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Freischmidt H, Guehring T, Thomé P, Armbruster J, Reiter G, Grützner PA, Nolte PC. Treatment of Large Femoral and Tibial Bone Defects With Plate-Assisted Bone Segment Transport. J Orthop Trauma 2024; 38:285-290. [PMID: 38381977 PMCID: PMC11017834 DOI: 10.1097/bot.0000000000002784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES The purposes of this study were to assess clinical and radiographic outcomes following plate-assisted bone segment transport (PABST) in large bone defects of the lower extremities. METHODS DESIGN Retrospective study of prospectively collected data. SETTING Level-1 trauma center located in Germany. PATIENT SELECTION CRITERIA Patients who underwent PABST and were at least 1 year postoperatively were included. OUTCOME MEASURES AND COMPARISONS Demographic data were collected. Radiographic apparent bone gap (RABG), time to consolidation, time to full weight-bearing, and consolidation index were calculated. Numeric rating scale, lower extremity functional scale (LEFS), and complications were assessed. RESULTS Fifteen patients [13 male; mean age 51 years (range, 20-75)] underwent PABST and had follow-up at a mean of 29.1 months. The tibia was affected in 8 and the femur in 7 patients. Preoperative RABG was 60 mm [interquartile range (IQR): 40-125], and bone defects were caused by septic nonunions in 73% of patients. Fourteen patients (93%) demonstrated consolidated transport callus at 7.3 months [95% confidence interval (95% CI), 6-8.5], and 9 patients (60%) demonstrated complete consolidation of both docking site and transport callus at 11.5 months (95% CI, 7.3-15.3). Postoperative RABG was 0.1 mm (IQR: 0-0.8), and consolidation index was 1.9 months/cm (95% CI, 1.3-2.5). All patients achieved full weight-bearing at 8.7 months (IQR: 6.5-10.3). LEFS was 42 (95% CI, 34-50), and numeric rating scale was 3 (95% CI, 2-4). Patients treated for tibial defects had a significantly higher consolidation rate compared with patients treated for femoral defects ( P = 0.040). CONCLUSIONS PABST demonstrated high consolidation of transport callus with few complications. Although full weight-bearing was achieved in all patients, complete consolidation of the docking site was only present in 60% of cases. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Holger Freischmidt
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Thorsten Guehring
- Department of Shoulder and Elbow Surgery, Sportsmedicine & Traumatology, Diakonie Clinic Paulinenhilfe, Stuttgart, Germany
| | - Patrick Thomé
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Jonas Armbruster
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Gregor Reiter
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Paul Alfred Grützner
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Philip-Christian Nolte
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
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Tanaka A, Okamoto M, Kito M, Yoshimura Y, Aoki K, Suzuki S, Takazawa A, Komatsu Y, Ideta H, Ishida T, Takahashi J. Muscle strength and functional recovery for soft-tissue sarcoma of the thigh: a prospective study. Int J Clin Oncol 2023:10.1007/s10147-023-02348-4. [PMID: 37133781 DOI: 10.1007/s10147-023-02348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/25/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND This study aimed to investigate changes in muscle strength and functional outcome before and after surgery for soft-tissue sarcoma of the thigh and to examine the timing of recovery. METHODS From 2014 to 2019, 15 patients who underwent multiple resections of the thigh muscle for soft-tissue sarcoma of the thigh were included in this study. The muscle strength was measured with an isokinetic dynamometer for the knee joint and with a hand-held dynamometer for the hip joint. The functional outcome assessment was based on the Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), European Quality of Life-5 Dimensions (EQ-5D), and maximum walking speed (MWS). All measurements were conducted preoperatively and at 3, 6, 12, 18, and 24 months postoperatively, and the ratio of postoperative to preoperative value was used. A repeated-measures analysis of variance was performed to compare changes over time and to investigate the recovery plateau. Correlations between changes in muscle strength and functional outcomes were also examined. RESULTS The muscle strength of the affected limb, MSTS score, TESS, EQ-5D, and MWS were significantly decreased at 3 months postoperatively. The recovery plateau was subsequently reached at 12 months postoperatively. The changes in muscle strength of the affected limb and functional outcome showed a significant correlation. CONCLUSIONS The estimated postoperative recovery for soft-tissue sarcoma of the thigh is 12 months after surgery.
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Affiliation(s)
- Atsushi Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Munehisa Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yasuo Yoshimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kaoru Aoki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shuichiro Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Akira Takazawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yukiko Komatsu
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hirokazu Ideta
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takaaki Ishida
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Recurrence of knee flexion contracture after surgical correction in children with cerebral palsy. INTERNATIONAL ORTHOPAEDICS 2021; 45:1523-1530. [PMID: 33822275 DOI: 10.1007/s00264-021-05035-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Knee flexion contracture (FC) and crouch gait are challenging to treat in children with cerebral palsy (CCP), and recurrent knee FC after surgery is a severe complication. The aim was to identify factors associated with recurrent knee FC after surgery. METHODS The records of 62 CCP (age 10.6±2.6 years) who underwent surgery and were followed for > six months were reviewed. Knee FC was treated by hamstring lengthening, posterior knee capsulotomy, and femoral shortening/extension osteotomy until full extension was obtained. Kaplan-Meier analysis was used to estimate the probability of the correction being maintained. Cox proportional hazard modeling was used to compare parameters between patients with and without recurrent knee FC, with the time to recurrence as the endpoint. Potential confounding factors were included in the multivariate analysis. RESULTS In total, the procedure was performed on 122 knees. The average weight-for-age z score was -1.3±1.2. The average follow-up period was 5.4±4.2 years. Knee FC recurrence was observed in 37 knees (30%). The average recurrence-free time was 4.9 years, with most cases of recurrence (33 knees) occurring within six years after surgery. The factors associated with recurrence were age (HR, 1.19) and a required posterior knee capsulotomy procedure (HR, 4.53). CONCLUSION Recurrent knee FC after correction is associated with CCP who are older at the time of operation and when posterior knee capsulotomy is performed. The age at operation should be optimized. The sequence of procedures should be performed only as necessary to minimize the chance of post-operative muscle weakness and recurrence.
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Jahmani R, Lovisetti G, Alorjani M, Bashaireh K. Percutaneous femoral shortening over a nail using on-site smashing osteotomy technique. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:351-358. [PMID: 31542823 DOI: 10.1007/s00590-019-02556-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Closed femoral-shortening osteotomy over an intramedullary nail for the treatment of leg length discrepancy (LLD) is a demanding surgical technique, classically requiring specialized instrumentation (intramedullary saw and chisel). Herein, we describe our experience with shortening osteotomy over a nail, using a percutaneous multiple drill-hole osteotomy technique to perform the bone section with the osteotomized bone smashed and let on-site. METHOD We operated on six patients with LLD due to: hemihypertrophy syndrome (three patients), congenital short femur, hemiplegic cerebral palsy, and growth plate injury. Mean femoral shortening was 4.2 cm. Osteotomy was performed via a multiple drill-hole technique, and femurs were stabilized using an intramedullary nail. Post-operative clinical and radiological data were recorded. Residual LLD was assessed through long-standing teleroentgenography. RESULTS Shortening was achieved, with a final LLD of < 1 cm in all patients. All patients were satisfied and considered the lengths of the lower limbs to be equal. Our technique did not require special surgical skill or specialized instrumentation. Moreover, we did not record intraoperative and post-operative complications. DISCUSSION Percutaneous femoral-shortening osteotomy over a nail using the on-site smashing osteotomy technique was effective and safe in treating LLD in this initial case series.
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Affiliation(s)
- Rami Jahmani
- Department of Special Surgery/Orthopaedic Division, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan.
| | | | - Mohammed Alorjani
- Department of Pathology-Orthopaedic Pathology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaldoon Bashaireh
- Department of Special Surgery/Orthopaedic Division, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
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Kähler Olesen U. [Plate-assisted segmental bone transport with a lengthening nail and a plate : A new technique for treatment of tibial and femoral bone defects]. Unfallchirurg 2019; 121:874-883. [PMID: 30242443 DOI: 10.1007/s00113-018-0546-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Distraction osteogenesis represents an effective procedure for treatment of bone defects from various causes (e.g. trauma, malignancy, congenital and infection). In the past the available procedures were practically exclusively external. PRINCIPLES In the plate-assisted segmental bone transport (PABST) procedure a commercially available motorized intramedullary lengthening nail is used for segment transport. The transport segment is transported along a bone plate, which is responsible for maintaining the position of the proximal and distal main fragments. SURGICAL TECHNIQUE In staged sequences, a plate spanning the defect is placed. A lengthening nail is inserted in an antegrade or retrograde direction and a vascularized transport segment is created with an osteotomy. Bone transport is initiated at 1.0 mm a day. The transport segment is pulled or pushed into place, depending on the location of the bone void. In due time, a docking procedure is performed and full weight bearing is allowed. Supplementary lengthening can be initiated at docking or in a separate procedure. In smaller defects the gap is closed immediately over the plate and the bone is lengthened by the nail in the opposite end of the defect. CONCLUSION The presented method is a valuable addition to the armamentarium for treatment of bone defects. The main advantages are the avoidance of external fixation (fixation wires, Schanz screws) and the creation of physiological bone substitute. Vital soft tissues are essential for a good outcome. With appropriate management (systematic debridement, local and systemic administration of antibiotics and free soft tissue flaps), this method can be a solution to even complex reconstructive problems.
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Affiliation(s)
- Ulrik Kähler Olesen
- Abteilung für Orthopädische Chirurgie, Copenhagen Limb Lengthening and Bone Reconstruction Unit, Rigshospitalet, Blegdamsvej 9, 2100, Kopenhagen, Dänemark.
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Plate-assisted Bone Segment Transport With Motorized Lengthening Nails and Locking Plates: A Technique to Treat Femoral and Tibial Bone Defects. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:e064. [PMID: 31592010 PMCID: PMC6754216 DOI: 10.5435/jaaosglobal-d-19-00064] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This article describes a new bone transport technique for femoral and tibial bone defects using lengthening nails combined with locking plates. We term it plate-assisted bone segment transport (PABST).
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Fragomen AT, Teplensky J, Robert Rozbruch S. Carbon-Fiber-Reinforced Polymer Intramedullary Nails Perform Poorly in Long-Bone Surgery. HSS J 2019; 15:109-114. [PMID: 31327940 PMCID: PMC6609670 DOI: 10.1007/s11420-018-9634-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 09/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Carbon-fiber-reinforced (CFR) polymer has produced great excitement in the orthopedic community as a material that will reduce bone healing times and provide improved image quality. Osteotomy stabilized with an intramedullary (IM) nail has become a common technique to address post-traumatic malalignment of the lower extremity. PURPOSES/QUESTIONS The following questions were asked: (1) Did CFR polymer nails provide a rapid healing time after long bone osteotomy, shortening, or fracture? (2) Did the CFR polymer nails produce unexpected complications? METHODS A retrospective review was conducted in patients who received CFR polymer IM nails for various indications, from April 2016 to January 2017 in a deformity and trauma practice, using patient charts and radiographs. The primary outcomes were time to union and incidence of complications including nonunion, hardware failure, neurovascular injury, venous thromboembolism, and infection. RESULTS Twelve patients who received CFR polymer IM nails in 16 limbs for various indications were included in our analysis. Patients were followed for an average of 16.9 months. Eleven limbs underwent realignment and were corrected an average of 23° through a diaphyseal osteotomy. Three limbs underwent limb-shortening surgery, an average of 25 mm, through an open, excisional osteotomy of the femoral diaphysis. Two diaphyseal, closed tibia fractures underwent routine IM nailing. The average time to union was 107.6 days, which included all limbs that united (11/16, 69%). Nonunion occurred in 5/16 (31%) of limbs. Complications recorded included nonunion and hardware failure, most of which resulted in unplanned surgery. CONCLUSIONS The use of the CFR polymer IM nail was associated with loss of fixation and nonunion after surgeries that have traditionally healed uneventfully. The increased elasticity of the CFR polymer allows for more motion at the osteotomy/fracture interface than the stiffer titanium counterparts, exposing long-bone osteotomies to delayed union and nonunion, a finding seen with CFR polymer plates. The overwhelmingly poor early results of this device applied to a long-bone deformity practice have led these authors to abandon the use of this implant.
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Affiliation(s)
- Austin T. Fragomen
- 0000 0001 2285 8823grid.239915.5Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Jason Teplensky
- 0000 0001 2164 3847grid.67105.35School of Medicine, Case Western Reserve University, Cleveland, OH 44106 USA
| | - S. Robert Rozbruch
- 0000 0001 2285 8823grid.239915.5Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Wright J, Bates P, Heidari N, Vris A. All Internal Bone Transport: Use of a Lengthening Nail and Double Plating for Management of Femoral Bone Loss. Strategies Trauma Limb Reconstr 2019; 14:94-101. [PMID: 32742421 PMCID: PMC7376584 DOI: 10.5005/jp-journals-10080-1431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Variety of techniques for management of segmental femoral bone loss have been described, each with different advantages and challenges during treatment. The development of motorized lengthening nails has provided a potential for all internal bone transport, avoiding some of the difficulties with external fixation in the femur. At present, there is limited published literature on experiences in this technique. Aim The development of this technique aimed to overcome the difficulties previously reported for internal bone transport in the femur, particularly varus deformity and joint stiffness. Technique We describe the technique of double plating with bone transport utilizing a magnetic lengthening nail to manage segmental femoral bone loss. The benefits of the technique are discussed, along with specific challenges and lessons that have been learned through experience of internal bone transport. Conclusion Use of a magnetic lengthening nail and double plating as a method of all internal bone transport provides an option for the management of massive femoral bone loss, while avoiding some of the challenges that have been reported with the existing techniques. Clinical significance This technique provides an additional method in the armamentarium of the trauma or limb reconstruction surgeon treating massive femoral bone loss. How to cite this article Wright J, Bates P, Heidari N, et al. All Internal Bone Transport: Use of a Lengthening Nail and Double Plating for Management of Femoral Bone Loss. Strategies Trauma Limb Reconstr 2019;14(2):94–101.
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Affiliation(s)
- Jonathan Wright
- Department of Paediatric Orthopaedics and Limb Reconstruction, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Peter Bates
- Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Nima Heidari
- Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Alexandros Vris
- Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, UK
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Tanaka A, Yoshimura Y, Aoki K, Kito M, Okamoto M, Suzuki S, Momose T, Kato H. Knee extension strength and post-operative functional prediction in quadriceps resection for soft-tissue sarcoma of the thigh. Bone Joint Res 2016; 5:232-8. [PMID: 27317788 PMCID: PMC4921041 DOI: 10.1302/2046-3758.56.2000631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/22/2016] [Indexed: 12/26/2022] Open
Abstract
Objectives Our objective was to predict the knee extension strength and post-operative function in quadriceps resection for soft-tissue sarcoma of the thigh. Methods A total of 18 patients (14 men, four women) underwent total or partial quadriceps resection for soft-tissue sarcoma of the thigh between 2002 and 2014. The number of resected quadriceps was surveyed, knee extension strength was measured with the Biodex isokinetic dynamometer system (affected side/unaffected side) and relationships between these were examined. The Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), European Quality of Life-5 Dimensions (EQ-5D) score and the Short Form 8 were used to evaluate post-operative function and examine correlations with extension strength. The cutoff value for extension strength to expect good post-operative function was also calculated using a receiver operating characteristic (ROC) curve and Fisher’s exact test. Results Extension strength decreased when the number of resected quadriceps increased (p < 0.001), and was associated with lower MSTS score, TESS and EQ-5D (p = 0.004, p = 0.005, p = 0.006, respectively). Based on the functional evaluation scales, the cutoff value of extension strength was 56.2%, the equivalent to muscle strength with resection of up to two muscles. Conclusion Good post-operative results can be expected if at least two quadriceps muscles are preserved. Cite this article: A. Tanaka, Y. Yoshimura, K. Aoki, M. Kito, M. Okamoto, S. Suzuki, T. Momose, H. Kato. Knee extension strength and post-operative functional prediction in quadriceps resection for soft-tissue sarcoma of the thigh. Bone Joint Res 2016;5:232–238. DOI: 10.1302/2046-3758.56.2000631.
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Affiliation(s)
- A Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Y Yoshimura
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - K Aoki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - M Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - M Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - S Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - T Momose
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - H Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Wilson CL, Gawade PL, Ness KK. Impairments that influence physical function among survivors of childhood cancer. CHILDREN (BASEL, SWITZERLAND) 2015; 2:1-36. [PMID: 25692094 PMCID: PMC4327873 DOI: 10.3390/children2010001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/18/2014] [Indexed: 11/29/2022]
Abstract
Children treated for cancer are at increased risk of developing chronic health conditions, some of which may manifest during or soon after treatment while others emerge many years after therapy. These health problems may limit physical performance and functional capacity, interfering with participation in work, social, and recreational activities. In this review, we discuss treatment-induced impairments in the endocrine, musculoskeletal, neurological, and cardiopulmonary systems and their influence on mobility and physical function. We found that cranial radiation at a young age was associated with broad range of chronic conditions including obesity, short stature, low bone mineral density and neuromotor impairments. Anthracyclines and chest radiation are associated with both short and long-term cardiotoxicity. Although numerous chronic conditions are documented among individuals treated for childhood cancer, the impact of these conditions on mobility and function are not well characterized, with most studies limited to survivors of acute lymphoblastic leukemia and brain tumors. Moving forward, further research assessing the impact of chronic conditions on participation in work and social activities is required. Moreover, interventions to prevent or ameliorate the loss of physical function among children treated for cancer are likely to become an important area of survivorship research.
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Affiliation(s)
- Carmen L. Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS-735 Memphis, TN 38105, USA; E-Mails: (P.L.G.); (K.K.N.)
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Guagliardi A, Giannini C, Cedola A, Mastrogiacomo M, Ladisa M, Cancedda R. Toward the x-ray microdiffraction imaging of bone and tissue-engineered bone. TISSUE ENGINEERING PART B-REVIEWS 2010; 15:423-42. [PMID: 19537948 DOI: 10.1089/ten.teb.2009.0034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The hierarchical structure of bone makes the X-ray microdiffraction scanning techniques one of the most effective tool to investigate the structural features of this tissue at different length scales: the atomic/nanometer scale of the X-ray scattering signals and the macroscopic scale of the scanned sample area. The potentiality of the microdiffraction approach has been verified also by investigations on tissue-engineered bone substitutes used to repair large hard bone defects. The aim of this review is to present the most representative and recent results obtained through high-resolution scanning microdiffraction techniques studying both natural and tissue-engineered bone. The rapid evolution of the instrumental set-ups and the advanced methods of data analysis are described. Recent examples in which X-ray microbeams were used for imaging quantitative features of natural bone tissue and engineered bone substitutes are presented along with the qualitative and quantitative information extracted from the two-dimensional patterns collected on bone samples and on ex vivo cell seeded bioceramic implants. Thanks to the microdiffraction approach, several aspects of the mechanisms leading to the generation of the new bone, coupled to the scaffold resorption in the tissue-engineered constructs, have been tentatively interpreted. The potential of X-ray microdiffraction as an imaging tool in the field of bone tissue engineering is discussed and the key role of high-spatial resolution, availability of automatic tools (for dealing with the huge amount of experimental data) and advanced analysis techniques is elucidated. Finally, future perspectives in the field are presented.
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Moraal JM, Elzinga-Plomp A, Jongmans MJ, Roermund PMV, Flikweert PE, Castelein RM, Sinnema G. Long-term psychosocial functioning after Ilizarov limb lengthening during childhood. Acta Orthop 2009; 80:704-10. [PMID: 19995320 PMCID: PMC2823305 DOI: 10.3109/17453670903473024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Accepted: 07/17/2009] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Few studies have been concerned with the patient's perception of the outcome of limb lengthening. We describe the psychological and social functioning after at least 2 years of follow-up in patients who had had a leg length discrepancy and who had undergone an Ilizarov limb lengthening procedure. PATIENTS AND METHODS Self-esteem and perceived competence were measured in 37 patients (aged 17-30 years) both preoperatively and at a mean follow-up of 7 (2-14) years. At follow-up, health-related quality of life, functioning at school, daily activities, and treatment-related experiences were measured, and also retrospectively for the preoperative period. RESULTS Preoperative and follow-up scores for self-esteem were similar. Overall perceived competence scores at follow-up were comparable to that of a healthy normal population. Patients' perceived athletic competence was lower and their perceived level of behavioral conduct was higher. At follow-up, patients had more positive appraisal of their physical appearance. Most health-related quality of life scores were not significantly different to those of the healthy normal population, apart from a reduced gross motor function, less vitality, and more pain. Patients with a remaining leg length inequality (LLI) of more than 2 cm had lower quality of life scores for gross motor function, sleep, pain, vitality, and depressive feelings. INTERPRETATION At an average of 7 years after an Ilizarov limb lengthening procedure, patients still have physical restraints, but they appear to have normal psychosocial functioning, self-esteem, and perceived competence. These patients have quality of life scores comparable to those of norm groups, apart from a reduced gross motor function, less vitality and more pain. Residual LLI of more than 2 cm remains important even after long-term follow-up; these patients report lower quality of life.
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Affiliation(s)
- Judith M Moraal
- Department of Paediatric Psychology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
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Mastrogiacomo M, Muraglia A, Komlev V, Peyrin F, Rustichelli F, Crovace A, Cancedda R. Tissue engineering of bone: search for a better scaffold. Orthod Craniofac Res 2005; 8:277-84. [PMID: 16238608 DOI: 10.1111/j.1601-6343.2005.00350.x] [Citation(s) in RCA: 193] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Large bone defects still represent a major problem in orthopedics. Traditional bone-repair treatments can be divided into two groups: the bone transport (Ilizarov technology) and the graft transplant (autologous or allogeneic bone grafts). Thus far, none of these strategies have proven to be always resolving. As an alternative, a tissue engineering approach has been proposed where osteogenic cells, bioceramic scaffolds, growth factors and physical forces concur to the bone defect repair. Different sources of osteoprogenitor cells have been suggested, bone marrow stromal cells (BMSC) being in most cases the first choice. METHODS AND RESULTS In association with mineral tridimensional scaffolds, BMSC form a primary bone tissue which is highly vascularized and colonized by host hemopoietic marrow. The chemical composition of the scaffold is crucial for the osteoconductive properties and the resorbability of the material. In addition, scaffolds should have an internal structure permissive for vascular invasion. Porous bioceramics [hydroxyapatite (HA) and tricalcium phosphate] are osteoconductive and are particularly advantageous for bone tissue engineering application as they induce neither an immune nor an inflammatory response in the implanted host. Earlier, we first reported a cell-based tissue engineering procedure to treat three patients with long bone segmental defects. Cells were loaded on a 100% HA porous ceramic. These scaffolds proved to have good osteoconductive properties resulting in a good functional recovery, but they have not been resorbed after more than 5 years from the implant. In addition, due to the high density of the mineral and the relatively low porosity (50-60%), it was very difficult to monitor the patient recovery during the post-surgery time using X-rays. CONCLUSIONS We report here some pre-clinical testing of new scaffolds. To compare these second generation ceramic scaffolds more suitable for a tissue engineering approach we had to first establish animal models and analysis procedures including the use of X-ray-computed microtomography associated with X-rays synchroton radiation.
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Affiliation(s)
- M Mastrogiacomo
- Dipartimento di Oncologia, Biologia e Genetica, Istituto Nazionale per la Ricerca sul Cancro, dell'Universita di Genova, Italy
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