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PubMed1994

A simple method to ensure proper screw position and plate size selection using the Morscher cervical spine locking plate. Technical note.

The use of bone plate instrumentation with screw fixation has proved to be a useful adjunctive measure in anterior cervical spine fusion surgery. Proper fitting, positioning, and attachment of this instrumentation have been shown to be frequently suboptimal if done without radiographic guidance. The most commonly used method of radiographic assistance for placement of this instrumentation is fluoroscopy. While this gives satisfactory technical results, it is expensive and time-consuming, and exposes the patient and the operating room personnel to ionizing radiation. The authors present a simple technique to ensure screw placement and plate fitting using Kirschner wires and a single lateral radiograph. This technique saves time, reduces exposure to radiation, and has led to satisfactory results in over 20 operative cases.

Bone Plates↗
PubMed2006

Chitosan-glycerol phosphate/blood implants elicit hyaline cartilage repair integrated with porous subchondral bone in microdrilled rabbit defects.

OBJECTIVE: We have previously shown that microfractured ovine defects are repaired with more hyaline cartilage when the defect is treated with in situ-solidified implants of chitosan-glycerol phosphate (chitosan-GP) mixed with autologous whole blood. The objectives of this study were (1) to characterize chitosan-GP/blood clots in vitro, and (2) to develop a rabbit marrow stimulation model in order to determine the effects of the chitosan-GP/blood implant and of debridement on the formation of incipient cartilage repair tissue. METHODS: Blood clots were characterized by histology and in vitro clot retraction tests. Bilateral 3.5 x 4 mm trochlear defects debrided into the calcified layer were pierced with four microdrill holes and filled with a chitosan-GP/blood implant or allowed to bleed freely as a control. At 1 day post-surgery, initial defects were characterized by histomorphometry (n=3). After 8 weeks of repair, osteochondral repair tissues between or through the drill holes were evaluated by histology, histomorphometry, collagen type II expression, and stereology (n=16). RESULTS: Chitosan-GP solutions structurally stabilized the blood clots by inhibiting clot retraction. Treatment of drilled defects with chitosan-GP/blood clots led to the formation of a more integrated and hyaline repair tissue above a more porous and vascularized subchondral bone plate compared to drilling alone. Correlation analysis of repair tissue between the drill holes revealed that the absence of calcified cartilage and the presence of a porous subchondral bone plate were predictors of greater repair tissue integration with subchondral bone (P<0.005), and of a higher total O'Driscoll score (P<0.005 and P<0.01, respectively). CONCLUSIONS: Chitosan-GP/blood implants applied in conjunction with drilling, compared to drilling alone, elicited a more hyaline and integrated repair tissue associated with a porous subchondral bone replete with blood vessels. Concomitant regeneration of a vascularized bone plate during cartilage repair could provide progenitors, anabolic factors and nutrients that aid in the formation of hyaline cartilage.

Animals↗
PubMed1996

Effects of radiation therapy on reconstruction of mandibular defects with a titanium reconstruction plate.

Titanium fixation plates are commonly used in reconstruction of mandibular defects resulting from tumor resections in head and neck surgery. The effects of radiation therapy on the interface of bone, plate, and soft tissue were examined in this in vivo study. Four conditioned beagles had 1-cm segmental mandibular defects that were reconstructed with titanium plates. Two of the four also had placement of vascularized bone grafts. Healing was evaluated with or without postoperative radiotherapy. After collection of tissues using histologic methods and analysis with energy-dispersive spectroscopy, we found that the effects of radiation on bone-plate and bone-screw interfaces is minimal. Although radiation decreased the bone density and the rate of bone repair at the bone-screw interface, this did not appear to affect stability of the plate repair or the viability of bone tissue.

Animals↗
PubMed1989

[Bone morphology following plate osteosynthesis as measured by axial tomography].

Previous examinations using computed tomography have shown that no geometrical changes in the cross-section was induced by the plate fixation; bone density was slightly reduced (10% in average) in the entire cross-section and not only next to the plate. A tomographic analysis is presented here about the quality and the amount of bone in the affected leg, compared to the contralateral one.

Adolescent↗
PubMed1997

[Development of three dimensional bone-connecting plate and its clinical application].

Biomechanical assessment showed that the three dimensional plate developed by the authors which had stereo-rigidity in the fixation of long bone fractures was superior to compressive plate and flanged plate in terms of anti-compressive and anti-torsional strength. The anti-bending strength was superior to the flanged plate but inferior to compressive plate. The comprehensive nature of the three dimensional plate remained superior. Clinical application in 112 cases with 85 of them being followed-up for 8-44 months showed that bone union occurred in 45-98 days. The average was 82 days. In 65 cases of them the plates had been removed. No delayed-union or non-union occurred. Preliminary experience showed that the three dimensional plate was a new design for the treatment of long bone fractures. It can be applied to various types of long bone fractures especially the severe comminuted fractures owing to its requirement of proper fixation.

Adolescent↗
PubMed1998

Use of a locking reconstruction bone plate/screw system for mandibular surgery.

PURPOSE: This study examined the use of a locking reconstruction bone plate/screw system for use in mandibular surgery. PATIENTS AND METHODS: All patients treated with a locking reconstruction bone plate/screw system for fractures of the mandible or continuity defects in an 18-month period were prospectively studied. Ease of use of the locking plate/screw system, characteristics of the fractures/defects, and complications were tabulated. RESULTS: One hundred two locking bone plates were placed in 84 patients. Most patients (n=75) were treated for fractures of the mandible; there were eight continuity defects and one case of mandibular narrowing. There were no cases of malocclusion or difficulties encountered in using the plate/screw system. Loss of fixation was encountered in only one patient. CONCLUSIONS: The use of a locking plate/screw system was found to be simple, and it offers advantages over conventional bone plates by not requiring the plate to be compressed to the bone to provide stability.

Adolescent↗
PubMed1988

Stability of simultaneous maxillary intrusion and mandibular advancement: a comparison of rigid and nonrigid fixation techniques.

This study examines the short-term stability of bimaxillary surgery following Le Fort I impaction with simultaneous bilateral sagittal split osteotomies and mandibular advancement using two standard techniques of postsurgical fixation. Fifteen adults had skeletal plus dental maxillomandibular fixation, and fifteen adults had rigid internal fixation using bone plates in the maxilla and bicortical bone screws between the proximal and distal segments in the mandible. The group with rigid internal fixation did not undergo maxillomandibular fixation. Radiographic cephalograms were analyzed during the postsurgical period to evaluate skeletal and dental stability. There was no statistical difference in postsurgical stability with rigid internal fixation or skeletal plus dental maxillomandibular fixation other than the vertical position of the maxillary molar; the skeletal plus dental maxillomandibular fixation group had a significant amount of postsurgical intrusion of the maxillary molar when compared with the rigid internal fixation group. Although the other measures showed no statistically significant difference between the experimental groups, the amount of variability in postsurgical stability in the group with skeletal plus dental maxillomandibular fixation was greater than that found in the group with rigid internal fixation.

Bone Plates↗
PubMed2005

[Repair of refractory bone nonunion in the distal humerus].

OBJECTIVE: To investigate the effect of microsurgical repair of refractory bone defects and nonunion in distal humerus. METHODS: Twelve cases of bone defects and nonunion in distal humerus were repaired with free vascularised fibular graft and fixed with the anatomical bone plate. Of the 12 cases, 8 had pseudarthrosis, and 4 had bone defects 3-5 cm. Fibular graft ranged from 5-15 cm, 8.5 cm in average. RESULTS: After a follow-up of 3-18 months, 8.5 months in average, all cases of free vascularised fibular graft healed within 3-8 months. The fibular graft thickened as time passed. Normal recessive osseous elbow joint, improvement in the inflection and extension of elbow joint, and normal revolving of forearm were attained. The short of limbs were corrected. Satisfactory functions of supporting and fine operation were attained. CONCLUSION: With the support of anatomical bone plate, the fibular graft can help the recovery of joint function and repair bone defects and nonunion as to avoid joint replacement with prosthesis.

Adolescent↗
PubMed1991

Radiographic, high detail radiographic, microangiographic and histological findings of the distal portion of the tarsus in weanling, young and adult horses.

Clinical radiographic (LM and D35L-P1MO views), high detail radiographic, microangiographic and histological findings of the distal portion of the tarsus of 16 horses (five weanling, four young and six adult), without known clinical histories, were evaluated to determine the sensitivity of clinical radiographs for the detection of abnormalities in the distal tarsus and the prevalence of abnormalities in this population. Clinical radiographic and high detail radiographic abnormalities were observed in at least 30 per cent of the tarsi examined. Statistical agreement between observations from clinical radiographs and corresponding post mortem high detail radiographs was not good for subchondral bone plate irregularities and joint margin changes. Three patterns of sclerosis of the medullary spongiosa were visualised on high detail radiographs: thickening of the subchondral bone plate was seen commonly in the weanling group, whereas arching and bridging patterns were more prevalent in the young and adult groups. Bone production on the dorsal cortex of the central and third tarsal bones did not increase with age. Abnormalities in vascular perfusion and articular cartilage histology were observed in association with subchondral bone plate irregularities and focal regions of osteopenia observed on high detail radiographs.

Aging↗
PubMed1985

Rigid fixation of maxillary osteotomies: a preliminary report and technique article.

The authors review their experiences with seventy cases of maxillary osteotomy rigidly stabilized with bone plates and minimal or no maxillomandibular fixation. The surgical technique, which allows consistent placement of plates in dense bone without endangering root apices, is described in detail. Orthodontic management has been started as early as 3 weeks postoperatively. A disadvantage of small plates is the possible need for their removal, which requires a second surgical procedure. Plates have been removed or replaced in five patients in this series.

Bone Plates↗
PubMed1993

Treatment of mandibular angle fractures using the AO reconstruction plate.

Fifty-two patients with fracture of the mandibular angle were treated by extraoral open reduction and internal fixation using the AO reconstruction bone plate (Synthes, Paoli, PA). None were placed into postsurgical maxillomandibular fixation. Four patients developed early infections requiring incision and drainage (7.5%). One patient required removal of the hardware after the fracture had healed. The use of the AO reconstruction bone plate for fractures of the mandibular angle was found to be very predictable and was associated with a low rate of complications.

Adolescent↗
PubMed1991

Cranial deformation in craniosynostosis. A new explanation.

Skull growth after premature fusion of a single suture was described by Virchow in 1851. He observed that growth was restricted in a plane perpendicular to a fused suture. However, he failed to predict the compensatory growth patterns that produce many of the deformities recognized as features of individual craniosynostosis syndromes. The deformities resulting from premature closure of a coronal, sagittal, metopic, or lambdoid suture can be predicted by the following observations: (1) cranial vault bones that are prematurely fused act as a single bone plate with decreased growth potential; (2) asymmetrical bone deposition occurs mainly at perimeter sutures, with increased bone deposition directed away from the bone plate; (3) sutures adjacent to the stenotic suture compensate in growth more than those sutures not contiguous with the closed suture; and (4) enhanced bone deposition occurs along both sides of a nonperimeter suture that is a continuation of the prematurely closed suture. These four rules were derived by critically examining the clinical deformities observed with each form of craniosynostosis. These rules assume that cranial sutures have the capacity to compensate by depositing bone asymmetrically along their edges. Unequal growth patterns have been demonstrated in the frontonasal suture of rabbits by Selman and Sarnat. In addition, unequal bone deposition has also been demonstrated along the parieto-interparietal suture in albino rats by Baer. Human studies to determine if asymmetrical bone deposition actively occurs along cranial vault sutures in response to a stenotic suture have not been performed, however. It is also unclear whether these four guidelines apply to cranial base abnormalities observed with craniosynostosis. As new radiologic techniques develop to define the configuration of the skull in intricate detail, a skull pattern of growth explaining the pathogenesis of all deformities created by premature fusion of a cranial vault suture may become apparent.

Animals↗
PubMed1989

Cranial vault growth in craniosynostosis.

Skull growth after single suture closure was described in 1851 by Virchow, who noted that growth in the plane perpendicular to a fused suture was restricted. However, this observation failed to predict compensatory growth patterns that produce many of the deformities recognized as features of individual syndromes. The deformities resulting from premature closure of a coronal, sagittal, metopic, or lambdoid suture can be predicted on the basis of the following observations: 1) cranial vault bones that are prematurely fused secondary to single suture closure act as a single bone plate with decreased growth potential; 2) asymmetrical bone deposition occurs mainly at perimeter sutures, with increased bone deposition directed away from the bone plate; 3) sutures adjacent to the prematurely fused suture compensate in growth more than those sutures not contiguous with the closed suture; and 4) enhanced symmetrical bone deposition occurs along both sides of a non-perimeter suture that is a continuation of the prematurely closed suture. These observations regarding growth in craniosynostosis are illustrated with clinical material in this report.

Cranial Sutures↗
PubMed1994

Long-term changes in the haversian systems following high-dose irradiation. An ultrastructural and quantitative histomorphological study.

The effects of high-dose irradiation on the morphology of haversian bone were studied, over a fifty-two-week period, in seventy-seven adult rabbits, after the administration of a single dose of radiation (therapeutic x-ray; twenty-five, fifty, or 100 gray) to one knee joint. The specimens of bone were examined with microangiography, light and transmission electron microscopy, and histomorphometry. Analysis was performed on the haversian bone in the subchondral bone plate of weight-bearing portions of the femoral condyles. Microangiography demonstrated dilatation of the microvasculature four weeks after irradiation. Beginning at twelve weeks, there was a marked decrease in vascularity; no obvious recovery of the subchondral bone had occurred by fifty-two weeks. At four weeks, morphological analysis revealed two changes in the haversian canals: simple occlusion of the haversian vessels with loss of cells in the canal, and dilatation of the capillaries with abnormal resorption of the perivascular bone matrix by osteoclasts. The abnormal bone resorption was not coupled with subsequent new-bone formation, resulting in increased porosity. Beginning at four weeks, a progressive decrease in the number of haversian vessels and in cellularity became prominent. The decrease in cellularity involved all types of cells, including endothelial cells, pericytes, perivascular mesenchymal cells, osteoblasts, osteocytes, and osteoclasts. The loss of perivascular cells was often but not always associated with occlusion of the haversian vessels. Histomorphometry revealed both time-dependent and dose-dependent decreases in capillary density (the number of intraosseous capillaries per unit area) and in the number of osteocytes in the subchondral bone plate. The porosity of the same areas showed a significant increase by four weeks (p < 0.001 after administration of twenty-five gray and p < 0.01 after administration of both fifty and 100 gray), but between twelve and fifty-two weeks, there was only a slight additional increase. Statistical analysis revealed significant correlations between capillary density and osteocyte survival (p < 0.001) and between capillary density and porosity (p < 0.001). The portion of the subchondral bone plate that was located farthest from the non-irradiated normal bone showed progressive damage and no sign of recovery at fifty-two weeks.

Animals↗
PubMed2007

Histopathologic study of long-bone growth plates confirms the basset hound as an osteochondrodysplastic breed.

Osteochondrodysplasias are caused by abnormal development and growth of cartilage and bone. These abnormalities have been reported in both humans and animals with dwarfism. The basset hound is considered a breed with a disproportionate prevalence of dwarfism, the cause of which is unknown. To determine the type of osteochondrodysplasia in this breed, we analyzed histologically the growth plates from the long bones of a basset hound and a Doberman pinscher, both 2 mo old. Tissue was fixed in 4% paraformaldehyde, embedded in paraffin, sectioned at 5 microm, stained with hematoxylin and eosin, and analyzed by light microscopy. Our results suggest that by this method the basset hound can be defined only as a breed having osteochondrodysplasia due to a primary cartilage problem in the growth plate.

Animals↗
PubMed1998

Age-related changes in the articular cartilage of human sacroiliac joint.

Iliac and sacral articular cartilage of 25 human sacroiliac joints (1-93 years) are examined by light microscopy and immunohistochemistry in order to gain further insight into the nature and progress of degenerative changes appearing during aging. These changes can already be seen in younger adults as compared to cartilage degeneration known in other diarthrodial joints. Structural differences between sacral and iliac cartilage can already be observed in the infant: the sacral auricular facet is covered with a hyaline articular cartilage, reaching 4 mm in thickness in the adult and staining intensely blue with alcian blue at pH1. Iliac cartilage of the newborn is composed of a dense fibrillar network of thick collagen bundles, crossing each other at approximately right angles. A faint staining with alcian blue suggests a low content of acidic glycosaminoglycans. In the adult, iliac cartilage becomes hyaline and its maximal thickness reaches 1-2 mm. Both articular facets exhibit morphological changes during aging that are more pronounced in the iliac cartilage and resemble osteoarthritic degeneration; the staining pattern of the extracellular matrix becomes inhomogenous, chondrocytes are arranged in clusters and the articular surface develops superficial irregularities and fissures. Sometimes fibrous tissue fills up these defects. Nevertheless, large areas of iliac cartilage remain hyaline in nature. Sacral articular cartilage often remains largely unaltered until old age. The sacral subchondral bone plate is usually thin and shows spongiosa trabeculae inserted at right angles, suggesting a perpendicular load on the articular facet. Iliac subchondral spongiosa shows no definite alignment and joins the thickened subchondral bone plate in an oblique direction. The iliac cartilage therefore seems to be stressed predominantly by shearing forces, arising from the changing monopodal support of the pelvis during locomotion. The subchondral bone plate on both the iliac and sacral auricular facet is penetrated by blood vessels that come into close contact with the overlying articular cartilage. These vessels may contribute to the high incidence of rheumatoid and inflammatory diseases in the human sacroiliac joint. Immunolabelling with an antibody against type II collagen reveals a diminished immunoreactivity in the upper half of adult sacral cartilage and only a faint and irregular labelling in the iliac cartilage. Type I collagen can be detected in a superficial layer on the sacral articular surface and around chondrocyte clusters in iliac cartilage, as in dedifferentiating chondrocytes during the development of osteoarthritis.

Adolescent↗
PubMed2003

Repositioning of the vertebral artery with titanium bone fixation plate for trigeminal neuralgia.

BACKGROUND: Trigeminal neuralgia is usually treated by the padding method using Teflon felt. However this can not be done in certain cases in whom a large tortuous vertebrobasilar artery compresses the fifth nerve. The transposition method using the sling may be an alternative method. But this method is not an easy procedure and requires a relatively large craniotomy. Two cases were treated by a new and simpler effective technique. CLINICAL PRESENTATION: Two cases of the trigeminal neruralgia were treated. The first case was a 71 year-old male and the second case was a 63 year-old male. The history of the medical treatments were similar and both cases had had trigeminal nerve blocks and were prescribed carbamazepin. However, the pain control was insufficient in both cases. In both cases, three dimensional computerized tomography showed the large tortuous right vertebral artery ran just behind the clivus and compressed the right trigeminal nerve. In the second case past history showed a recent hypertensive cerebellar hemorrhage. TECHNIQUE AND RESULTS: A right suboccipital craniotomy were performed in both cases. In both cases, the right vertebral artery compressed the trigeminal nerve in a rostral direction. The sling technique with nylon sutures was tried in both cases but failed during surgery. Then, the bone fixation stainless plate was cut to 10 cm in length and pre-shaped with pliers. After being shaped, the distal end of the plate was inserted between the vertebral artery and fifth nerve and the proximal end of the plate was fixed to the skull by screw. The fifth nerve was completely isolated from the artery as they were in direct contact. After surgery, the pain disappeared completely during the follow-up of one and a half year in the first case and 9 months in the second case. CONCLUSION: The plate can be bent and curved with plier to suit each individual case. This technique is easily applied even when the slings or other isolation technique is not available and appeared to achieve the mechanically stronger reposition and fixation of a very large and tortuous artery away from the trigeminal nerve.

Aged↗
PubMed1978

Repair of carpometacarpal instability after radiocarpal arthrodesis in a dog.

A 4-year-old male German Shepherd Dog sustained subluxation of the right radiocarpal joint. A coaptation splint did not adequately stabilize the carpus, and arthrodesis of the radiocarpal joint was undertaken, utilizing a wedge graft and bone plate. Despite successful fusion of the joint, lameness persisted in the affected limb. The lameness was attributed to subsequent carpometacarpal subluxation, which was presumed to result from the added stress of weight bearing on the carpometacarpal joint following the arthrodesis. Arthrodesis of the right intercarpal and carpometacarpal joints, utilizing cortical bone grafts and a bone plate, restored normal gait.

Animals↗