Pérdida de Hueso Tibial

Se presenta un caso de revitalización de un gran fragmento de tibia liofilizado y reimplantado dos meses después del accidente. Se propone como alternativa cuando no se dispone de banco de hueso ni unidad de microcirugíaThe viability of a bone segment of the tibia, preserved by lyophilization and reimplanted two month after the accident is reported in one case. The method used in the present case can be an alternative in Centers without facilities of microsurgical unit or bone banks

Effect of two cleaning processes for bone allografts on gentamicin impregnation and in vitro antibiotic release.

Bone allografts are a useful and sometimes indispensable tool for the surgeon to repair bone defects. Microbial contamination is a major reason for discarding allografts from bone banks. To improve the number of safe allografts, we suggest chemical cleaning of the grafts followed by antibiotic impregnation. Comparison of two chemical cleaning processes for bone allografts aiming for antibiotic impregnation and consequently delivery rates in vitro. Bone chips of 5–10 mm were prepared from human femoral heads. Two cleaning methods (cleaning A and cleaning B) based on solutions containing hydrogen peroxide, paracetic acid, ethanol and biological detergent were carried out and compared. After the cleaning processes, the bone chips were impregnated with gentamicin. Bacillus subtilis bioassay was used to determine the gentamicin release after intervals of 1–7 days. Differences were compared with non-parametric Mann–Whitney U tests. The zones of inhibition obtained from the bone grafts cleaned with both cleaning processes were similar between the groups. The concentration of the released antibiotic was decreasing gradually over time, following a similar pattern for both groups. The cleaning procedure A as well as the cleaning procedure B for bone allografts allowed the impregnation with gentamicin powder in the same concentrations in both groups. The delivery of gentamicin was similar for both groups. Both cleaning procedures were easy to be carried out, making them suitable for routine use at the bone banks

216 Jewish Hospital of St. Louis

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Design and management of an orthopaedic bone bank in the Netherlands

The design and management of an orthopaedic bone bank is a complex process in which medical organisation and legislation intertwine. Neither in the Netherlands, nor in any other European country, there are official guidelines for the organisation and management of an orthopaedic bone bank. In the Netherlands, the recently modified ‘law of security and quality for using human materials’ (WVKL) dictates requirements for technical and organisational aspects for the use of human tissue and cells. The bone bank procedures include a thorough questionnaire for donor selection, extensive serological, bacteriological and histopathological examination, as well as standard procedures for registration, processing, preservation, storage and distribution of bone allografts. This article describes the organisation of an accredited bone bank and can be used as a proposition for an official guideline or can be useful as an example for other orthopaedic bone banks in Europe

Bone Graft Types

Bone grafts have been used by surgeons for a variety of purposes including filling bone cysts, reconstruction of bone loss after trauma and tumor resections and osteogenesis in fractures with union problems. In recent years, a significant increase in the use of bone grafts for reconstructive purposes has necessitated bone grafts of much greater shape and size. Although the use of avascular bone transfers is becoming more preferred due to benefits such as good osteogenic properties, resistance to infection and hypertrophy over time, nonvascular bone grafts have a wide range of use in fracture repair and reconstruction, with new developments in bone morphogenetic protein and stem cell support areas resulting in the proliferation of bone banks. Bone grafts are evaluated in three main groups as follows: autografts, allografts and xenografts. We have compiled the types of bone grafts

Frozen cancellous bone allografts: positive cultures of implanted grafts in posterior fusions of the spine

We have carried out a study on the behaviour pattern of implanted allografts initially stored in perfect conditions (aseptically processed, culture-negative and stored at -80 degrees C) but which presented positive cultures at the implantation stage. There is no information available on how to deal with this type of situation, so our aim was to set guidelines on the course of action which would be required in such a case. This was a retrospective study of 112 patients who underwent a spinal arthrodesis and in whom a total of 189 allograft pieces were used. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV (via PCR techniques) were negative. The allografts were stored by freezing them at -80 degrees C. A sample of the allograft was taken for culture in the operating theatre just before its implantation in all cases. The results of the cultures were obtained 3-5 days after the operation. There were 22 allografts with positive culture results (12%) after implantation. These allografts were implanted in 16 patients (14%). Cultures were positive for staphylococci coagulase negative (ECN) in 10 grafts (46%), Pseudomonas stutzeri in two grafts (9%), Corynebacterium jeikeium in two grafts (9%), staphylococci coagulase positive in two grafts (9%) and for each of the following organisms in one case each (4%): Corynebacterium spp., Actinomyces odontolyticus, Streptococcus mitis, Peptostreptococcus spp., Rhodococcus equi and Bacillus spp. No clinical infection was seen in any of these patients. Positive cultures could be caused by non-detected contamination at harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment different from our antibiotic protocol is required in the case of positive culture results of a graft piece after implantation

Razvoj banke koštanog tkiva u Sveučilišnoj kliničkoj bolnici Mostar

Bone tissue banks are necessary for collection, production, testing, packaging, storage and delivery of bone transplants. Bone tissue bank is a link between the donor and the recipient by which the donation becomes a medium of health improvement for both the donor and the recipient. At the Department of Orthopedics, Mostar University Clinical Hospital, about 200 total hip replacements are performed per year. Most patients undergoing total hip replacement surgery (90%) have been diagnosed with osteoarthritis, and they are suitable donors, having in mind their age and comorbidities. In the same Department, around 50 procedures that require bone transplants are performed per year. A team of highly competent surgeons are working on an intensive process of adaptation oriented to quality improvement and intensification of the activity, both with the goal of meeting the standards of excellence in orthopedic surgery. The presence of a bone tissue bank has a favorable impact on the quality of health care owing to bone transplant availability, as well as on the scientific role of a highly specialized institution that examines the properties of bone tissue.Banke koštanog tkiva su odgovorne za skupljanje, proizvodnju, ispitivanje, pakiranje, skladištenje i isporuku koštanih transplantata. Banka koštanog tkiva premosnica je od donora k primatelju prilikom koje se donacija pretače u sredstvo za poboljšanje zdravstvenog stanja kako primatelja tako i davatelja. Na Klinici za ortopediju Sveučilišne kliničke bolnice Mostar na godinu se ugradi oko 200 totalnih proteza kuka. Većini bolesnika kojima se ugrađuje totalna proteza kuka (90%) identificirana je dijagnoza osteoartritisa te su pogodni davatelji, s tim da se u obzir uzimaju komorbiditeti i životna dob. Na godinu se na Klinici izvodi oko 50 različitih operacija za koje trebaju koštani presatci. Tim visoko kompetentnih kirurga bavi se intenzivnim procesom adaptacije koji je orijentiran poboljšanju kvalitete i jačanju aktivnosti s ciljem zadovoljenja standarda izvrsnosti u ortopedskoj kirurgiji. Prisutnost ovakve koštane banke učinkovito utječe na kvalitetu skrbi kako zbog brže dostupnosti implantata tako i zbog znanstvene uloge visoko specificirane ustanove koja bazično istražuje svojstva koštanog tkiva

Allogenic Decal-Bone Grafts: A Viable Option in Clinical Orthopedics

One has to resort to allogenic source of bone grafts especially in filling up of large or multiple containable cavitary lesions, structural reconstruction of large circumferential osteoperiosteal defects, extensive spinal fusions for gross deformities, or extensive operative reconstruction after total joint replacements. These procedures demand an abundant quantity of bone material in which a patient’s (recipient’s) body cannot supply without significant morbidity and risks. At present most of the allogenic bone banks use deep-freezing or freeze-drying or radiation for long-term preservation. The techniques maintain sterility, reduce immunogenicity, and provide adequate structural integrity; however, such procedures reduce the bone-forming biological activity and are expensive. We have worked for clinical translation of the basic research performed by Marshal Urist (1965–1994). After extensive experimental observations, we have been using partially decalcified allogenic bone as grafts in clinical cases since 1978. Favorable outcome has been observed in benign cystic lesions, wide-gap grafting, and spinal fusions. Minimum follow-up for declaring “success” or “failure” of the procedure was 2 years after implantation

Radar, December 1963-January 1964

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