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Comparison of Surface Area across the Allograft-Host Junction Site Using Conventional and Navigated Osteotomy Technique.

Lall A, Hohn E, Kim MY, Gorlick RG, Abraham JA, Geller DS - Sarcoma (2012)

Bottom Line: Compared with a control of 0.69 square inches, average contact area was found to be 30.5% of optimal surface contact.Compared with a control of 0.76 square inches, average contact area was found to be 43.7% of optimal surface contact.Limited contact achieved using standard techniques may play a role in the high rate of observed non-union, and an increase in contact area using computer-assisted navigation may improve rates of bone healing.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Montefiore Medical Center, The Children's Hospital at Montefiore, Bronx, NY 10467, USA ; The Albert Einstein College of Medicine, Bronx, NY 10461, USA.

ABSTRACT
Bulk allograft reconstruction plays an important role in limb-salvage surgery; however, non-union has been reported in up to 27% of cases. The purpose of this study is to quantify average surface contact areas across simulated intraoperative osteotomies using both free-hand and computer-assisted navigation techniques. Pressure-sensitive paper was positioned between two cut ends of a validated composite sawbone and compression was applied using an eight-hole large fragment dynamic compression plate. Thirty-two samples were analyzed for surface area contact to determine osteotomy congruity. Mean contact area using the free-hand osteotomy technique was equal to 0.21 square inches. Compared with a control of 0.69 square inches, average contact area was found to be 30.5% of optimal surface contact. Mean contact area using computer-assisted navigation was equal to 0.33 square inches. Compared with a control of 0.76 square inches, average contact area was found to be 43.7% of optimal surface contact. Limited contact achieved using standard techniques may play a role in the high rate of observed non-union, and an increase in contact area using computer-assisted navigation may improve rates of bone healing. The development of an oncology software package and navigation hardware may serve an important role in decreasing non-union rates in limb salvage surgery.

No MeSH data available.


Related in: MedlinePlus

Scheme of femoral sawbones under compression plating at the simulated allograft-host junction site (SAHJS). Images demonstrating 100% contact (a), minimal contact with gapping (b).
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fig2: Scheme of femoral sawbones under compression plating at the simulated allograft-host junction site (SAHJS). Images demonstrating 100% contact (a), minimal contact with gapping (b).

Mentions: Compression across the SAHJS was achieved by first fixing the plate to one side of the SAHJS using a single fully-threaded non-locking cortical screw placed centrally within the plate's hole. Next, an eccentrically placed fully-threaded non-locking cortical screw was inserted on the opposite side of the SAHJS and compression ensued with complete seating of the screw. The pressure indicating film (28–85 PSI, 2–6 kg/cm2) acts as a force-sensing resistor between the cut ends of femoral sawbones under compression plating (Figure 2). Hardware was then removed with care in order to protect the pressure sensitive paper from scuffing or manipulation prior to analysis. A total of 32 samples were obtained using the free-hand technique and 22 samples were obtained using computer-assisted navigation.


Comparison of Surface Area across the Allograft-Host Junction Site Using Conventional and Navigated Osteotomy Technique.

Lall A, Hohn E, Kim MY, Gorlick RG, Abraham JA, Geller DS - Sarcoma (2012)

Scheme of femoral sawbones under compression plating at the simulated allograft-host junction site (SAHJS). Images demonstrating 100% contact (a), minimal contact with gapping (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539445&req=5

fig2: Scheme of femoral sawbones under compression plating at the simulated allograft-host junction site (SAHJS). Images demonstrating 100% contact (a), minimal contact with gapping (b).
Mentions: Compression across the SAHJS was achieved by first fixing the plate to one side of the SAHJS using a single fully-threaded non-locking cortical screw placed centrally within the plate's hole. Next, an eccentrically placed fully-threaded non-locking cortical screw was inserted on the opposite side of the SAHJS and compression ensued with complete seating of the screw. The pressure indicating film (28–85 PSI, 2–6 kg/cm2) acts as a force-sensing resistor between the cut ends of femoral sawbones under compression plating (Figure 2). Hardware was then removed with care in order to protect the pressure sensitive paper from scuffing or manipulation prior to analysis. A total of 32 samples were obtained using the free-hand technique and 22 samples were obtained using computer-assisted navigation.

Bottom Line: Compared with a control of 0.69 square inches, average contact area was found to be 30.5% of optimal surface contact.Compared with a control of 0.76 square inches, average contact area was found to be 43.7% of optimal surface contact.Limited contact achieved using standard techniques may play a role in the high rate of observed non-union, and an increase in contact area using computer-assisted navigation may improve rates of bone healing.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Montefiore Medical Center, The Children's Hospital at Montefiore, Bronx, NY 10467, USA ; The Albert Einstein College of Medicine, Bronx, NY 10461, USA.

ABSTRACT
Bulk allograft reconstruction plays an important role in limb-salvage surgery; however, non-union has been reported in up to 27% of cases. The purpose of this study is to quantify average surface contact areas across simulated intraoperative osteotomies using both free-hand and computer-assisted navigation techniques. Pressure-sensitive paper was positioned between two cut ends of a validated composite sawbone and compression was applied using an eight-hole large fragment dynamic compression plate. Thirty-two samples were analyzed for surface area contact to determine osteotomy congruity. Mean contact area using the free-hand osteotomy technique was equal to 0.21 square inches. Compared with a control of 0.69 square inches, average contact area was found to be 30.5% of optimal surface contact. Mean contact area using computer-assisted navigation was equal to 0.33 square inches. Compared with a control of 0.76 square inches, average contact area was found to be 43.7% of optimal surface contact. Limited contact achieved using standard techniques may play a role in the high rate of observed non-union, and an increase in contact area using computer-assisted navigation may improve rates of bone healing. The development of an oncology software package and navigation hardware may serve an important role in decreasing non-union rates in limb salvage surgery.

No MeSH data available.


Related in: MedlinePlus