Autogenous Greater Omentum,as a Free Nonvascularized Graft,Enhances Bone Healing: An Experimental Nonunion Model

Reconstruction of vascularity is an early event in fracture healing and upregulation of angiogenesis may therefore promote the formation of bone. We have investigated the potentiality of autogenous free nonvascularized greater omentum to stimulate the formation of bone in an experimental hypertrophic nonunion model. Twelve dogs assigned into two identical groups underwent a standard nonunion operation. In the experimental group, this was followed by application of autogenous greater omentum as a free nonvascularized graft around the osteotomy gap. Radiographic assessments were conducted time-sequentially until euthanasia 16 weeks after surgery. Histological analysis was performed on the mid-radial diaphysis containing the 4-month-old osteotomy site. Radiological and histological properties of the group treated with free transplant of the greater omentum revealed complete union. In contrast, there was no evidence indicating union in the control group. Analyses of the radiological and histological scores confirmed that osteotomies treated with free transplant of the autogenous greater omentum had united, whereas the osteotomies of the control group failed to unite. Significant differences between the mean values for radiological and histological-grading score in the control and experimental groups were detected (p < 0.05). We showed that free graft of autogenous greater omentum could stimulate the formation of competent bone in an environment deprived of its normal vascularization. Hence, it could be recommended to enhance healing when the fractures are at risk of nonunion.     

Free Graft of Fascial Tube in Flexor Tendon Repair in the Digital Sheath of the Hand: An Attempt at a Composite Tissue Autograft

Various reconstructive methods have been reported for cicatricial tendon beds. Since 1970, when the flexor tendon gliding mechanism of the finger has been damaged in the area of “no man's land” and conditions are less than optimal for conventional tendon grafting, the authors have attempted to graft a fascial tube including tendon and paratenon of the palmaris longus. The technique is described and the results reported.     

Comparison of Functional and Radiological Outcomes of Transverse Patellar Fractures Fixed with Tension Band Fixation Using Cannulated Screws and Kirschner Wires: A Prospective Randomized Study

PurposeTo compare functional and radiological outcomes of transverse patella fractures treated with tension band wiring using either two 4.5 mm cannulated screws or Kirshner wire.MethodsThis is a non-blinded prospective randomized study comprising of two groups (n = 30 each) with closed transverse patella fractures treated with tension band wiring using Kirschner wire (K wire group) and two 4.5 mm cannulated screws (CCS group). Outcomes measured were radiological union, Knee Society score, range of motion and post-operative complications.ResultsThe CCS group showed a statistically significant higher range of motion than K wire group for each follow up (p < 0.001 in flexion and p < 0.005 in extension). A statistically significant higher percentage of patients in the CCS group showed signs of union at 6th and 12th post-operative week (p = 0.001 and 0.011 respectively) but no difference at 24th post-operative week (p = 0.313). The rate of hardware complications was significantly higher in K wire group (p = 0.001). No significant difference was noted in in the Knee society score and post-operative complications between the groups.ConclusionThis study concludes that the fixation of closed transverse patella fractures using two 4.5 mm cannulated screws is allows a faster rate of union, a better knee range of motion and lesser hardware complications as compared to Kirschner wires. However more studies with larger sample sizes and longer follow up are required.     

Subchondral defects in caprine femora augmented with in situ setting hydroxyapatite cement, polymethylmethacrylate, or autogenous bone graft: biomechanical and histomorphological analysis after two-years.

Juxta-articular defects pose significant challenges due to the high risk of fracture of the subchondral plate and articular cartilage. We evaluated the mechanical and histomorphological repair process of caprine subchondral femoral defects augmented with either a bioresorbable in situ setting hydroxyapatite cement (HAC), polymethylmethacrylate (PMMA), autogenous bone graft (AG), or left empty. Twelve-mm subchondral defects were made bilaterally in the medial femoral condyles of skeletally mature goats and augmented with a test material or left empty. Femurs were harvested at varying time periods out to 2 years and evaluated for subchondral stiffness and histomorphological indices. Several defects augmented using autograft or left empty sustained focal fracture of the subchondral plate. No HAC or PMMA augmented defects showed evidence of subchondral fracture. The HAC and PMMA augmented defects showed comparable stiffness at all time points. The mean volume fraction of HAC remaining within the defects progressively decreased from 96% at 24 h to 38% at 2 years. The new bone replacing the HAC appeared to have normal physiological architecture and orientation. In situ setting hydroxyapatite cement may be a viable alternative for the repair of subchondral defects with an important advantage that while undergoing gradual resorption and replacement with host bone, mechanical integrity of the skeletal defect is maintained.     

Prolonged Ischemic Time,Delayed Graft Function,and Graft and Patient Outcomes in Live Donor Kidney Transplant Recipients

The association between prolonged cold ischemic time (CIT) and graft and patient outcomes in live donor kidney transplant recipients remains unclear. The aims of this study were to examine the association of CIT with delayed graft function and graft loss in live donor kidney transplant recipients and those who participated in the Australian Paired Kidney Exchange program using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry. Of 3717 live donor transplant recipients between 1997 and 2012 who were followed for a median of 6.6 years (25 977 person‐years), 224 (25%) experienced CIT >4–8 h. Donor age was an effect modifier between CIT and graft outcomes. In recipients who received kidneys from older donors aged >50 years, every hour of increase in CIT was associated with adjusted odds of 1.28 (95% confidence interval [CI] 1.07–1.53, p = 0.007) for delayed graft function, whereas CIT >4–8 h was associated with adjusted hazards of 1.93 (95% CI 1.21–3.09, p = 0.006) and 1.91 (95% CI 1.05–3.49, p = 0.035) for overall and death‐censored graft loss, respectively, compared with CIT of 1–2 h. Attempts to reduce CIT in live donor kidney transplants involving older donor kidneys may lead to improvement of graft outcomes.