Autologous Transplantation of Press‐fit Bone Cylinders in the Treatment of Pelvic Nonunion

Abstract

The present study describes method for autologous bone transplantation to an area of nonunion at the pelvic ring in a way that ensures the best possible bone‐to‐bone interface (“press‐fit”) and provides optimal preconditions for the ingrowth of the bone graft. We modified a technique that has been used to transplant press‐fit bone‐baseplate‐cartilage cylinders for the repair of joint cartilage defects. The technique allows for precise harvesting of bone cylinders with a diamond‐coated and fluid‐cooled instrument. At the site where the graft shall be inserted, a cylindrical hole is created with a corresponding hollow diamond‐coated trephine. This ensures an optimal press‐fit implantation of the graft. The new surgical technique has been applied in four patients with nonunion of the pelvic ring. No intraoperative or postoperative complications occurred. In three patients, the procedure led to a reduction of pain and a higher level of mobility as well as a timely radiographic union (imaging not available for another patient). Our technique offers a valuable new treatment option for pelvic nonunion. The current article serves as a proof of concept. Future comparative studies will have to determine its value in detail.

Clinical Outcomes of Treatment Strategies for Postoperative Plate Fracture and In Situ Fracture of the Femoral Shaft

“…This may lead to delayed fracture healing or even nonhealing. Some scholars also believe that the clinical efficacy of intramedullary pin fixation is not superior to that of plate fixation, which has its own unique advantages and irreplaceable effects [28][29][30]. The plate has its own unique advantages and irreplaceable functions, including the following: the full exposure of the fracture end during surgery, the cleaning and trimming of the fracture end, the bone grafting, the improvement of the contact area of the fracture end, and the effective compression; the plate has obvious advantages over the intramedullary pin in terms of rotation resistance, especially in non-isthmus fractures of the femur; the plate does not need to disrupt the blood flow in the medullary cavity during the surgery; in addition, for patients with fractured plates, the internal fixation device needs to be removed by incision during surgery and a longer plate can be implanted in the original surgical approach without another.…”

The Antibacterial Effect, Biocompatibility, and Osteogenesis of Vancomycin-Nanodiamond Composite Scaffold for Infected Bone Defects

“…51,52 Autologous bone transplantation is highly safe and considered the gold standard for bone defect repair, but the source of donors is limited. 53,54 However, rejection of allogeneic bone affects fracture healing. 55 An increasing number of scholars are currently focusing on the preparation of artificial bone repair materials 56,57 and local drug release systems.…”

A novel press-fit minimally-invasive symphysiodesis technique

“…This allows the surgeon to modify the depth of cortical bone resection, but also results in soft tissue damage, especially of the remaining anterior or posterior symphyseal ligaments. To treat osteochondral defects, the usage of press‐fit cylinders has been well established in past years [14, 15]. However, its use in the treatment of pelvic non‐unions has been described in only few cases.…”

“…However, its use in the treatment of pelvic non‐unions has been described in only few cases. Herath et al described the usage of Surgical Diamond Instruments (SDI) to create press‐fit cylinders for the treatment of posterior pelvic ring non‐unions [15]. According to the results of our institution for the posterior pelvic ring, we created the novel minimally‐invasive symphysiodesis method as described in this article.…”