FCyran at mednet
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Apr 23, 2008, 3:24 PM
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RE: [ORT-L] Fwd: Polyostotic Fibrous Dysplasia: Zaheer
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I have not had to re-operate on any of my patients treated yet (approximately 50-60). I have been using it mostly in kids, and adults with cystic tumors (ABC, NOF,UBC, Fibrous dysplasia, etc). I'm waiting a few more months to get final 2 year post op follow ups on the remaining patients - nothing is published yet.
I haven't had to use it for a non-union. I think anything placed by the bone is more likely to fail without the proper biology.
I'm in agreement with you as to why it might not have worked - no BMA. I think that's why illiac crest tends to work - comes with it's own osteoblasts. I have gone back in on other lesions treated with allograft cancellous chips+DBM+BMP two years later, and it too also came out like it was just put in - not encouraging, as the X-rays looked like it was incorporated.
-----Original Message-----
From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org]On
Behalf Of dan schlatterer
Sent: Wednesday, April 23, 2008 6:31 AM
To: ORT-L@www2.aaos.org
Subject: RE: [ORT-L] Fwd: Polyostotic Fibrous Dysplasia: Zaheer
hello,
I am interested in reading your report on vitoss and BMA. I have had two nonunions recently one in
a pilon fracture and another in a midshaft tibia in which vitoss alone was used. The BMA probably
is the difference in outcome. in the attached picture note in the mid portion a grainy substance.
this is the vitoss in the same consistency as when it was placed 4 months prior. it was easily
curetted out and replaced with iliac crest bone graft. of course this is just two cases and
without BMA. thanks
dan schlatterer
--- "Cyran, Francis M.D." <FCyran@mednet.ucla.edu> wrote:
> I and my senior partner (J Eckardt) manage fibrous dysplasia by bonegrafting, and protective
> reinforcement (plates, rods, etc) until the new bone is healed. Ignore the iliac wing lesion
> for now. Bed rest until the femoral neck Fx is healed is a good idea. Since you're only 29,
> avoiding a hip replacement is a good idea too.
>
> I would reccomend curetting out the lesion, and bone grafting it. Eckardt uses iliac crest bone
> graft, and supplements it with cancellous bone chips and whatever BMP they have around. I am
> working on publishing using Vitoss (tricalcium phosphate in a porous matrix)bone substitute with
> bone marrow aspirate. I have several patients with fibrous dysplasia treated in this fasion,
> and all are doing well.
>
> Since the entire proximal femur is affected, the rod needs to be removed, prox femur/femoral
> neck need to be curetted out, via sub vastus approach. Lateral curetting entry portal into the
> femur can also be used to place the cephalo-medullary rod (IMHS (Smith and Nephew), or TFN
> (Synthes).
>
> Enclosed is a radiograph of a 19 yo male with an ABC (aneurysmal bone cyst) before and after
> surg. He is now 2 years out, asymptomatic, runs etc. Sorry couldn't find any more recent
> films, other that these.
>
> Francis Cyran, M.D.
>
> Assistant Professor of Orthopaedic Oncology
>
> UCLA, Department of Orthopaedic Surgery
>
> 1250 16th St., Suite 745
>
> Santa Monica, California, 90404
>
> (310) 319-3800 (Office)
>
> (310) 319-1240 (Fax)
>
> -----Original Message-----
> From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org]On Behalf Of Zaheer Iqbal Naru
> Sent: Friday, April 18, 2008 1:10 PM
> To: ORT-L@www2.aaos.org
> Subject: [ORT-L] Fwd: Polyostotic Fibrous Dysplasia: Zaheer
>
>
>
> i need your help
> kindly guide me at least if this is not the right place i am heading for
>
> HI,
>
>
>
> i have recently undergone a 3D reconstructive CT Scan. images acquired thus are attached. i have
> been advised bed rest for two months i.e., 8 weeks and allowed touch down weight bearing for
> right leg due to a hairline fracture in the right femoral shaft. moreover, i am not feeling any
> pain in any of my bones right now. my doctor is avoiding a surgery at this time he is of the
> view that my bones are very weak therefore, he has put me on FOSAMAX 70mb Weekly and OSTEOCARE
> D3 ADVANCE (calcium supplement). he is planning a surgery after two months to strengthen the
> right proximal femur and right femoral neck buy pinning right fibular bone into these.
>
> it seems that i am a polyostotic subject. what are the options left to me now? as my right
> ilium, socket of right femoral head and left femoral neck are involved.
>
> is it safe to be on bed rest as there is an incomplete fracture of the right femoral neck up to
> the medial cortex?
>
> thanking you in anticipation
>
> REGARDS,
>
>
>
> _________________________________________
> Zaheer Iqbal Naru
> B.E. (Mech), UET LHR
> Engineer (Projects) Grade - 2
> Northern Camps
> Sui Northern Gas Pipelines Limited
> 3rd Floor, Project Head Quarter, GAS HOUSE
> 21 - Kashmir Road
> Lahore, 54000
> Pakistan
> Mobile 92 333 4969726
> _________________________________________
>
>
> Send instant messages to your online friends http://uk.messenger.yahoo.com
>
>
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>
Daniel Schlatterer, DO
Interim Program Director, Dept. of Orthopaedic Surgery
Director, Orthopaedic Trauma
Atlanta Medical Center
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Atlanta, GA 30312
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