Injury
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Review Case Reports
The use of bone-graft substitutes in large bone defects: any specific needs?
The gold standard for restoring bone defects is still considered to be autologous bone grafting. However, clinical benefits are not guaranteed and donor-site complications and morbidity is not infrequent. Research is on-going for the development of alternative bone substitutes of both biological and synthetic origin. The purpose of this study was to evaluate the type of materials used and their efficacy for the treatment of large bone defects in traumatology and orthopaedic surgery. ⋯ Proper assessment of the biological and mechanical environment and accurate patient selection are necessary to judge the extent of therapy the injury warrants. A sound understanding of various aspects of biomaterial properties and their relation and influence towards bone healing is of utmost importance. We suggest the application of polytherapy for the treatment of large bone defects and advocate the use of the diamond concept as a guideline.
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Total hip replacement is increasingly used to treat diseased and damaged joints. With time, some joint replacements may require revision, mainly because of instability and mechanical loosening, and this is of particularly significance to younger patients. A major problem in revision surgery is the loss of bone stock and the consequent difficulty in reconstructing a stable joint. Loss of bone stock has been widely treated using bone autografts and allografts but supplies are limited. Use of bone graft substitutes in combination with, or as a substitute for, human bone is a possible alternative. ⋯ With increased allograft shortage, bone graft substitutes will be required in hip revision surgery. However, appropriately designed randomised controlled trials are required to compare use of existing and new bone graft substitutes with established practice. As well as prosthesis related outcomes, studies should explore the patient experience of revision hip replacement with bone graft substitute material.
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Reconstruction of large bone defects or non-unions resulting from biochemical disorders, tumour resections or complicated fractures is still a challenge for orthopaedic and trauma surgery. On the one hand, autografts harbour most features of ideal bone graft substitutes but on the other hand, they have a lot insurmountable disadvantages. ⋯ Whilst osteoconductivity of biomaterials for bone tissue engineering strategies can be directed by their composition, surface character and internal structure, osteoinductive and osteogenic features can be provided by growth factors originally participating in fracture healing and/or multipotent mesenchymal stromal/stem cells (MSC) capable of rebuilding bone and marrow structures. In this review, aspects of the clinical application of the most commonly used growth factors for bone repair, the bone morphogenetic proteins (BMPs), and the potential use of human MSC for clinical application will be discussed.
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In September 2007, the National Institute for Health and Clinical Excellence (NICE) in the UK issued a newly updated guideline (CG56) on the early care of adults and children with head injuries.(8) The guideline gives some new recommendations, in particular with regards to imaging of children with head injury. We undertook a study to investigate the management of children presenting with head injury to our emergency department and to assess their outcomes and the CT scanning rate. ⋯ The actual CT scanning rate observed was 2.1%, rising to 18.1% after strictly applying NICE criteria. This increased scanning rate raises some important issues with regards to patient safety and service provision.
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To investigate the current state of trauma care in mainland China, and to propose possible future suggestions for the development of the trauma care system in mainland China. ⋯ Although great progress has been made in trauma care in mainland China, there are many failings. To improve trauma care in China, the establishment of a sophisticated trauma system and various enhancements on trauma prevention are urgently required.