贯背阔肌肌皮瓣游离移植治疗GustiloⅢB和ⅢC型胫骨骨折骨外露,能获得良好的临床效果。     

股骨髁上骨不连的治疗

目的　探讨动力髁螺钉(dynamiccondylarscrew, DCS)加自体髂骨移植技术治疗股骨髁上骨不连的疗效。方法　18例股骨髁上骨不连,内固定采用DCS,对严重骨质疏松或骨不连靠近关节面的患者加用髁支持钢板头部;植骨采用自体髂骨,骨移植形式为骨块与碎骨条相结合。术后短期采用术后连续被动活动(CPM)锻炼膝关节功能,持续1年的长期被动与主动锻炼。随访时间12~70个月,平均34个月。　结果　所有患者骨不连均治愈,愈合时间为3~6个月,平均5个月。膝关节活动范围从平均73°(5°~135°)增加至平均97°(30°~135°)。13例疗效优良, 4例满意, 1例差。　结论　采用具有坚强固定及断端加压作用的DCS,必要时加用多孔髁部固定钢板,结合有效的自体髂骨植骨技术,以及合理的术后长期膝关节功能锻炼,是治疗股骨髁部骨不连的有效方法之一。     

Anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with glenoid deficiency using an autogenous tricortical iliac crest bone graft

BACKGROUND: Anterior shoulder instability associated with severe glenoid bone loss is rare, and little has been reported on this problem. Recent biomechanical and anatomical studies have suggested guidelines for bony reconstruction of the glenoid. HYPOTHESIS: Anatomical glenoid reconstruction will restore stability in shoulders with recurrent anterior instability owing to glenoid bone loss. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Eleven cases of traumatic recurrent anterior instability that required bony reconstruction for severe anterior glenoid bone loss were reviewed. In all cases, the length of the anterior glenoid defect exceeded the maximum anteroposterior radius of the glenoid based on preoperative assessment by 3-dimensional CT scan. Surgical reconstruction was performed using an intra-articular tricortical iliac crest bone graft contoured to reestablish the concavity and width of the glenoid. The graft was fixed with cannulated screws in combination with an anterior-inferior capsular repair. RESULTS: At mean follow-up of 33 months, the mean American Shoulder and Elbow Surgeons score was 94, compared with a preoperative score of 65. The University of California, Los Angeles score improved to 33 from 18. The Rowe score improved to 94 from a preoperative score of 28. The mean motion loss compared with the contralateral, normal shoulder was 7 degrees of flexion, 14 degrees of external rotation in abduction, and one spinous process level for internal rotation. All patients returned to preinjury levels of sport, and only 2 complained of mild pain with overhead sports activities. No patients reported any recurrent instability (dislocation or subluxation). The CT scans with 3-dimensional reconstructions obtained 4 to 6 months postoperatively demonstrated union of the bone graft with incorporation along the anterior glenoid rim and preservation of joint space. CONCLUSION: Anatomical reconstruction of the glenoid with autogenous iliac crest bone graft for recurrent glenohumeral instability in the setting of bone deficiency is an effective form of treatment for this problem.     

~(99m)Tc-MDP骨显像动态观察珊瑚羟基磷灰石人工骨修复骨干缺损

目的：应用核素骨显像观察不同骨移植物对实验动物骨干缺损修复的动态过程，评价术后不同时期移植骨成活状态。材料与方法：用ＲＯＩ方法定量对比计算三种材料植入区和正常骨区放射性浓集比值。结果：Ａ组（单纯人工骨组）６．０１；Ｂ组（红骨髓复合人工骨组）７．９５；Ｃ组（自体移植骨组）５．７７。结论：单纯人工骨组和自体移植骨组植入后成骨代谢无显著差异，加入自体红骨髓的复合工人骨组移植区成骨代谢明显优于前两组，成骨代谢最旺盛期为２～８周。     

Autogenous osteochondral ”plug” transfer for the treatment of focal chondral defects: postoperative MR appearance with clinical correlation

Objective: To describe the MR appearance following autogenous osteochondral ”plug” transfer for the treatment of focal chondral defects of the knee. Design and patients: Twenty-nine 1.5-T MR knee studies including dynamic gadolinium enhancement were performed on 21 patients following autogenous osteochondral ”plug” transfer. Three musculoskeletal radiologists retrospectively reviewed images to evaluate graft and donor site appearance and MR findings were correlated with clinical outcomes. Results: MR images demonstrated graft protuberance (n=12/21; range 1–2 mm), depression (n=2/21; range 1 mm), and surface incongruity: mild (n=17/21), moderate (n=2/21), marked (n=1/21). The T2 signal of graft cartilage was similar to that of adjacent cartilage in 25 of 29 examinations, and increased in four. Graft cartilage thickness relative to adjacent cartilage was <50% in six patients, 50–100% in 15. Graft enhancement in bone was absent at 2 weeks, but present at between 4 and 6 weeks following surgery. All patients had clinical follow-up examinations and knee outcome survey scores were obtained in 15 patients with follow-up greater than 3 months after surgery. All patients demonstrated the expected short-term progressive clinical improvement. Conclusion: MR images reveal a wide range of appearances following osteochondral ”plug” transfer. Minor variations in graft orientation and surface congruity do not result in adverse clinical outcome in the short term. Received: 8 January 2001 Revision requested: 21 February 2001 Revision received: 6 March 2001 Accepted: 6 March 2001     

Radiographic and scintigraphic courses of union in cervical interbody fusion: hydroxyapatite grafts versus iliac bone autografts.

This study investigated the radiographic and scintigraphic courses of union in cervical interbody fusion using hydroxyapatite (HA) grafts or iliac bone autografts. METHODS: Twelve patients underwent both serial plain radiography and bone scintigraphy during the 12 mo after surgery. Serial plain radiographs were obtained every month until the end of the study period. Bone scintigrams with 99mTc-hydroxymethylene diphosphonate (HMDP) were obtained at 2 wk and at 1, 2, 3, and 6 mo. Uptake of 99mTc-HMDP in the graft was expressed as a ratio of the counts in the graft to those in the axis. RESULTS: In the HA graft group, the plain radiographs of all patients showed a radiolucent stripe that disappeared 7.3 +/- 1.5 (mean +/- SD) months after surgery. In the autograft group, a radiolucent stripe around the graft was not seen for any patient, and union was confirmed by follow-up radiographs within 6 mo after surgery. The serial changes in the 99mTc-HMDP uptake ratio showed no difference between the 2 groups. The 99mTc-HMDP uptake ratio peaked 1 mo after surgery and decreased rapidly to a plateau within 2 mo. CONCLUSION: In the HA graft group, despite the presence of a radiolucent stripe around the graft for more than 6 mo, the scintigraphic course of union was not different from that in the autograft group. The likelihood is that the presence of a radiolucent stripe around the HA graft in the early months after surgery is not always a sign of pseudoarthrosis.     

Radiographic analysis of pasteurized autologous bone graft

Objective Local malignant bone tumor excision followed by pasteurization and subsequent reimplantation is a unique technique for reconstruction after resection of primary bone sarcomas. The purpose of this investigation was to assess the normal and abnormal long-term radiographic findings of intercalary and osteo-chondral pasteurized bone graft/implant composite.Design and patients The long-term radiographic findings of pasteurized bone grafts used in reconstruction after resection of bone and soft tissue sarcomas in relation to patients' clinical data were reviewed retrospectively. Thirty-one patients (18 females, 13 males; age range 7–77 years, mean 30 years) who underwent surgery between April 1990 and January 1997 at the authors' institute constituted the material of this study. They were followed up for at least 3 years or until the patient's death (mean 69 months). The International Society of Limb Salvage graft evaluation method that assesses the fusion, resorption, fracture, graft shortening, fixation, subluxation, joint narrowing and subchondral bone was used for evaluation of the radiographs.Results and conclusions Twenty-one patients (68%) showed complete incorporation of graft and eight patients (26%) had partial incorporation. The overall radiographic evaluation rate was 81%. Fracture (10%) and infection (16%) were the main complications. No local recurrence was detected. These results indicate that pasteurization of bone is a useful option for reconstruction after resection of malignant bone tumors.     

Scaphoid nonunions treated with vascularised bone grafts: MRI assessment

Purpose: To assess the value of MR imaging (MRI) with regard to union, graft viability and proximal pole bone marrow status, after use of vascularized bone grafts for treating scaphoid nonunions. Materials and methods: Vascularized bone grafts from the distal radius were used to treat 47 scaphoid nonunions resulting from fractures or enchondromas. Clinical and imaging evaluation was used for the pre- and postoperative assessment of all patients. Apart of conventional radiographs obtained in all cases, 15 patients were also assessed postoperatively with MRI at 3 months. From these 15 patients, eight were assessed preoperatively with MRI whereas nine had serial MRI evaluations at 6 and 12 months. The clinical follow-up time of this subgroup of 15 patients ranged from 6 to 27 months. Results: All patients showed clinical signs of union within 12 weeks form the procedure and at the latest follow-up they experienced complete (10 cases) or almost complete (five cases) relief from pain. Both plain and contrast-enhanced MRI obtained at 3 months showed viability of the bone graft in all cases. At 3 months union was established with plain radiographs in 12 patients at both sides of the graft and in three patients between the graft and proximal pole. At 3 months plain MRI showed nonunion in four patients (two between graft and proximal pole, two between graft and distal pole and one at both sides of the graft) whereas contrast-enhanced MRI revealed only one case of nonunion between graft and proximal pole. Four patients were considered to have osteonecrosis of the proximal pole intraoperatively. Two of them showed necrosis of the proximal pole with preoperative and postoperative plain radiographs and three of them with plain postoperative MRI. Contrast-enhanced MRI at 3 months showed postoperative reversal of necrotic changes in all four scaphoids. MRI also revealed bone marrow oedema of the carpal bones surrounding the scaphoid in 14 cases. Serial MRI at 6 and 12 months, obtained in nine patients, revealed resolution of the bone marrow oedema of the surrounding bones and full graft incorporation in all cases. Conclusion: Contrast-enhanced MRI is able to demonstrate the early union after treatment of scaphoid nonunions with vascularised bone grafts allowing thus earlier mobilisation. In addition, MRI can assess the viability of the proximal pole and the graft as well as the postoperative bone marrow oedema-like lesions of the surrounding bones.     

锁定加压钢板及解剖钢板治疗高能量胫骨远端骨折的对比研究

目的 对比锁定加压钢板(1ocking compression plate,LCP)及普通解剖钢板治疗高能量胫骨远端骨折的临床疗效.方法 2003年5月-2009年5月,采用LCP及解剖钢板治疗入选的高能量胫骨远端骨折42例.解剖钢板组24例,男16例,女8例;年龄20～54岁,平均39岁.按AO分型:A型13例,B型5例,C型6例.LCP组18例,男15例,女3例;年龄25～55岁,平均40岁.按AO分型:A型11例,B型3例,C型4例.比较两组的手术时间、出血量、透视次数、骨折愈合时间、踝关节功能及并发症,参照Mazur标准评价踝关节功能.结果 LCP组平均随访11.6个月,解剖钢板组平均随访14.2个月,均显示骨折愈合.解剖钢板组植骨比例多于LCP组.CP组透视次数L多于解剖钢板组.LCP组手术时间、手术切口、出血量、放射学愈合时间及术后并发症发生总数优于解剖钢板组.结论 LCP及解剖钢板治疗高能量胫骨远端骨折均可取得满意效果,但LCP具有创伤小、骨折愈合快、并发症少等优点,体现了生物学固定的优点,是治疗高能量胫骨远端骨折的有效方法.

Abstract：

Objective To compare the clinic effect of the locking compression plate (LCP) fixation and the anatomical plate in treatment of high-energy distal tibial fractures. Methods The study involved 42 patients with high-energy distal tibial fractures treated between May 2003 and May 2009. The anatomical plate group included 24 patients ( 16 males and 8 females, at average age of 39 years), of whom there were 13 patients with type A fractures, five with type B and six with type C according to the AO/ASIF classification. The LCP group included 18 patients ( 15 males and 3 females, at average age of 40 years), of whom there were 11 patients with type A fractures, three with type B and four with type C according to the AO/ASIF classification. All the patients were followed up for 8-17 months. Their functional and radiographic outcomes were collected. The operation time, intra-operative blood loss, X-ray exposure, bone healing time, post-operative complications and therapeutic effects were compared between both groups. Mazur's criteria was used to evaluate the function of the ankle. Results The LCP group was followed up for average 11.6 months and the anatomical plate group for average 14.2 months, which showed fracture healing in all the patients. The bone graft in the anatomical plate group was used more frequently than the LCP group, while the X-ray exposure in the LCP group was much more than that in the anatomical plate group. The operation time, incision size, blood loss, postoperative complications and radiographic bone healing time in the LCP group were significantly less than those in the anatomical plate group. Conclusions Both the LCP and anatomical plate are effective methods for the high energy distal tibial fractures. LCP has advantages of less trauma, quick fracture healing and less complications, is consistent with the biomechanics of internal fixation and hence is an ideal method for the treatment of the high-energy tibial fractures.     

Vascularisation of ocular coralline hydroxyapatite implants

Vascularisation of coralline hydroxyapatite used to replace the enucleated bulb is of critical importance for the uncomplicated implantation of a motility peg connecting the implant with the cosmetic prosthesis. Technetium-99m diphosphopropanedicarboxylic acid (DPD) single-photon emission tomography (SPET) was used to evaluate the rate of vascularisation as well as the time required for completion of vascularisation. Twenty-four patients were enrolled in the study, which was designed to evaluate vascularisation 10 days, 2 months and 4 months after implantation of a coralline implant. Nineteen patients completed the study and the visual impression of the completion of the vascularisation was scored from 0 (no vascularisation) to ++++ (complete vascularisation) for each patient. No tracer accumulation was detected in any patient at the 10-day examination. Increasing vascularisation was demonstrated with time, and full vascularisation of the coralline implant was seen in all but one case by 4 months after implantation. We conclude that vascularisation of ocular coralline hydroxyapatite implants occurs early and is completed by 4 months after implantation in most cases, but should be confirmed at this time by^99mTc-DPD SPET.