Outi Kaarela

Composite Implant of Native Bovine Bone Morphogenetic Protein (BMP) and Biocoral in the Treatment of Scaphoid Nonunions — A Preliminary Study

Background and Aims: Bone morphogenetic protein (BMP) has been shown to induce bone formation and union in long bone defects and nonunions. We report a preliminary study of a composite implant consisting of a biocoral frame, carrier collagen and bovine BMP in the treatment of scaphoid nonunions. Material and Methods: Two proximal and eight waist area scaphoid nonunions were treated using BMP/coral implant combined with either the Matti-Russe procedure (2 cases) or an interpositional bone graft fixed with screws or compression fixation pins (8 cases). In two cases only a one piece BMP/coral implant was used as an interpositional graft and in other cases interpositional autograft was used with granular BMP/coral implant placed between the fragments and the graft. Results and Conclusions: Only two wrists resulted in complete union. These preliminary results suggest that composite implant of BMP, as used in the present study, may not solve the problems encountered in the treatment of scaphoid nonunions. Poor vascular conditions in scaphoid may not provide enough mandatory osteogenic cells for BMP to function properly. In avascular conditions coral does not resorb edequately and implants may also work as a sequester between the bone graft and the scaphoid bone and therefore actually inhibit the healing process.

Composite implant of native bovine bone morphogenetic protein (BMP), collagen carrier and biocoral in the treatment of resistant ulnar nonunions: report of five preliminary cases

IntroductionBone morphogenetic protein (BMP) has been shown to induce bone formation and union in long bone defects and nonunions. There are, however, no previous reports of BMP being used for ulnar nonunions. We report on five cases of resistant ulnar nonunions treated with a composite implant consisting of a biocoral frame, collagen carrier, and bovine BMP.Materials and methodsFour diaphyseal and one olecranon ulnar nonunions were treated using BMP/coral implant combined with internal fixation. Additional autografting was used in three cases. All of the cases were challenging in their own ways: Three of the patients had been operated on earlier for their nonunion without success, one had a 40xa0mm bone loss, and one had a 9-month-old untreated olecranon fracture. After excision of the sclerotic surfaces of the nonunion, the gap was filled with autograft and a composite implant containing BMP. Fixation was done with a compression plate in the diaphyseal nonunions and with a tension band in the olecranon nonunion.ResultsSolid union was achieved in all five cases. No infections or other adverse effects were encountered.ConclusionThese preliminary results suggest that BMP-containing implants might be a feasible alternative or superior to autografting in the treatment of resistant ulnar nonunions.

Silicone replacement arthroplasty for Kienböck's disease

Thirty-nine patients with Kienböck’s disease underwent silicone replacement arthroplasty between 1979 and 1994. The patients were followed-up from 1 to 8 years (mean, 8 years). Sixteen prostheses (41%) have had to be removed, from 1 to 18 years postoperatively (mean, 5.6 years), 15 of them because of pain and silicone synovitis or cysts. It appears that silicone synovitis with cyst formation is an inevitable problem in the wrist after silicone replacement arthroplasty of the lunate, and this procedure is only a temporary solution for Kienböck’s disease.

Cosmetic results after wire-guided biopsy of benign breast lesions

BACKGROUNDnThere are surprisingly few reports about the cosmetic results of wire-guided biopsy of benign breast lesions as opposed to breast-conserving surgery and irradiation of early breast cancer (BCT).nnnSTUDY DESIGNnTwenty potential perioperative risk factors for adverse cosmetic results after wire-guided breast biopsy were prospectively evaluated in 101 patients undergoing the first single biopsy after suspicion of a malignant lesion that subsequently proved to be benign. The overall cosmetic result was evaluated by using 6 specific cosmetic indices individually scored 6 months after the breast biopsy.nnnRESULTSnThe overall cosmesis was excellent, good, fair, or poor in 48.5%, 26.7%, 12.9%, and 11.9% of cases, respectively. The corresponding figures according to appraisal by the patients were 22.8%, 58.4%, 17.8%, and 1.0%, respectively. Unsatisfactory (fair or poor) overall cosmetic results were related to excisions extending down to the fascia (p = 0.001) and postoperative complications (p = 0.018) in multivariate analysis. Notably, specimen volume had no significant impact on overall cosmesis, as opposed to cosmesis after BCT.nnnCONCLUSIONSnCosmetic outcomes after wire-guided biopsy of benign breast lesions were excellent or good in at least 75% of cases. Excisions extending down to the pectoralis fascia and complications were associated with poor aesthetic outcomes.

Wireless Infrared Thermometer in the Follow-Up of Finger Temperatures

After replantation surgery it is helpful to use temperature monitoring in order to detect vascular problems early. One of the methods currently employed is to use a thermometer with a wired probe attached to the tissue being monitored. An infrared wireless thermometer, commonly used in industry, measures temperatures of surfaces without actually touching them. The purpose of this study was to evaluate the efficacy of infrared wireless thermometer technology for monitoring finger temperature. Finger temperatures of 38 volunteers were measured using the infrared wireless thermometer. A traditional wired thermometer was used as control. The measurements of both thermometers were similar when the temperature was 31.5° and over, with no statistical differences (mean difference 0.06°, P=0.521). At lower temperatures, however, the wireless infrared thermometer showed slightly lower temperature values (mean difference 1.01°, P<0.001). There was no difference between the finger temperatures of smokers and non-smokers. There is potential for the wireless infrared thermometer to be used as an easier alternative to the traditional wired thermometer in monitoring temperatures of revascularised or replanted parts including digital replants. Further clinical studies would be warranted.

Bone tissue concentrations of ciprofloxacin released from biodegradable screws implanted in rabbits skull

Previously, ciprofloxacin-releasing polylactide/polyglycolide 80/20 (SR-PLGA) screws have proven to be biocompatible with sufficient strength. However, there has been no information about the local concentrations of ciprofloxacin in bone tissue after their implantation. To measure bone concentrations of ciprofloxacin, two screws were implanted in each rabbit, one on either side of the sagittal suture (nu2009=u200928 rabbits). Follow-up periods were 2, 4, 8, 16, 24, 52 and 78xa0weeks. From each rabbit, bone blocks containing one screw were retrieved and used to measure drug concentration. Ciprofloxacin concentration at 2xa0weeks follow-up was 4.4u2009±u20094.2xa0μg/g, 14.1u2009±u20092.7xa0μg/g at 4xa0weeks and 7.6u2009±u20094.5xa0μg/g at 8xa0weeks. Measured concentrations were very low at 16xa0weeks (mean 0.09u2009±u20090.04xa0μg/g) and 24xa0weeks (mean 0.04u2009±u20090.02xa0μg/g). Surprisingly, the concentration was higher again at 1xa0year (mean 1.3u2009±u20091.0xa0μg/g). At 1.5xa0years, concentration had decreased again (mean 0.8u2009±u20090.6xa0μg/g). The drug concentration in bone tissue was higher than minimal inhibitory concentration of ciprofloxacin (Staphylococcus aureus 0.1–1.0xa0μg/g) at 2, 4, and 8xa0weeks. Ciprofloxacin-releasing SR-PLGA 80/20 screws could be used clinically for osteofixation and infection treatment in cranial bone.

Pyrolytic carbon MCP arthroplasty: a report of seven prostheses implanted in two patients

Rheumatoid arthritis most commonly affects the metacarpophalangeal (MCP) joints of the hand. Pyrolytic carbon MCP arthroplasty has lately provided a new alternative in the treatment of these patients, but reports in the literature are still few. Here, we report the mid-term results of seven such prostheses implanted in two elderly patients with rheumatoid arthritis. Pyrolytic carbon MCP arthroplasty was performed on three MCP joints in one patient and on four MCP joints in another patient. A specific postoperative mobilization protocol was applied. Range of motion, grip strength, and pinch strength were recorded, and radiographs were taken at three, six, and ten months postoperatively. Ten months after the operation, the operated joints were pain-free, and grip and pinch strengths had improved. On average, the passive range of motion had improved and the active range of motion had remained about the same. The joints were clinically stable. No adverse remodeling or bone resorption was observed radiographically. Ulnar deviation recurred in one of the two cases. These results suggest pyrolytic carbon MCP arthroplasty to be a noteworthy alternative in the treatment of MCP joints affected by rheumatoid arthritis. Early treatment, before the development of severe soft tissue destruction, seems to yield better results.

Quality of life after free flap surgery for cancer of the head and neck in patients with or without postoperative complications

BackgroundDespite advances in surgical techniques, postoperative complications are frequent after free flap surgery for cancer of the head and neck. The present study assessed quality of life (QOL) in patients with and without postoperative complications.MethodsQOL was evaluated using RAND-36, EORTC-C30 and H&N-35, and UW-QOL questionnaires.ResultsOf 53 assessed patients, 29 (54.7%) had at least one complication. Those with medical complications (nu2009=u200912, 22.6%) had significantly lower QOL in all domains of RAND-36 except emotional well-being. They also reported lower scores in EORTC-C30 domains of financial difficulties, pain, and insomnia and UW-QOL domains of pain, activity, and recreation. The QOL for patients without complications was comparable to the general population.ConclusionQOL after free flap surgery for cancer of the head and neck is reduced in patients with postoperative medical complications.