The use of allogeneic bone and tendon tissue from a central bone bank

During the period January 1989 to December 1990 the use of bone and related soft tissue allografts from our bone bank was reviewed retrospectively. Data were complete for 278 patients, who received 403 allografts in total. Forty-nine patients were transplanted with a massive deep frozen bone allograft, 41 patients received a deep frozen soft tissue allograft, while 313 units of freeze dried bone allografts were transplanted into 188 patients. Massive deep-frozen bone allografts were used mainly in patients with bone tumours, fibrous dysplasia of the neck of the femur and for revision arthroplasty. Soft tissues were used mainly for reconstruction of ruptured cruciate ligaments. Freeze dried bone allografts such as cancellous chips as well as cortical cancellous chips were used for spinal fusion, arthroplasty, treatment of pseudarthrosis, fractures, tumours and fibrous dysplasia, and in maxillofacial defects. Cancellous blocks were used specifically for spinal fusion. Demineralized cortical dust was used mainly in maxillofacial surgery.     

Incorporation of cortical intercalary bone allografts. Experimental study on rabbits

An experimental study was carried out on 40 rabbits in order to evaluate the incorporation of large intercalary bone allografts and the influence of freezing on the bone graft. In 36 rabbits resection of 3 centimetres of diaphysis of the tibia was carried out and the defect was rebuilt with different types of bone graft: fresh autograft and frozen autograft, fresh allograft and frozen allograft; osteosynthesis was carried out with two intramedullary Kirschner needles. Monthly radiological studies were made until the sacrifice of the animals, at 2, 4 and 8 months. A densitometric, histological and diaphanisation study of the tibias was made with Spalteholz's technique. In 24 animals 25 mg/kg of oxytetracicline was administered 3 and 6 days before sacrifice, to study the velocity of bone apposition in the graft. We observed a good and excellent radiological consolidation in 80% of the grafts (99% in the autografts and 66% in the allografts). The bone density showed a fall until the 4th month due to bone reabsorption except in the group of fresh allografts. The revascularization of the allografts was slower and poorer than the autografts, but with the same vascular pattern. Bone incorporation and neoformation were greater in the autografts without significant differences with the frozen allografts. The speed of bone apposition did not change with the different types of bone graft used. Freezing facilitated and accelerated incorporation and the quantity of bone neoformation of the allografts.     

Transplantation using allogeneic bone in orthopedics

The reconstruction of large skeletal defects presents a challenging problem to the orthopaedic community. Currently bone graft surgery enjoys renewed interest because of the increased demand for bone grafts in limb salvaging bone tumour surgery and reconstructive surgery on failed arthroplasties. Two patients treated with an allograft are presented.     

The effect of 10% povidone--iodine solution on contaminated bone allografts

The aim of this study was to determine the efficacy of 10% povidone--iodine solution for the decontamination of bone allografts. Bone samples were prepared and tested for sterility using a femoral head removed at the time of primary hip replacement. They were contaminated by a suspension of Staphylococcus epidermidis and ground to measure the quantity of micro-organism attached to the bone. Two levels of contamination were used (1 x 10(3) vs. 1 x 10(4)CFU/mL) to check the efficiency of our method of measurement. Samples of the two groups were decontaminated with 10% povidone--iodine solution using different exposure times. Before decontamination, the count of bacteria attached to the bone was proportional to the bacterial concentration of the contaminating solution. The microbiocidal activity of 10% povidone--iodine solution was the same in both groups. The decontamination time was proportional to the bacterial concentration of the contaminating solution. The results of this preliminary study suggest that a 10% povidone--iodine solution can decontaminate inoculated bone grafts, but a sufficient time of exposure according to the level of contamination must be allowed.     

Experimental Testing of the Action of Vitamin D and Silicon Chelates in Bone Fracture Healing and Bone Turnover in Mice and Rats

This study presents findings on the biological action of an integrated supplement containing the following components involved in osteogenesis and mineralization: vitamin D and silicon in the bioavailable and soluble form. A hypothesis that these components potentiate one another’s action and make calcium absorption by the body more efficient was tested. Biological tests of the effect of vitamin D and silicon chelates on bone fracture healing and bone turnover were conducted using ICR mice and albino Wistar rats. Radiographic and biochemical studies show that the supplement simultaneously containing silicon chelates and vitamin D stimulates bone tissue regeneration upon mechanical defects and accelerates differentiation of osteogenic cells, regeneration of spongy and compact bones, and restoration of bone structure due to activation of osteoblast performance. Bone structure restoration was accompanied by less damage to skeletal bones, apparently due to better absorption of calcium from food. The studied supplement has a similar effect when used to manage physiologically induced decalcification, thus holding potential for the treatment of osteomalacia during pregnancy or occupational diseases (e.g., for managing bone decalcification in astronauts).     

Beneficial effects of cryosurgical treatment in benign and low-grade-malignant bone tumors in 120 patients

BACKGROUND: Benign and low-grade malignant bone tumours are generally treated with intralesional curettage. At microscopic level tumour cells are left behind and may be responsible for a recurrence. Therefore adjuvant local treatment is necessary. METHOD: By spraying liquid nitrogen into the remaining cavity, tumour cells are frozen very rapidly. Ice crystals formed in the (tumour) cell will mechanically damage the cell resulting in cell necrosis. This combined treatment of surgery and freezing is called cryosurgery. RESULTS: In 120 patients with a follow-up of at least 1 year the treatment results were good. The tumours were: aneurysmatic bone cyst (n = 32), simple bone cyst (n = 13), chondroid tumour (n = 43), giant-cell tumour (n = 13), eosinophilic granuloma (n = 7) and monostotic fibrous dysplasia (n = 12). There were 10 recurring tumours, some of them very small; 6 recurrences were treated successfully by cryosurgery again; in 2 recurrences marginal resection was carried out; 2 recurrences remained (as yet) untreated. CONCLUSION: Cryosurgery as a therapy of benign and low-grade malignant bone tumours yields results nearly as good as marginal resection, and has the advantage that segmental bone resections, which need extensive reconstructions are avoided.     

Hospital-based allogenic bone bank--10-year experience

Bone banking in a hospital provides resources of allogenic bone grafts. However, they may transmit infection from donor to recipient. We found few reports discussing the infection rate and monitoring processes associated with bone banks. The discard rate using the screening test was 18.5% (309/1674) in this series. The leading cause was hepatitis B antigen (HBsAg) positive donor serum (67%), followed by Venereal Disease Research Laboratory (VDRL) positive donor serum (15%), and anti-hepatitis C virus (HCV) positive donor serum (12%). The overall infection rate in the recipients was 1.3% (17/1365). Among 1353 implanted allografts, 22 cases (1.6%) had a positive swab culture result after thawing. Only four out of these 22 cases (18.2%) developed infection. However, the wound cultures of the infected recipients were different from the swab culture of thawing allografts except in one case. Among the 1331 recipients with sterile allograft bones, 13 (1%) were found to have infection. In conclusion, our bone bank operates under a strict monitoring system which results in a low infection rate. The recipient's status, the aseptic technique and environment during operation is likely to be more critical in prevention of allograft-related infection.     

Interactions between concentrations of chemical elements in human femoral heads

Environmental and occupational exposure to various metals has been a major public health concern and the subject of many studies. With the development of industry and transportation, environmental pollution has markedly worsened. As a result, metals are now ubiquitous and are absorbed into the body with food, drinking water, and polluted air. Exposure to these elements leads to numerous health problems, affecting almost every system of the human body, including the skeletal system. Bone is a specific research material that is difficult to obtain, therefore chemical analyses of metal concentrations in this tissue are rarely found in the literature. Nevertheless, bone, due to its long regeneration period, can serve as a biomarker of a long-term metal accumulation resulting from environmental or occupational exposure. Our study was conducted on bone samples harvested from inhabitants of the Upper Silesia region during hip replacement surgery. Femoral heads removed during surgery were sectioned into slices and further subdivided into samples comprising articular cartilage, cortical bone, and trabecular bone. Concentrations of 12 trace elements were measured with an atomic absorption spectrophotometry method. We found significant correlation between concentrations of these metal elements in the samples of cortical bone. This is determined not only by the physiological functions of these metals in hydroxyapatite, but also by the specific mineral structure of the bone tissue.     

Localized accumulation of lead within and among bones from lead-dosed goats

The principal aim of this study was to gain a better understanding of where lead (Pb) accumulates and how it is distributed, within the bones of dosed goats. Adult goats were periodically dosed with Pb over a number of years for the primary purpose of producing blood pools containing endogenously bound Pb, for the New York State Blood Lead Proficiency Testing Program. Bone samples (e.g., primarily tibia, femur, humerus, and radius) were collected post-mortem from 11 animals and were analyzed for Pb content by acid digestion and electrothermal atomic absorption spectrometry (ETAAS or GFAAS). Average tibia Pb levels were found to correlate strongly with the cumulative Pb dose (r²=0.81). However, the concentration of Pb in different bones and even within a small area of the same bone varied tremendously. Blood-rich trabecular (spongy) bone, such as the patella and calcaneus, were much more enriched in Pb than was cortical (compact) bone. In some dosed animals, the Pb concentration in the tibia was markedly higher at the proximal and distal ends of the bone compared to the mid-shaft. The implications of these findings with regard to the noninvasive measurement of lead in bone by XRF methods are discussed.     

自体颅骨移植在口腔颌面部畸形中的应用

研究自体颅骨外板移植在治疗口腔颌面部畸形或缺损中的作用。方法经面中份骨折复位固定时的冠状切口或颅骨直接切口。获取所需的颅骨外板。经调磨塑形后配合坚强内固定技术用于口腔颌面部畸形的矫正或骨骼支架的重建。结果31例口腔颌面部畸形或骨缺损患者用自体颅骨进行治疗。其中外伤所致眶底缺损17例、颧骨陈旧性骨折6例、颞颌关节强直面部畸形5例，肿瘤切除后重建2例，唇腭裂畸形1例。通过6个月至7年(平均11个月)的随访，所有病例术后创口愈合良好。移植骨成活。未见明显吸收。供受骨区切口瘢痕不明显，患者面部外形均有不同程度的改进，取得了满意的临床效果。1例术后3个月内有轻微下睑外翻，通过自行按摩半年后已不明显。结论自体颅骨移植并发症少，移植后很少吸收，可很好的完成面部支架的重建。有效地矫正各种原因导致的口腔颌面部骨骼畸形及缺损。颅骨采取方便。手术创伤小，对生理功能干扰小。是理想的移植材料。     

逆行胭窝及小腿内后侧皮瓣修复胫前近段软组织缺损

目的探讨修复胫前近段软组织缺损的适宜方法。方法采用逆行胭窝及小腿内后侧皮瓣修复胫前近段软组织缺损18例,其中骨外露13例、钢板外露5例。皮瓣切取大小6．5cm×4．0cm～12．5cm×7．0cm。结果18例胫前近段软组织缺损患者除1例术后发生浅表感染,经换药逐渐愈合外,皮瓣全部成活,均达到一期消灭创面,局部无功能受限,且受区的外形较好;供区打包植皮,全部成活,没有发现明显的供区功能障碍。所有患者随访3～12个月（平均8个月）,皮瓣质地及外观均良好,功能恢复满意。结论逆行胭窝及小腿内后侧皮瓣具有血液供给可靠,皮瓣切取面积大,皮瓣较薄,局部转移距离短,易转移,易于切取等优点。适宜修复胫前近段皮肤软组织缺损,且在皮瓣的下方可切取腓肠肌内侧头并转移覆盖创面,对骨、钢板外露能起到预防感染及抗感染作用,故对胫前近段大面积皮肤软组织缺损伴骨及钢板外露是一种较好的修复方法。     

逆行腘窝及小腿内后侧皮瓣修复胫前近段软组织缺损

目的 探讨修复胫前近段软组织缺损的适宜方法.方法 采用逆行胭窝及小腿内后侧皮瓣修复胫前近段软组织缺损18例,其中骨外露13例、钢板外露5例.皮瓣切取大小6.5 cm×4.0 cm～12.5 cm×7.0 cm.结果 18例胫前近段软组织缺损患者除1例术后发生浅表感染,经换药逐渐愈合外,皮瓣全部成活,均达到一期消灭创面,局部无功能受限,且受区的外形较好;供区打包植皮,全部成活,没有发现明显的供区功能障碍.所有患者随访3～12个月(平均8个月),皮瓣质地及外观均良好,功能恢复满意.结论 逆行腘窝及小腿内后侧皮瓣具有血液供给可靠,皮瓣切取面积大,皮瓣较薄,局部转移距离短,易转移,易于切取等优点.适宜修复胫前近段皮肤软组织缺损,且在皮瓣的下方可切取腓肠肌内侧头并转移覆盖创面,对骨、钢板外露能起到预防感染及抗感染作用,故对胫前近段大面积皮肤软组织缺损伴骨及钢板外露是一种较好的修复方法.     

上臂外侧骨皮瓣移植修复手部复合伤

目的 介绍应用游离上臂外侧骨皮瓣移植修复手部软组织并掌骨缺损的手术疗效。方法 对19例手部软组织及掌骨缺损的患者，设计带桡侧副动脉后支的肱骨下段骨皮瓣一期修复皮肤和骨缺损。结果 骨皮瓣全部存活，术后随访6～12个月，皮瓣质地优，移植骨块全部骨性愈合，手功能按手外科学会上肢部分功能评定试用标准评定，优18例，良1例。结论 游离上臂外侧骨皮瓣切取方便，血供可靠且不损伤主要血管，是修复手部组织伴骨缺损的较好方法。     

Fractures of the extremely atrophic mandible

Fracture treatment of the extremely atrophic mandible is a challenge to the surgeon because of the special problems and complications. A reliable method is the internal fixation technique with multiple split rib grafts. By use of immediate split rib bone grafting secondary revisions and reconstructions may be avoided. The technique and rationale are discussed.     

Is adiposity advantageous for bone strength? A peripheral quantitative computed tomography study in late adolescent females

BACKGROUND: Whereas excess adiposity is presumed to be advantageous for the skeleton, studies investigating relations between bone strength and fat during youth have been equivocal. OBJECTIVES: Relations of percentage body fat (BF) and bone strength indexes were assessed in late adolescent females, taking into consideration surrogates of muscle force [ie, muscle cross-sectional area (MCSA) and bone length]. Bone measurements in the normal- and high-fat groups were also compared. DESIGN: Late adolescent females (n = 115; aged 18.2 +/- 0.4 y) participated in this cross-sectional study. Fat-free soft tissue mass, fat mass, and percentage BF were measured with the use of dual-energy X-ray absorptiometry. Tibial and radial peripheral quantitative computed tomography measurements were taken at the 4% (trabecular bone), 20% (cortical bone), and 66% (for measurement of MCSA) sites from the distal metaphyses. RESULTS: Percentage BF was inversely related to radial cortical bone area, total bone cross-sectional area (CSA), cortical bone mineral content (BMC), periosteal circumference, and strength-strain index (SSI) (20% site; all P < 0.05). After control for MCSA and limb length, negative relations remained between percentage BF and radial measurements and were also observed at the tibia (20% site). Unadjusted bone measures were not different between groups. After control for MCSA, the high- compared with the normal-fat group had lower bone measures at the 20% site (cortical bone area and cortical BMC at the tibia, total bone CSA at the radius, and SSI at both the tibia and radius; P < 0.05 for all). CONCLUSION: Excess weight in the form of fat mass does not provide additional benefits, and may potentially be negative, for adolescent bone.     

上臂外侧骨皮瓣移植修复手部复合伤

目的介绍应用游离上臂外侧骨皮瓣移植修复手部软组织并掌骨缺损的手术疗效。方法对19例手部软组织及掌骨缺损的患者,设计带桡侧副动脉后支的肱骨下段骨皮瓣一期修复皮肤和骨缺损。结果骨皮瓣全部存活,术后随访6~12个月,皮瓣质地优,移植骨块全部骨性愈合,手功能按手外科学会上肢部分功能评定试用标准评定,优18例,良1例。结论游离上臂外侧骨皮瓣切取方便,血供可靠且不损伤主要血管,是修复手部组织伴骨缺损的较好方法。     

Invasive Streptococcus pyogenes after allograft implantation--Colorado, 2003

Allograft tissues are used for various orthopedic procedures (e.g., ligament reconstruction, meniscal transplantation, and spinal surgery). In 2002, approximately one million allografts were distributed for transplantation (American Association of Tissue Banks [AATB], unpublished data, 2002). Recent reports of allograft-associated infections have prompted evaluation of the processing and quality-control methods employed by tissue processors. This report describes a case of invasive disease with Streptococcus pyogenes (i.e., group A streptococcus [GAS]), after reconstructive knee surgery using contaminated allograft tissue and provides recommendations to reduce the risk for allograft-associated infections. Although allograft infections are rare, they highlight the need for improved tissue evaluation and processing standards.     

Factors that affect bone mineral accrual in the adolescent growth spurt

The development of bone mass during the growing years is an important determinant for risk of osteoporosis in later life. Adequate dietary intake during the growth period may be critical in reaching bone growth potential. The Saskatchewan Bone Mineral Accrual Study (BMAS) is a longitudinal study of bone growth in Caucasian children. We have calculated the times of maximal peak bone mineral content (BMC) velocity to be 14.0 +/- 1.0 y in boys and 12.5 +/- 0.9 y in girls; bone growth is maximal approximately 6 mo after peak height velocity. In the 2 y of peak skeletal growth, adolescents accumulate over 25% of adult bone. BMAS data may provide biological data on calcium requirements through application of calcium accrual values to factorial calculations of requirement. As well, our data are beginning to reveal how dietary patterns may influence attainment of bone mass during the adolescent growth spurt. Replacing milk intake by soft drinks appears to be detrimental to bone gain by girls, but not boys. Fruit and vegetable intake, providing alkalinity to bones and/or acting as a marker of a healthy diet, appears to influence BMC in adolescent girls, but not boys. The reason why these dietary factors appear to be more influential in girls than in boys may be that BMAS girls are consuming less than their requirement for calcium, while boys are above their threshold. Specific dietary and nutrient recommendations for adolescents are needed in order to ensure optimal bone growth and consolidation during this important life stage.     

Time for Revival of Bone Biopsy with Histomorphometric Analysis in Chronic Kidney Disease (CKD): Moving from Skepticism to Pragmatism

Bone Biopsy (BB) with histomorphometric analysis still represents the gold standard for the diagnosis and classification of different forms of renal osteodystrophy. Bone biopsy is the only technique able to provide comprehensive information on all bone parameters, measuring static and dynamic parameters of turnover, cortical and trabecular microarchitecture, and mineralization defects. In nephrological practice, bone biopsy yields relevant indications to support therapeutic choices in CKD, heavily impacting the management and prognosis of uremic patients. Unfortunately, the use of bone biopsy has decreased; a lack of expertise in performing and interpreting, perceived procedure invasiveness and pain, and reimbursement issues have all contributed to this decline. Nevertheless, both bone biomarkers and instrumental images cannot be considered reliable surrogates for histological findings, being insufficiently accurate to properly evaluate underlying mineral and bone disorders. This is a multidisciplinary position paper from the Nephrology and Osteoporosis Italian Scientific Societies with the purpose of restating the role of bone biopsy in CKD patient management and of providing strong solutions to allow diffusion of this technique in Italy, but potentially also in other countries. The Italian approach through the optimization and standardization of bone biopsy procedure, the construction of the Italian Hub and Spoke network, and a request for adjustment and national homogenization of reimbursement to the Italian Health Ministry has led the way to implement bone biopsy and to improve CKD patient management and prognosis.     

Young adults with Ewing's sarcoma

Ewing's sarcoma was diagnosed in three men, one aged 22 and two aged 30. The disease was diagnosed by biopsy and chromosome investigations (t(11;22)-translocation). In the youngest patient with localised disease, supplementary radiotherapy was withheld in view of the good results of induction chemotherapy, surgery and consolidation chemotherapy. However, four months later, there was a localised recurrence, again followed by induction chemotherapy, chemotherapy at high dosage, stem cell transplantation, radiotherapy and finally surgical intervention, after which a complete remission was achieved. The 30-year-old man with localised disease was given induction chemotherapy, surgery, consolidation chemotherapy and radiotherapy; 14 months after the diagnosis he was in good condition. The other 30-year-old man had metastases in TXII and both lungs. Despite intensive therapy he died 8 months after diagnosis. Ewing's sarcoma is a musculoskeletal malignancy that occurs in children and adolescents but also in young adults. It generally manifests itself as a painful swelling originating in bone or soft tissue. There are often accompanying symptoms such as weight loss and fever. In 20-25% of cases there are already metastases (to the lungs, bone and bone marrow) by the time of diagnosis. The diagnosis and treatment of this rare, therapy-sensitive disease should take place in a study setting and in co-operation with a multidisciplinary sarcoma working group.