Use of an autogenous cancellous bone graft in the treatment of subchondral bone cysts in the medial femoral condyle of the horse

The clinical features, diagnosis and radiological findings of eight cases of a subchondral bone cyst involving the medial condyle of the femur are described. Surgical treatment, which comprised performing an arthrotomy of the femorotibial joint, curetting and packing the cystic cavity with an autogenous cancellous bone graft, is described.     

Use of cancellous bone graft in treatment of navicular bone osteomyelitis in a foal

A 3-month-old Quarter Horse filly stepped on a fence staple and developed navicular bone osteomyelitis of the right hindfoot. A 1.5-cm spherical portion of medullary cavity containing purulent material was debrided and flushed with 0.9% NaCl solution. Cancellous bone was collected from a caudal sternebra and placed into the defect. The solar defect had filled with granulation tissue and was epithelialized 6 weeks after surgery. At 6-month follow-up evaluation, the navicular bone defect had healed and the foal was sound on the limb. Cancellous bone grafting may have merit for the treatment of navicular bone osteomyelitis in the horse.     

Results of treatment of subchondral bone cysts in the medial condyle of the equine femur with an autogenous cancellous bone graft

The results of surgical treatment of 10 subchondral bone cysts, all located in the medial femoral condyle, are presented. A cancellous bone graft was used in nine cases and a two component acrylic bone cement was used in the case of an extremely large cyst. Eight out of the 10 cases made a satisfactory clinical recovery.     

Effect of hyperbaric oxygen treatment on incorporation of an autogenous cancellous bone graft in a nonunion diaphyseal ulnar defect in cats

OBJECTIVE: To determine whether hyperbaric oxygen treatment (HBOT) would affect incorporation of an autogenous cancellous bone graft in diaphyseal ulnar defects in cats. ANIMALS: 12 mature cats. PROCEDURE: Bilateral nonunion diaphyseal ulnar defects were created in each cat. An autogenous cancellous bone graft was implanted in 1 ulnar defect in each cat, with the contralateral ulnar defect serving as a nongrafted specimen. Six cats were treated by use of hyperbaric oxygen at 2 atmospheres absolute for 90 minutes once daily for 14 days, and 6 cats were not treated (control group). Bone labeling was performed, using fluorochrome markers. Cats were euthanatized 5 weeks after implanting, and barium sulfate was infused to evaluate vascularization of grafts. Ulnas were evaluated by use of radiography, microangiography, histologic examination, and histomorphometric examination. RESULTS: Radiographic scores did not differ between treatment groups. Microangiographic appearance of grafted defects was similar between groups, with all having adequate vascularization. Differences were not observed between treated and nontreated groups in the overall histologic appearance of decalcified samples of tissue in grafted defects. Mean distance between fluorescent labels was significantly greater in cats given HBOT than in nontreated cats. Median percentage of bone formation in grafted defects was significantly greater in cats given HBOT. CONCLUSIONS: Hyperbaric oxygen treatment increased the distance between fluorescent labels and percentage of bone formation when incorporating autogenous cancellous bone grafts in induced nonunion diaphyseal ulnar defects in cats, but HBOT did not affect revascularization, radiographic appearance, or qualitative histologic appearance of the grafts.     

Comparison of bone healing by demineralized bone matrix and autogenous cancellous bone in horses

OBJECTIVE: The purpose of this study was to compare bone healing induced by equine demineralized bone matrix (DBM) to autogenous cancellous bone graft (ACB) or no graft (control) in a rib-defect model in horses. STUDY DESIGN: The osteogenic properties of ACB and DBM were evaluated in bilateral 19-mm circular defects created in the outer cortex of the 6th and 8th ribs of each horse. ANIMALS OR SAMPLE POPULATION: Eight mature horses. METHODS: Three rib defects in each horse were randomly treated with each of the 3 treatment groups, and the fourth rib defect received a random treatment. Rib sections, including the defects, were harvested 56 days after implantation and examined for bone mineral density, percent ash and calcium and graded for signs of radiographic and histological healing. RESULTS: All ribs were fractured at the defect site and were classified as nonunion fractures 56 days after implantation. There were no significant differences among groups in bone mineral density and signs of radiographic or histological healing. There was an increased volume of bone in control and ACB-treated sites compared with DBM-treated sites. Rib defects treated with ACB were significantly higher in percent ash and calcium than those treated with DBM. DBM elicited no inflammatory reaction, and remodeling occurred around the periphery and within vascular channels of the decalcified particles. CONCLUSION: DBM particles remodel from the periphery, which may explain the significantly lower percent ash, calcium, and bone when compared with ACB, because 2- to 4-microL pieces of DBM may act as space-occupying masses until completely mineralized. There was no evidence of enhanced healing associated with the use of DBM in this model. CLINICAL RELEVANCE: Particles of 2 to 4 mm DBM should not be used as an aid to fracture repair because particles of this size interfere with normal mineralization. However, our model of nonunion fracture healing may be useful in future studies.     

Open drainage and delayed autogenous cancellous bone grafting for treatment of chronic osteomyelitis in dogs and cats

Ten dogs and 1 cat with 12 chronically infected bones were treated surgically by means of saucerization, primary internal or external rigid fixation, and open irrigation drainage. After formation of a healthy granulation bed, autogenous cancellous bone grafting and skin closure were performed. Eleven of 12 bones healed 4 to 7 weeks (mean, 4.8 weeks) after treatment, without recurrence of infection. Eight of 12 chronically infected bones had a polymicrobial infection, with 2 to 6 bacterial species isolated. Gram-negative bacteria were isolated from 7 of the 12 bones, and anaerobic bacteria were isolated twice.     

Effects of autogenous cancellous bone on healing of homogenous cortical bone grafts

A comparative clinical and histological study was made of the effects of autogenous cancellous grafts on the rate of healing of homogenous cortical bone grafts in dogs: their right foreleg received homogenous bone grafts and their left foreleg received pre-drilled homogenous bone grafts filled with autogenous cancellous bone. Histologically, the use of homogenous cortical grafts with pre-drilled holes and autogenous cancellous bone appeared to accelerate reorganization and development of these grafts. This was seen particularly 1–2 months post-operatively and at nine months when the graft in the left leg was made up of spongy bone marrow; whereas the right leg graft still contained compact dead bone and the marrow was filled with fibrous tissue.     

Use of autogenous fascia lata graft for perineal herniorrhaphy in dogs

OBJECTIVE: To evaluate the effectiveness of a herniorrhaphy technique, using an autogenous fascia lata graft (FLG) for perineal hernia (PH) repair in dogs. STUDY DESIGN: Prospective clinical study. ANIMALS: Twelve dogs with PH. METHOD: PHs were repaired with FLG harvested from the dog's ipsilateral thigh and sutured directly into the perineal defect. Correction of associated conditions, and castration were performed. Surgical time, pain, inflammation, pattern of defecation, lameness, hospitalization time, postoperative complications, and owner satisfaction were recorded. Histopathologic examination was performed in 1 dog euthanatized 10 months after repair. RESULTS: Hernia did not recur (mean follow-up, 5.8 months). Lameness was the most frequent minor complication, and was resolved within a few days. Transient rectal prolapse occurred in 2 dogs with bilateral PH. The mean (+/-SD) hospitalization was 1.8+/-0.9 days, and the surgical time was 76.5+/-9.8 minutes. Histopathologic examination in 1 dog revealed perfect integration of FLG into adjacent tissues without substantial tissue reaction. CONCLUSIONS: FLG reconstruction of PH is a simple, effective method of treatment. CLINICAL RELEVANCE: FLG can be used without major complications for primary repair of PH, as an augmentation procedure when the internal obturator muscle is thin or friable, or when herniation has recurred after another repair technique.     

Comparison of healing of the osteotomy gap after tibial tuberosity advancement with and without use of an autogenous cancellous bone graft

Objective: To evaluate and compare healing, with and without the use of bone graft, of the gap created during tibial tuberosity advancement (TTA). Study Design: Prospective study and case series. Animals: Dogs treated with TTA (n=67). Methods: Prospective study: Mediolateral radiographic projections (6 weeks and 4 months) after TTA without use of bone graft (group I, n=14) were compared with radiographs of consecutive TTA in which the gap was filled with autologous cancellous bone graft (group II, n=14). Two scoring techniques (A, B) were used. Score A was used to grade the overall osteotomy healing (0=no healing, 4=healed osteotomy). Score B evaluated, independently of each other, healing in 3 sites: proximal to the cage (B1), between cage and plate (B2), and distal to the plate (B3). Case series: nongrafted TTA (4–25 weeks, n=39) were evaluated for healing (Score A). Data was analyzed using t‐tests and ANOVA. Significance was set at P≤.05. Results: Prospective study: Score A, B2, and B3 showed no difference in healing between groups at 6.8 weeks and 4.2 months. Score B1 revealed, in both rechecks, a significantly higher density in group II. Case series: Radiographs at 11.59±5.99 weeks scored 3.3 (2–4). No healing related complications were observed. Conclusion: The osteotomy gap created during TTA healed within expected time regardless of bone graft use.     

Evaluation of the proximal portion of the femur as an autogenous cancellous bone donor site in dogs.

The proximal portion of the femur was evaluated as a source of autogenous cancellous bone in dogs. Bilateral oval cortical defects were created in the lateral subtrochanteric area of the femur in 16 dogs. Cancellous bone was removed and the weight recorded. Cancellous bone was similarly harvested from the proximal portion of the humerus in 7 of these dogs. Subtrochanteric femoral defects in 11 dogs were randomly assigned to receive cancellous bone graft obtained from the femur (n = 4) or the humerus (n = 7). Subtrochanteric defects in 5 dogs were not grafted. Radiographic assessment of subtrochanteric defects was performed at 4-week intervals, and histologic assessment at 4, 8, 16, and 24 weeks after surgery. Nongrafted donor sites healed by ingrowth of trabecular bone during the first 12 weeks after surgery. By week 24, the lateral cortical wall had reformed, but remodeling was incomplete. Donor sites grafted with cancellous bone healed similarly, but with more rapid healing and more complete remodeling evident by week 24. Although the mean weight of cancellous bone harvested from the proximal portion of the femur (0.82 +/- 0.22 g) was significantly (P less than 0.05) less than that harvested from the proximal portion of the humerus (1.38 +/- 0.29 g), there was no qualitative histologic or radiographic difference in bony healing of grafted defects. We determined that the proximal portion of the femur can be safely used to provide moderate amounts of cancellous bone, and that a second bone graft can be collected from the same subtrochanteric donor site after 12 weeks.     

Effects of a fixed compression load on the osteogenic effect of autogenous cancellous bone grafts in dogs.

A standardized cortical defect was created on the caudal cortex of the proximal portion of each ulna in 5 adult mixed-breed dogs. One gram of autogenous cancellous bone graft (ACBG) was obtained from the greater tubercle of the ipsilateral humerus. The cortical defect in the ulna of 1 limb was filled with 1 g of ACBG that had been compressed with 2-MPa pressure for 30 seconds. One gram of noncompressed ACBG was placed into the contralateral ulnar cortical defect. The compressed and noncompressed ACBG recipient sites were radiographed at weekly intervals. Dogs were euthanatized 8 weeks after surgery, and the ACBG recipient sites were harvested for histomorphometric analysis. Optical densitometry was performed on all radiographs. There was no significant difference between compressed and noncompressed ACBG with optical densitometry or histomorphometric analysis for total bone area. We concluded that there was no difference in osteogenic capability between compressed and noncompressed ACBG of equal mass.     

Effects of gelatin sponge implantation in cancellous bone defects in dogs

Reports from oral surgeons suggested that packing bone defects with cellulose or collagen stimulated cancellous bone replacement. The study reported here was designed to evaluate a similar method for augmenting the remodeling of cancellous bone defects and graft donor sites. Gelatin sponge was implanted into bony defects created in the proximal humeral metaphysis of 5 adult Beagles after collection of cancellous bone. A similar defect created in the contralateral humerus was left unpacked. Four months after creation of the defect, the dogs were euthanatized, and the surgical sites were evaluated by use of correlated microradiographic and histologic examination. Unpacked sites had filled completely with loosely woven trabecular bone. Remodeling had not taken place in sites packed with gelatin sponge. Gelatin sponge did not elicit any reaction in the surrounding bone, but remained in situ and obstructed new bone formation. Gelatin sponge blocked rather than augmented cancellous bone replacement.     

Comparison of autogenous cancellous bone grafts obtained from the sternum and proximal portion of the tibia of llamas.

OBJECTIVE: To describe the anatomy of the sternum in llamas, define the surgical approach to the sternum for collection of cancellous bone graft tissue, and compare the histologic appearance of graft tissue obtained from the sternum with that obtained from the proximal portion of the tibia. DESIGN: Prospective study. ANIMALS: 12 llamas, 3 to 19 years old, that had been submitted for necropsy. PROCEDURE: Radiographs were taken of the sternum and left tibia of the llamas. Measurements of the sternum were determined from the radiographs and adjusted for magnification. Sternebrae volumes were estimated from these measurements. Anatomic dissections to the center of the fourth sternebra and the proximal portion of the tibia were made, and a surgical approach to the sternum was developed. Cancellous graft tissue was obtained from each site and submitted for histologic evaluation. RESULTS: Sternebrae 3, 4, and 5 were significantly larger in volume than the other sternebrae. The ventral aspect of the fourth sternebra was readily accessed for removal of graft tissue by making a 6-cm-long ventral midline incision centered 17 cm craniad to the xipnoid. Mean soft tissue thickness overlying the ventral aspect of the fourth sternebra was 3.1 cm. More tissue was obtained from the sternal (mean, 9.11 g) than from the tibial (mean, 5.16 g) sites. Sternal graft tissue consisted of trabecular bone spicules with predominantly hematopoietic marrow, whereas tibial tissue consisted of trabecular bone spicules with only fatty marrow. CONCLUSIONS AND CLINICAL RELEVANCE: The fourth sternebra in llamas is readily accessible for obtaining autogenous cancellous bone graft tissue that consists of predominantly hematopoietic marrow.     

Evaluation of a technique for collection of cancellous bone graft from the proximal humerus in horses

OBJECTIVES: To describe a technique for collecting cancellous bone graft from the proximal humerus in horses. STUDY DESIGN: Prospective evaluation of an experimental bone graft collection technique. ANIMAL POPULATION: Eight horses, 3-15 years, weighing 495-605 kg. METHODS: Horses were anesthetized and positioned in lateral recumbency. The lateral aspect of the proximal humerus was exposed by a 7-10-cm incision extending distally from the greater humeral tubercle, followed by sharp dissection through the omotransversarius muscle and between the infraspinatus and deltoideus muscles. A 12-mm cortical defect was incrementally created in the lateral proximal humerus. Human bone graft harvesting equipment (Acumed, Beaverton, OR) was drilled through this defect to collect a core of cancellous bone. In five horses additional cancellous bone was then collected with conventional instruments. Bone samples were weighed and histologically examined. Horses were monitored and graded for quality of anesthetic recovery, incisional complications, and postoperative lameness. RESULTS: Total mean (+/-SD) surgical time for harvesting bone with the Acumed system and traditional techniques (n=5) was 38+/-6 minutes (range, 32-47 minutes). Mean cancellous bone weight collected with the Acumed system was 3.6+/-0.8 g (range, 2.0-4.6 g), and cancellous bone collected conventionally was 25.6+/-7.5 g (range, 16.8-34.2 g). Minimal incisional complications or postoperative lameness were observed. Mortality was 12.5%; one horse fractured the operated humerus during anesthetic recovery. CONCLUSION: The Acumed system provided limited cancellous bone when used with the technique described. However, the quantity of cancellous bone collected with traditional harvesting instruments was comparable to other sites used in horses. The procedure was associated with minimal postoperative incisional complications or lameness, but because one horse suffered a catastrophic humeral fracture further research is required to assess the effects of this procedure on humeral breaking strength. CLINICAL RELEVANCE: Based on the risk of catastrophic fracture, this technique cannot be recommended for use in clinical cases, especially if an unassisted recovery from general anesthesia is planned.     

Treatment of severely comminuted diaphyseal fractures in the dog, using standard bone plates and autogenous cancellous bone graft to span fracture gaps: 11 cases (1979-1983)

Severely comminuted diaphyseal fractures in 11 dogs were repaired with standard bone plates that spanned a fracture gap filled with autogenous cancellous bone graft. Five dogs had closed injuries, 4 dogs had open fractures, and 2 dogs had infected nonunion fractures for which previous attempts at internal pin fixation had failed. A second autogenous cancellous bone graft was performed in 3 of the dogs during the healing period. The technique was successful in all dogs. The technique was considered a versatile and relatively simple alternative, compared with meticulous small fragment reconstruction and cortical bone allografts.     

Combined xeno/auto-grafting of a benign osteolytic lesion in a dog, using a novel bovine cancellous bone biomaterial

CASE HISTORY: A 4-year-old female Labrador Retriever was diagnosed with an osteolytic lesion of the right distal radius. CLINICAL FINDINGS: Radiographs indicated a well-circumscribed radiolucent area 18 x 15 x 8 mm, centred on the distal radial physeal scar. DIAGNOSIS: Histopathology, performed via Jamshidi needle biopsy and following surgical curettage, was inconclusive but suggested either an aneurysmal bone cyst or fibrous dysplasia. CLINICAL RELEVANCE: A novel processed cancellous bovine bone xenograft was used in conjunction with autogenous cancellous bone (at a ratio of approximately 4:1) to fill the curetted defect. There were no observed complications associated with the use of this new biomaterial. Osteointegration of the bone graft was followed using conventional radiographs and peripheral quantitative computed tomography (pQCT) for 10 months post-operatively. Radiographically, the osteolytic lesion modelled to resemble metaphyseal trabeculation. The cross-sectional area and the average bone density of the grafted lesion determined using pQCT data increased over time, suggesting healthy osteoconduction and native bone production.     

The effect of compacted cancellous bone grafting on the healing of subchondral bone defects of the medial femoral condyle in horses

Objective— To compare the quality of second-intention healing and that of compacting sternally harvested cancellous bone into subchondral bone defects of the medial femoral condyle in horses.
Study Design— A controlled experiment using a surgical technique that minimizes soft tissue trauma, customized for consistency among horses.
Animals or Sample Population— Ten horses, aged 2 to 5 years, free of hindlimb lameness and with radiographically normal stifles.
Methods— After a 12.7-mm-diameter × 19-mm-deep defect was created into randomly selected medial femoral condyles, bone and cartilage healing was evaluated over a 6-month period in control horses (  n = 5  ) and horses receiving a compacted cancellous bone graft (  n = 5  ). Healing was evaluated using lameness assessment, radiographic and microradiographic interpretation, arthroscopic appearance, percent bone fill, proteoglycan content, and histology.
Results— Six months after surgery, there was no significant difference between grafted and ungrafted defects with respect to lameness, radiographic score, or percent bone fill. Histologically, grafted defects were characterized by the presence of dead graft and secondary cyst formation in four defects. Ungrafted defects filled with fibrous tissue and no cyst formation were identified.
Conclusions— Grafted defects do not heal better than ungrafted defects, and lameness was not affected by surgical technique.
Clinical Significance— Cartilage healing is similar in grafted and ungrafted defects in the equine medial femoral condyle at 6 months, suggesting that surgical debridement alone of cystic structures remains the treatment of choice.