Reconstruction of cortical bone
using coral
We
have just seen the reconstruction of spongy bone at the ends of a long
bone, using natural coral. Now let's see how to rebuild the wall (cortical
bone) of a long bone.
Here's
an example of a young man, 20 years old, who was injured in a road accident
(long-term follow-up for 10 years).
Patient's clinical history:
After
many problems, he saw the doctor about the delay in consolidation of his
femur. He had two metal devices (external fixators), one in front and
one on the side of the thigh. The knee was locked and stiff in extension.
The thigh bone (femur) was not strong. There were several centimetres
missing between the two ends. The ends were stripped and white. In short,
this bone had to be consolidated by the insertion of material. The classic
technique consists of taking a fragment of the patient's bone from the
pelvis (a graft) and inserting it so that it fills the void and consolidates
the bone.
This excellent technique is tried and tested and practised by most traumatologists.
If we can accept the idea that a biomaterial behaves like an immunologically
compatible bone graft, it should be possible to obtain the same result
but with a distinct advantage. We are not obliged to take a bone graft.
We don't have to perform another operation which is always painful.
The
coral implantation was performed. The coral spheres on all four sides
of the bone wall were counted.
Counting spheres
|
Spheres |
Feb
1993 |
Mar
1993 |
Sept
1993 |
Dec
1993 |
June
1994 |
May
1995 |
Apr
1996 |
Apr
1997 |
May
1998 |
May
1999 |
Dec
1999 |
Feb
2002 |
Medium |
|
111 |
89 |
52 |
57 |
38 |
34 |
22 |
20 |
24 |
13 |
7 |
0 |
Lateral |
|
68 |
55 |
21 |
19 |
- |
- |
- |
- |
- |
7 |
9 |
0 |
Anterior |
|
79 |
57 |
- |
- |
- |
- |
6 |
9 |
- |
- |
15 |
10 |
Posterior |
|
100 |
74 |
50 |
52 |
47 |
- |
32 |
39 |
21 |
29 |
24 |
15 |
|
A
parallel was established between the disappearance of the spheres and
the formation of the bony callus.
Compared evolution of callus
development and disappearance of the coral
DATE |
BONY CALLUS |
NATURAL CORAL |
PARTIAL |
UNITING |
RODS |
SPHERES |
|
A. |
P. |
I. |
E. |
A. |
P. |
I. |
E. |
Visibles |
Resorbed |
Visibles |
Resorbed |
DECORTICATION + Coral GRAFT (50% porosity) |
25-02-93 |
0 |
0 |
0 |
0 |
|
|
|
|
++++ |
|
++++ |
|
25-03-93 |
|
+ |
+ |
|
|
+ |
+ |
|
++++ |
|
++++ |
|
20-04-93 |
|
+ |
+ |
|
|
++ |
++ |
|
++++ |
|
++++ |
|
ABLATION OF FIXATOR + PLATE |
10-05-93 |
|
++ |
++ |
|
|
++ |
++ |
+ |
++++ |
|
+++ |
+ |
10-09-93 |
+ |
|
|
|
+ |
+++ |
+++ |
|
+++ |
+ |
++ |
++ |
13-12-93 |
++ |
|
|
|
+ |
+++ |
++++ |
|
++ |
++ |
+ |
+++ |
14-06-94 |
++ |
|
|
|
+ |
++++ |
++++ |
|
++ |
++ |
+ |
+++ |
03-04-95 |
++ |
|
|
|
+ |
++++ |
++++ |
|
++ |
++ |
+ |
+++ |
11-05-96 |
++ |
|
|
|
++ |
++++ |
++++ |
|
++ |
++ |
+ |
+++ |
29-04-97 |
++ |
|
|
|
++ |
++++ |
++++ |
|
++ |
++ |
+ |
+++ |
11-05-98 |
++ |
|
|
|
++ |
++++ |
++++ |
|
++ |
++ |
+ |
+++ |
ABLATION OF THE PLATE |
11-12-99 |
++ |
|
|
|
++ |
++++ |
++++ |
++++ |
++ |
++ |
+ |
+++ |
29-01-02 |
+++ |
|
|
|
+++ |
++++ |
++++ |
++++ |
++ |
++ |
15% |
85% |
Visual scale : + = 25% ; ++ = 50% ; +++ = 75
% ; ++++ = 100% |
Walls : A=Anterior ; P=Posterior ; E=External
; I=Internal |
|
A
complete and gradual reconstruction of the femoral walls (container) took
place. Reconstruction involved five phases (numbered in Roman numerals).
I: FIRST BIORESORBABILITY
- It occurs centrifugally with disappearance of the central spheres.
- Resorption is quantitative. The peripheral spheres remain visible.
- It is rapid, taking place in two to three months (spheres).
- The layout, dispersion and distribution of the spheres is random.
II: ALIGNMENT IN A COLUMNAR RIDGE
- The spheres were aligned vertically, parallel to the main diaphyseal
axis.
- Alignment occurred over six to nine months (spheres).
- Sphere dispersion remains random.
II: REDUCING THE DIAMETER OF THE COLUMNS
- The diameter of the columns is reduced by medullary resorbability.
- A concentration of spheres was noted along the main axis of the
diaphyseal wall. It took place in centrifugal fashion.
- This arrangement took place between twelve and eighteen months
(spheres).
III: REMODELLING THE COLUMNAR RIDGE
- The spheres were in a longitudinal architectural structure, aligning
in fine columns along the main parietal axis, one above the other.
- Reduction in width of the column
IV: SECOND RESORBABILITY
- Reduction in sphere diameter, producing the cortical bone which
becomes punctiform.
- The second resorption occurs in twelve months on average (spheres).
- Production of Haversian type cortical bone occurs at the same
time.
V: CORTICALISATION AND CORTICAL THICKENING
- Homogeneous reconstruction of the periosteal cortex precedes that
of the endomedullary cortex.
- This occurs a few weeks later and is complete in one year.
- The wall under compression thickens and becomes homogeneous.
- The thickening is complete in one year.
|
X-rays
copies on tracing paper shows the progress of reconstruction of the wall
– the container.
We
trace the logarithmic curves of the coral disappearance.
A
magnificent femoral diaphysis (part of the femur between hip and knee)
is reconstructed before your eyes.
The
result relative to knee stability and mobility is clear (mobility: 0-105°).
|