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When addressing bone defects resulting from trauma, infection, or tumors, the use of allogenic bone is often necessary. While autografts are considered the standard, they have limitations and can lead to donor site morbidity. Consequently, there has been exploration into the feasibility of utilizing allogenic bone and bone graft replacements. Allogenic bone transplants are acquired from donors following rigorous procurement, sterile processing, and donor screening procedures. To ensure the safe storage and effective utilization of allograft material, a bone banking system is employed. Establishing and managing an orthopedic bone bank, entails navigating complex legal and medical organizational aspects. This paper examines the establishment and operation of bone banks in India, drawing upon our first-hand experience in managing one at a tertiary care center in Northern India.Level of evidence: Level IV., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: This study analyzed the increase in disposal rate of femoral heads in the bone bank of a single hospital from medical disease and drug history, as assessed by the Korean health insurance review and assessment service. Materials and Methods: The disposal rate and cause of 340 femoral heads were analyzed according to the regulations of the bone bank based on the standard model of the Ministry of food and drug safety. Results: One hundred and seven (33%) of 323 femoral heads collected from 2009 to 2018, and 65 (46%) of 142 femoral heads collected from 2015 to 2018 were discarded. The most common causes were related to the history of dementia and the administration of radioisotope for nuclear medicine. Conclusion: The current methods and screening tools can lead to errors in disposing of the available tissues in a bone bank. Thus, improved standards and screening methods are needed. [ABSTRACT FROM AUTHOR]

Abstract The donation of bone and tendon tissues is an important source of biological material used in several surgical techniques. The removal of such tissues generates an important aesthetic sequel in the donor that requires limb reconstruction before returning the corpse to the relatives. The technique used by the Banco de Ossos do Paraná (Bone Bank from Paraná), Brazil, employs metal rebar, silicone tubes and nylon clamps to rebuild the limbs, it is easy to perform and has satisfactory aesthetic results.

For a long time the use of bone grafting has demonstrated its interest in orthopedic surgery and traumatology. The autografts which are still very frequently used present various problems. On the one hand, it is necessary to find a correct mechanical quality and a sufficient quantity of bone. On the other hand, the graft removal lengthens the operative time and generally painful in postoperative. These disadvantages of autografts have led to the development of bone allografts. Indeed, the low immunogenic power of the bone, the good integration of the graft and the ease of bone preservation techniques make it possible to overcome the various problems posed by bone autografts. The increasing use of bone allografts has resulted in the need for a structure allowing the management of graft stocks. The purpose of this work is to demonstrate the mode of operation of a bone bank, whose conservation activity is limited to the femoral heads treated by cryopreservation and without secondary sterilization process. The bank collaborates with all orthopedic surgeons in the Rabat and Casablanca city at first and then with all orthopedic surgeons in Morocco. It provides allografts in quality and safety. [ABSTRACT FROM AUTHOR]

Objective This study compared stability, removal torque, bone implant contact (BIC) and area (BA) of implants installed simultaneously with onlay autografts or allografts in rabbits' tibias. Material and methods Total of 18 rabbits were used in this study. Fresh frozen allografts were obtained from six animals at T(-6). Two implants with autogenous grafts (Group 1) or allografts (Group 2) were simultaneously inserted into both sides of the tibiae in a vertical periimplant defect model at T0. The resonance frequency (ISQ) was measured in implant proximal epiphysis on the day of installation of T0 and T18 (18 weeks post-surgery). At T18 the removal torque was assessed at the distal implants, the implants' proximal epiphysis and surrounding bone were harvested to perform histomorphometric analysis. The BIC and BA within the limits of the implants threads were evaluated. Results The ISQ revealed a statistically significant difference between T0 and T18 in each group (p = 0.024, p = 0.003). The removal torque indicates that there was no significant difference between the two groups (p = 0.47). No significant differences were observed between the groups regarding both BIC (p = 0.3713) and the BA (p = 0.3883). Conclusion Both grafts and implants demonstrated the same stability, torque removal and the BIC and BA. [ABSTRACT FROM AUTHOR]

Musculoskeletal allografts are now commonly used. To decrease the potential risks of transmission of pathogenic bacteria, fungi, or viruses to the transplant recipients, certain issues regarding the management of patients who receive contaminated allografts need to be addressed. We aimed to clarify the incidence and extent of disease transmission from allografts by analyzing the allografting procedures performed in the bone bank of our hospital over the past 20 years. We retrospectively reviewed the data from our allograft registry center on 3979 allografts that were implanted in 3193 recipients throughout a period of two decades, from July 1991 to June 2011. The source of the allografts, results of all screening tests, dates of harvesting and implantation, and recipients of all allografts were checked. With the help of the Center for Infection Control of our hospital, a strict prospective, hospital-wide, on-site surveillance was conducted, and every patient with healthcare-associated infection was identified. Fisher’s exact test was used to compare the infection rate between recipients with sterile allografts and those with contaminated allografts. The overall discard and infection rates were, respectively, 23% and 1.3% in the first decade (1991–2001); and 18.4% and 1.25% in the second decade (2001–2011). The infection rate of contaminated allograft recipients was significantly higher than that of sterile allograft recipients (10% vs. 1.15%, P < 0.01) in the second decade. Both infection and discard rates of our bone bank are comparable with those of international bone banks. Strict allograft processing and adequate prophylactic use of antibiotics are critical to prevent infection and disease transmission in such cases. [ABSTRACT FROM AUTHOR]

Background: Calcaneum is the largest and longest tarsal bone in the foot and forms the prominence of the heel. The middle third of the superior surface of calcaneus provides an articular facet for the talus bone. Objective: The study seeks to observe the variations in the morphology and morphometry of the talar articular facets on the superior surface of dry calcaneal bones of adult human in South-Eastern Nigerian population. Materials and methods: The study was carried out with 220 adult non-pathological dry calcanei, 111 bones of left side and 109 bones of right side of unknown sex from bone banks of various medical colleges in South-Eastern Nigeria. Each calcaneus was examined for various patterns of articulating facets for talus, the shapes of the facets and the length, width and interfacetal distances were also documented. Results: Pattern 1 was common in the present study (59.6% right and 51.4% left). Pattern 2 has an incidence of 7.3% on the right and 8.1% on the left side. Pattern 3 was found with an incidence of 11.9% on the right and 13.5% on the left side and pattern 4 was found with an incidence of 21.1% on the right and 27% on the left side constituting the second most common pattern of talar articular facets on the superior surface of the calcaneus. The oval shape was common in the anterior and middle talar articular facets with an incidence of 52.86% and 64.39% respectively, oval and convex was common in the posterior facet (70% cases) and the elongated shape was common among the fused anterior and middle facet (63.12%) with elongated oval common in subtype 2 (27.87%) and elongated constricted common in subtype 1 (35.25%). The length of the calcanei was recorded at a mean±SD of 7.10±0.70cm (left side) and 7.01±0.72cm (right side) and that of the width was recorded at 2.77±0.38cm (left side) and 2.77±0.37cm (right side). The distance between the Anterior and Middle facets was mean±SD of 0.50±0.15cm (left side) and 0.48±0.15cm (right side), the Posterior and Middle facets at 0.59±0.20cm (left side) and 0.56±0.17cm (right side) and that between the Anterior and Posterior facets at 1.43±0.27cm (left side) and 1.42±0.29cm (right side). Conclusion: The individual and racial differences of the anatomic construction of calcaneal talar articular facets influence the static and kinetic dynamics of foot. A good knowledge of the calcaneal facet pattern and shape would assist better treatment and management options for calcaneal fractures. It also necessitates a modification of western surgical techniques to suit the Nigerian scenario for calcaneal osteotomy. [ABSTRACT FROM AUTHOR]

This research aimed to analyze the costs of bone grafting through a bone tissue bank in a Chilean regional health service. Methods: First, we developed a preliminary epidemiological study to obtain the necessary data for the analysis, specifically on bone graft procedures in a local health service (Servicio Salud Concepción). Next, we performed a budget impact analysis. Results: We analyzed a total of 6,252 cc of bone grafts, with a total cost of USD$156,000 per year. We found a potential recovering capacity of 302 ± 16 femoral heads per year from the total hip replacement procedures. Based on these results, bone tissue banks could save USD$145,000 hospital costs annually. Studying a representative health service from Chile, this analysis revealed a dependency on imported bone substitutes and autografts. These requirements can be supplied sustainably by a bone tissue bank based on donations of femoral heads under the current legislation of the Chilean health authority.

Background: Bangkok Biomaterial Center is the only allogenic bone bank in Thailand, supplying the bones to all medical centers. From a report, a certain number of post-operative complications were found. Objective: To compare pre-protocol revision and post-protocol revision success rates and complications associated with the use of allogenic bone grafts relative to perioperative handling and care of allogenic bone. Material and Method: This retrospective comparative study was conducted at the Bangkok Biomaterial Center, Faculty of Medicine Siriraj Hospital, Mahidol University. All registration forms and surgical follow-up reports relating to the use allogenic bones procured from our bone bank between 2005 and 2015 were reviewed. New recommendations for the use of our allogenic bones were established in 2009. Results and complications after allogenic bone transplantation between 2005 and 2008 were compared with results and complications after transplantation to a new protocol between 2009 and 2015. Descriptive analysis and analysis of variance were used to evaluate the data. Results: Data of 825 patients who underwent deep frozen allogenic bone transplantation and 1,541 patients who underwent freeze-dried allogenic bone transplantation were retrospectively reviewed. Overall, the complication rate was reduced from 14.83% in the pre-protocol revision period to 5.15% in the period after the new recommendations for perioperative graft handling were established and implemented. Conclusion: New recommendations for the handling and care of allogenic bone during the perioperative period significantly reduced post-operative complications in patients who received transplantation with deep frozen allogenic bone. The infection rate in patients who received allogenic bone graft was very low. [ABSTRACT FROM AUTHOR]

Bancos de ossos são necessários para prover material biológico para uma série de procedimentos ortopédicos. A crescente necessidade de tecidos musculoesqueléticos para transplante é decorrente do desenvolvimento de novas técnicas cirúrgicas e fez com que diversos serviços se dispusessem a ter sua própria fonte de tecidos para transplante. Para aumentar a segurança dos tecidos transplantados, normas foram impostas pelo governo para o funcionamento dos bancos, o que limitou o número de instituições autorizadas. O bom desempenho de um banco de ossos depende de um rígido controle de todas as etapas, passando pela formação de equipes bem treinadas para captação, pela seleção de doadores, pela realização de diversos exames nos tecidos captados e pelo controle rigoroso das técnicas de processamento utilizadas. A associação desses fatores faz com que a abrangência do uso e do número de pacientes receptores seja ampliada, a contaminação de tecidos seja de incidência estatisticamente desprezível e haja rastreabilidade entre doadores e receptores. Este trabalho descreve as considerações técnicas quanto ao funcionamento de um banco, uso de enxertos e aplicações ortopédicas, bem como aspectos éticos e principais obstáculos enfrentados.Bone banks are necessary to provide biological material for a series of orthopedic procedures. The growing need for musculoskeletal tissues for transplantation is due to the development of new surgical techniques, and has made it so that a variety of services were willing to have their own source of tissue for transplantation. To increase the safety of transplanted tissues, standards for the operation of banks were imposed by the government, which limited the number of authorized institutions. The good performance of a bone bank depends on strict control of all stages, from the formation of well-trained teams for capturing, for donor selection, for conducting various tests on the tissues obtained, and by the strict control of the processing techniques used. The combination of these factors makes it so that the scope of use and the number of recipient patients increases, the incidence of tissue contamination is statistically insignificant, and that there is traceability between donors and receptors. This paper describes the technical considerations regarding the functioning of a bank, use of grafts and orthopedic applications, as well as ethical aspects and the main obstacles encountered.

OBJETIVO: Avaliar as características da distribuição desses por um Banco de Tecidos no Brasil. MÉTODOS: Base de dados do Banco de Tecidos entre setembro de 2006 e junho de 2008. Características dos receptores foram tabuladas. Os tipos de tecidos processados foram: cabeças femorais, osso metafisio-epifisário, osso cortical, ossos curtos ou chatos e tendões. O destino dos enxertos foi analisado. Frequências das distribuições foram obtidas e analisadas. RESULTADOS: Foram distribuídas 734 unidades tecidos fresco-congelados, transplantadas em 683 receptores. Doadores de múltiplos órgãos originaram 97,9% dos tecidos e doadores vivos os demais. Foram transplantados 489 unidades de osso córtico-esponjoso, 137 de osso metafisio-epifisário, 44 de osso chato ou curto, 3 de tendão, 29 de osso particulado e 32 de cabeças femorais. A média de idade dos receptores foi 50,3 anos, sendo 59,5% do sexo feminino e 40,5% do masculino. Os tecidos foram destinados para uso ortopédico em 21,1% dos casos e buco-maxilo-facial, em 78,9%. CONCLUSÃO: O Banco de Tecidos aumentou o número de distribuições em resposta à demanda crescente de tecidos, principalmente para uso em cirurgia buco-maxilo-facial.OBJECTIVE: Is to evaluate the characteristics of the distribution of these grafts by a Tissue Bank in Brazil. METHODS: Tissue Bank database from September 2006 to June 2008. The characteristics of the recipients were drawn up in the table form. The types of tissue processed were: femoral heads, metaphyseal-epiphyseal bone, cortical bone, flat or short bones and tendons. The intended purpose of the grafts was analyzed, and distribution frequencies were also obtained and analyzed. RESULTS: Altogether, 734 units of fresh-frozen tissue were distributed and transplanted into 683 recipients. In terms of origin of the tissues, 97.9% came from multiple organ donors, and the remainder from living donors. A total of 489 units of cortical bone were transplanted, 137 of metaphyseal-epiphyseal bone, 44 of short or flat bones, 3 of tendon, 29 of particulate bone and 32 femoral heads. The mean age of the recipients was 50.3 years; 59.5% were women and 40.5% men. The tissues were used in orthopedic surgeries in 21.1% of the cases, and in oral and maxillofacial procedures in 78.9%. CONCLUSION: The Tissue Bank has increased the number of distributions in response to the growing demand for tissues, particularly for use in oral and maxillofacial procedures.

Purpose: Although structural bone allografts have been used for years to treat large defects caused by tumour or trauma, selecting the most appropriate allograft is still challenging. The objectives of this study were to: (1) describe the establishment of a visual bone bank system and workflow of allograft selection, and (2) show mid-term follow-up results of patients after allograft implantation. Methods: Allografts were scanned and stored in Digital Imaging and Communications in Medicine (DICOM) files. Then, image segmentation was conducted and 3D model reconstructed to establish a visual bone bank system. Based on the volume registration method, allografts were selected after a careful matching process. From November 2010 to June 2013, with the help of the Computer-assisted Orthopaedic Surgery (CAOS) navigation system, the allografts were implanted in 14 patients to fill defects after tumour resection. Results: By combining the virtual bone bank and CAOS, selection time was reduced and matching accuracy was increased. After 27.5 months of follow-up, the mean Musculoskeletal Tumor Society (MSTS) 93 functional score was 25.7 ± 1.1 points. Except for two patients with pulmonary metastases, 12 patents were alive without evidence of disease at the time this report was written. Conclusions: The virtual bone bank system was helpful for allograft selection, tumour excision and bone reconstruction, thereby improving the safety and effectiveness of limb-salvage surgery. [ABSTRACT FROM AUTHOR]

During the 20th century, allograft implantation waned in popularity as a clinical activity. Reports appeared in the literature describing several small series of patients in whom bone was obtained from amputation specimens or recently deceased individuals. The concept of bone banking became a reality during and after World War II when the National Naval Tissue Bank was established in Bethesda and a number of small banks sprang up in hospitals throughout the world. Small fragments, either of cortical or medullary bone, from these banks were used heterotopically to augment spinal fusions, to implant into cyst cavities, or to serve as a scaffolding for repair of non- or delayed union of fractures of the long bones. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to quantify the amount of bone morphogenic protein 7 (BMP-7) in bone samples in different storage and treatment conditions used in bone banks and thereby evaluate the benefit of this test as a routine measure before bone grafting. Methods: Fresh as well as frozen bone chips, each with and without antibiotic impregnation, were screened for their BMP-7 content. Human bone chips were produced from femoral heads of two female donors who had undergone total hip replacement surgery. The amount of BMP-7 was detected using a commercially available enzyme-linked immunosorbent assay (ELISA) test. Results: There were no significant differences between groups in samples obtained from the first femoral head. Bone-chip samples derived from the second femoral head showed significant differences between groups. The actual amount of these differences was small and most likely biologically irrelevant. It is important to note that there was a significant difference between groups when comparing both femoral heads, reflecting donor-to-donor variability. Conclusion: ELISA testing for BMP-7 as a qualitative measurement of bone grafts should be considered a routine quality-control test for bone banks. [ABSTRACT FROM AUTHOR]

Objectives This study evaluated the stability of implants installed simultaneously and in a delayed manner in fresh frozen onlay allografts in the tibiae of rabbits. Material and methods Analyses of the resonance frequency ( ISQ) and removal torque were performed. The calvarium of three rabbits was used as donor site. Ten New Zealand female rabbits received four allografts of the same dimensions, two in each tibia. The tibiae were randomly allocated into the following two groups: Group 1, the tibiae that received implants after 84 days of healing, and Group 2, those who received the implants simultaneously with the grafts. Both groups were followed for 126 days. Proximal implants in each group were evaluated by resonance frequency ( ISQ) on days 0 and 126, and the distal ones with removal torque on day 126. Results In both groups, an increase in the ISQ value of day 0-126 was observed, with a statistically significant difference (Group 1 P = 0.049 and Group 2 P = 0.021). When comparing the resonance frequency at day 0 to day 126, and the gain of stability between these days, no statistically significant difference between groups could be observed. The removal torque showed a statistically significant difference between groups 1 and 2 ( P = 0.042). Conclusion There was an increase in stability in groups according to the analysis of resonance frequency. Implants installed in a delayed manner in allografts showed higher shear force, according to the removal torque analysis. [ABSTRACT FROM AUTHOR]

To share our experience of establishing a bone bank in Pakistan, and the clinical use of these indigenously produced bone grafts. We retrospectively reviewed our experience of the procurement, processing, and storage of bone grafts at a bone bank in Karachi, Pakistan, the first bone bank to be established in a public sector hospital in Pakistan. The bone bank was established at Sindh Institute of Urology and Transplantation (SIUT), Karachi, in collaboration with Department of Orthopaedic Surgery, Dow University of Health Sciences/Civil Hospital, Karachi (CHK) in May, 2015. Since then, a large number of bone grafts from the tissue bank have been used for various orthopedic procedures. This paper describes the problems and challenges faced in establishing and running a tissue bank in a Muslim and a developing country and the progress of the bone bank over the first 4 years. A total of 93 bone grafts were retrieved and preserved in the bone bank over the 4-year period. Among these, 56 (60.2%) bones were retrieved from male donors and 37 (39.8%) from females. The mean age of all donors was 55.9 ± 15.34 years (range: 16-90 years). All bone donors were living patients. No c bones were obtained from deceased donors. Types of bone grafts included: femoral heads, 68; head with neck of femur, 19; radius and ulna, 1; lower femur, knee joint, lower leg and foot bones, 4; and skull bone, 1. All grafts were subjected to aerobic and anaerobic bacterial cultures, as well as fungal cultures. Microbiological contamination was observed in 18/93 (19.35%). All culture positive bones were discarded. Bone grafts issued from the bank and transplanted were 51/93 (54.8%) in all. Bone grafts were used in a variety of tumor and non-tumor orthopaedic procedures in CHK. Nine bone grafts were donated to the other hospitals to be used for revision total hip replacement and tumor surgeries. There were no service charges. Two patients (3.92%) developed infections postoperatively, one superficial and one deep. No other complications were noted. This is the preliminary report on the establishment and functioning of a bone bank in a public sector hospital in Pakistan. The favorable outcome has inculcated confidence in orthopedic surgeons for greater use of bone allografts for a variety of indications in this country., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

We analyzed the prevalence and predisposing factors for the overall rejection rate after retrieval of 267 fresh femoral head allografts over the past 7 years. The present study aimed to assess the quality system of institutional bone banking that can provide high-standard allografts with a low infection rate. Retrospective analysis of bone banking from June 2013 to December 2019 was conducted on 267 donors and 153 recipients. Of the 267 donated femoral heads, 74 were rejected, giving an overall rejection rate of 27.71%. The leading cause of allograft rejection was the inability to perform serology tests due to donor death; the absence of serological tests itself, and the donor refusal to perform the serology 6-month retest in 42 donors (15.72%). At retrieval, 12 allografts were positive, giving an overall contamination rate of 4.49%. Seven (2.62%) of the 267 allografts failed the blood screening tests. Thirteen allografts (4.86%) were discarded because of suspected damage to the packaging or disuse during surgery. An infection rate of 1.30% was found following transplantation. Over the past 7 years of bone banking, our results show that the overall rejection rate and the allograft-related infection rate correlate with international standards. The leading cause of allograft rejection was the inability to perform serology tests due to donor death and their refusal to perform the serology retests. Besides stringent aseptic allograft handling, donor motivation to participate in bone banking is extremely important for its efficient functioning., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: The recommendations for storage temperature of allogeneic bone are varying between -20 °C and -70 °C and down to -80 °C. The necessary temperature of storage is not exactly defined by scientific data, and the effect of different storage temperatures onto the biomechanical and the biological behavior is discussed controversially. Methods: The historical development of storage temperature of bone banks is described. A survey on literature concerning the biomechanical and biological properties of allograft bone depending on the procurement and storage temperature is given as well as on national and international regulations on storage conditions of bone banks (European Council, American Association of Tissue Banks (AATB), European Association of Tissue Banks (EATB)). Results: Short-term storage up to 6 months is recommended with -20 °C and -40 °C for a longer period (AATB), and EATB recommends storage at -40 °C and even -80 °C while the regulations of the German German Medical Association (Bundesärztekammer) from 2001 recommend storage at -70 °C. Duration of storage at -20 °C can be maintained at least for 2 years. The potential risk of proteolysis with higher storage temperatures remains, but a definite impairment of bone ingrowth due to a storage at -20 °C was not shown in clinical use, and no adverse biomechanical effects of storage at -20 °C could be proven. Conclusion: Biomechanical studies showed no clinically relevant impairment of biomechanical properties of cancellous bone due to different storage temperatures. Sterilization procedures bear the advantage of inactivating enzymatic activity though reducing the risk of proteolysis. In those cases a storage temperature of -20 °C can be recommended for at least a period of 2 years, and the risk of undesired effects seems to be low for native unprocessed bone. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The resurgence of decompressive craniectomy surgeries for management of intracranial hypertension has led to a parallel increase in cranioplasty procedures for subsequent reconstruction of the resultant extensive skull defects. Most commonly, cranioplasties are performed using the patients' own cryopreserved skull flaps. Currently, there are no standardized guidelines for freeze-storage of bone flaps either nationally or internationally. In this initial study, the authors surveyed major neurosurgical centres throughout Australia to document current clinical practices. Twenty-five neurosurgical centres affiliated with major public, teaching hospitals in all Australian states were included in the current survey study. A standardized survey guide incorporating standardized questions was used for data collection either by phone interviews and/or electronic (email) communication. Details regarding bone flap preparation following craniectomy, temperature and duration of freeze-storage, infection control/micro-contamination detection protocols, pre-implantation procedures were specifically recorded. Cranioplasty using cyropreserved autogenous bone flaps remains the most common (96%) mode of skull defect reconstruction in major neurosurgical centres throughout Australia. Following the initial craniotomy, the harvested skull flaps were most frequently (88%) double- or triple-bagged under dry, sterile conditions. In 16% of hospitals, skull flaps were irrigated either with antibiotic mixed-saline or Betadine prior to cryopreservation. Skull biopsies or swabs were obtained from the skull flaps for micro-contamination studies in accordance with departmental protocol in 68% of hospitals surveyed. Subsequently, the bone flaps were cryopreserved at wide ranging temperatures between −18°C to −83°C, for variable time intervals (6 months to 'until patient deceased'). Twelve neurosurgical centres (48%) elected for bone flap storage to be undertaken at the local bone bank. In the remainder (52%) of the hospitals, bone flaps were cryopreserved in locally maintained freezers. Prior to re-implantation of the skull flaps at subsequent cranioplasty surgeries, six (24%) of the neurosurgical centres had specific thawing procedures involving immersion of the frozen bone flaps in Ringer's solution and/or Betadine. Further pre-implantation bacteriological cultures from bone biopsies or swabs were obtained only in three (12%) hospitals. This study has documented highly varied skull flap cryopreservation and storage practices in neurosurgical centres throughout Australia. These differences may contribute to relatively high complication rates of infection and bone resorption reported in the literature. The results of the current study argue for the further need of high quality clinical and basic science research, which aims to characterize the effect of current skull flap management practices and freeze-storage conditions on the biological and biomechanical properties of skull bone. [ABSTRACT FROM AUTHOR]

Introduction: Routine spinal fusion techniques have involved removal of all soft tissues and articular facets, decortication of all posterior elements, and application of bone graft to the fusion area. Bone grafting has been performed mainly using the patient's own bone (autograft bone), most commonly from the iliac crest. The use of autograft bone is accompanied by complications or problems because of harvesting and donor-site morbidity. Several studies have already reported the use of allograft bone in scoliosis surgery. However, these studies are small series with short-term follow-up. Method: Twenty-two patients with scoliosis who underwent posterior spinal fusion and pedicle-screw-alone fixation using banked allograft bone obtained from the regional bone bank in Japan were analyzed. The average age at surgery was 13 years 5 months. The average follow-up was 2 years 7 months, and the average age at the last follow-up was 15 years 6 months. Scoliosis curves were divided into two groups (single curve group and double curve group). Results: For the single curve group, the average preoperative coronal curve measured 78° (48°-85°) and the postoperative curve measured 22° (8°-35°), with no loss of correction at the last follow-up. For the double curve group, the average preoperative thoracic curve measured 64° (48°-85°) and the lumbar curve measured 42° (38°-60°). The average postoperative thoracic curve measured 12° (8°-34°) and lumbar curve measured 15° (8°-32°), with no significant loss of correction at the last follow-up. No patients had clinical complaints in the region of surgery at 9 months after surgery and thereafter. There were no complications including loss of correction, nonunion, infection and instrumentation failure. At the last follow-up, patients/parents were interviewed and asked to complete an outcome satisfaction questionnaire. They were asked to rate the outcome as very satisfactory, satisfactory, neither satisfactory nor unsatisfactory, unsatisfactory, or very unsatisfactory. Seventeen patients (77%) were very satisfied, four patients (17%) were satisfied, and one patient (6%) was neither satisfied nor unsatisfied. Autograft bone and banked allograft bone appear to yield comparable results and clinical outcomes. Conclusion: However, in Japan, various expenses accrue to supply a safe and premium quality of banked allograft bone. Financial issue must be resolved as soon as possible. [ABSTRACT FROM AUTHOR]

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Background: Seated working positions are often regarded as a cause for discomfort in the musculoskeletal system. Performing work in different working positions-that is, alternating between sitting and standing (sit-stand workstation paradigm)-could help reduce physical complaints. Objective: The questions were whether performing office work partly in a standing position leads to reduced complaints and whether standing would change the efficiency of data entry office work. Method: We investigated the effect of a sit-stand workstation paradigmd during experimental data entry office work on physical and psychological complaints and data entry efficiency by conducting a randomized controlled trial with 60 male participants ages 18 to 35 years. Results: In this experiment, musculoskeletal complaints were reduced by a sit-stand workstation paradigm. A trend could be identified indicating a small but nonsignificant loss of efficiency in data entry while standing. Conclusion: A sit-stand workstation paradigm reduces musculoskeletal complaints without considerably affecting data entry efficiency under the presented study conditions (young male participants, short duration, fixed and controlled sit-stand workstation paradigm, simulated experimental working condition). Application: According to the present data, implementing a sit-stand workstation paradigm can be an effective workplace health intervention to reduce musculoskeletal complaints. This experiment encourages further studies on the effectiveness of a sit-stand workstation paradigm. Experimental research and field studies that prove the reduction of complaints when introducing a sit-stand workstation paradigm in the workplace could be the basis for evidence-based recommendations regarding such interventions. [ABSTRACT FROM AUTHOR]

Background: An audit performed in the use of non-irradiated femoral head bone graft at the Geelong Hospital over a 10-year period. While it is thought the non-irradiated bone graft provides a better structural construct there is theoretical increased risk of infection transmission. Methods: We performed a retrospective review of prospectively collected data in the use of non-irradiated bone allograft used from the Geelong Hospital Douglas Hosking Research Institute bone bank over a 10-year period. The review was performed using data collected from the bone bank and correlating it with the patient’s medical record. All complications, including infections, related to the use of the allograft were recorded. Results: We found that over the 10 years to 2004 that 811 femoral heads were donated, with 555 being used over 362 procedures in 316 patients. We identified a total of nine deep infections, of which seven were in joint replacements. Overall this was a 2.5% deep infection rate, which was lowered to 1.4% if the previously infected joints that were operated on were excluded. Conclusion: The use of non-irradiated femoral head bone graft was safe in a regional setting. [ABSTRACT FROM AUTHOR]

This paper describes a methodology for the simulation of musculoskeletal disorders. Our clinical study is related to osteoarthritis (OA) of the hip, a pathogenesis possibly due to impingements. These bone collisions lead to abnormal joint mechanics which is characterized by contact pressure and stress distribution upon the joint cartilages. The proposed methodology combines different approaches from modeling to simulation. The simulation is based on patient-specific anatomical models, where acquisition modalities are noninvasive and flexible. Based on static magnetic resonance imaging (MRI) data, a discrete deformable models method is used for modeling the organs of the musculoskeletal system. Femoroacetabular movements are estimated using an optical motion capture system and are validated by a dynamic MRI analysis. To achieve accurate deformations, techniques to generate volumetric meshes are developed based on the medial axis (MA) information. Finally, a computationally efficient fast functional joint model is used to simulate the mechanical behavior of the soft tissues. The goal of such a simulation is to allow the investigation of the relevant contact and cartilages deformation under movement, which can be useful for diagnosis, pre- or post-operative planning and training. This will benefit further developments in surgical techniques and minimally invasive procedures. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Incorporation of a human bone allograft requires osteoclast activity and growth of recipient osteoblasts. The aim of this work was to study the effects produced by autoclavated and −80°C frozen bone allografts on osteoblast proliferation and synthesis of interleukin 6 (IL6), activator of bone resorption, aminoterminal propeptide of procollagen I (PINP), marker of bone matrix formation, and osteoprotegerin (OPG), inhibitor of osteoclast activity and differentiation. Allografts were obtained from human femoral heads. Human osteoblasts were cultured in the presence (problem group) or in the absence (control group) of allografts during 15 days. Allografts produced a decrease in osteoblast proliferation in the first week of the experiment, and an increase in IL6 mRNA, both at 3 h and 2 days, and an increase in the IL6 released to the culture medium the second day of the experiment. We found a decrease in OPG released to the culture on the 2nd and fourth days. These results suggest an increase in bone resorption and a decrease in bone formation in the first week of the experiment. In the second week, allografts produced an increase in osteoblast proliferation and PINP release to the culture medium, indicating an increase in bone formation; an increase in OPG released to the culture medium, which would indicate a decrease in bone resorption; and a decrease in IL6, indicating a decrease in bone resorption stimulation. These results demonstrate that autoclavated and −80°C frozen bone allografts produce in bone environmemt changes that regulate their own incorporation to the recipient bone. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:200-207, 2008 [ABSTRACT FROM AUTHOR]

A retrospective clinical review was done on 54 revision hip patients. Radiological analysis examined the Gross and AAOS classifications, stem position, cement mantles, allograft and evolution (subsidence, resorption and remodelling). The Harris Hip score was used for clinical assessment. We used bone bank allograft and a polished non-collared stem LD. The follow-up period was 60.5 months (19.4-152.4), and the average age 68.5 (range: 22-85). There were 21 females and 33 males. The surgical approach was: lateral (5.56%) posterior (91.4%); trochanteric osteotomy: 25.9%; associated acetabular revision: 59.3%; previous operations: 1.9. The preoperative Harris score was 35 (28-40) and rose to 81 (50-99) postoperatively. The stem alignment was neutral (44.44%), varus (38.89%) and valgus (16.67%). The femur/stem diameter relationship was 1.8 (1.2-2.7). There were no changes in stem alignment in 94.4%. An adequate cement mantle was: proximal zone (61.1%), medium zone (27.8%) and distal zone (16.7%). The rate of any subsidence was 38.9% (progressive: 12.96%). The rate of complications was 40.7% and included periprosthetic fracture: 14.8%; superficial infection: 1.9%; deep late infection: 1.9%; dislocation: 3.7%; heterotopic ossification: 13%. The rate of new stem revision was 16.6%. The clinical and radiological success rate was 77.78%. A greater incidence of revisions has been found in stem malalignment, progressive subsidence, a Harris increase of <20 points, allograft resorption, small diameter stems and inadequate cement mantle. We recommend hard impaction and a cement mantle of at least 2 mm. Non-progressive subsidence does not increase stem loosening. The technique has been useful in recovering bone stock in a severely defective femur and achieves a stable reconstruction. The level of evidence was therapeutic study level III-2 (retrospective cohort study; see the instructions to the authors for a complete description of the levels of evidence). [ABSTRACT FROM AUTHOR]

Introduction. One of the most important technologies developed in the last fifty years has been the tissue and bone banking technology, this technology has allowed an important improvement in treatment of multiple diseases of the musculoskeletal system. Historic background. The first successful bone xenograft was reported in 1668 by Job Janszoon Van Meekeren, the first successful bone allograft report was done by William MacEwen in 1879. During the second half of the XIX century and the XX century there was a lot of investigation about bone grafts, at the same time there was an important technologic development that allows the arise of the bone and tissue banks in the first half of the XX century. The first projects of bone and tissue banks in Mexico were done in the decade of 1940, the majority of these projects were abandoned because there were many limitations in the country for this institutions. Utilization of bone allografts in Mexico. Since September the 26th of 2000 until June the 30th of 2004 this bone and tissue bank has provided 4,175 allografts utilized in 2,451 surgical procedures, these surgical procedures were done in 27 states around the Mexican Republic. Research. There are several research projects in our Bone and Tissue Banking, the most important of them is the culture of autologous chondrocites for treatment of chondral defects. Conclusion. The availability of bone allografts procured, processed and distributed according to national and international standards increases the therapeutic options and outcomes for our patients and contributes to the advance of the national orthopedic surgery. [ABSTRACT FROM AUTHOR]

Background and Aim: Conventional banking of bone allografts has been well documented in the literature. It relies on standardised screening and providing a sterile storage facility. We report a new surgical technique of banking the femoral head in a surgically fashioned subperiosteal iliac pouch and its use for the donor's own surgery. Material and Methods: Thirteen patients with an average age of 60 years and a diagnosis of osteoarthritis of the hip with a contralateral symptomatic loose hip replacement were selected. The femoral head was harvested and banked. On retrieval, histological analysis was performed in four specimens with clinical and radiographic review of all subjects. Results: Radiographic results show good integration of the morselised femoral head bone graft in revision hip surgery. Histological results from four retrieved specimens show viability at eight years and eleven months from insertion into the pouch. Discussion: Autobanking of the patient's own femoral head is suitable in a select group of patients in whom a combined primary and contralateral revision total hip replacement poses an unacceptable anaesthetic risk. It has the advantage of providing a graft with osteoinductive potential and a reduced risk of infection. It eliminates the need for a storage facility and screening programme. It also provides a portable storage facility if the patient moves elsewhere. [ABSTRACT FROM AUTHOR]

The first investigation on allograft utilization was carried out in the 17th century. Allografts are very important in orthopedic surgery, avoiding local complications and limitations related to autologous graft harvest. There is no current information published on allograft distribution and utilization in Mexico. Objective: To describe the experience of the Bone and Tissue Bank of University Hospital, UANL, with special attention to final destination of bone allografts. Material and methods: Data on procurement and distribution of tissue between September 26, 2000 and July 31, 2003 has been included. Results: Fifty-seven tissue procurements in 9 cities in Mexico were done; only two donors were cadaveric donors. A total of 1,983 allografts were distributed and used in 1,172 surgical procedures in 23 states in Mexico. Sixty-four percent of the allografts were used by orthopedic surgeons, 95% being freeze-dried allografts. Conclusion: Since 2001 allograft distribution has shown an important increase, well above that reported by the American Association of Tissue Banks. We have been using allografts for orthopedic surgery as well as many other tissue banks. The current system for capturing cadaveric tissue donors in Mexico is not sufficient, implementation of specific programs focused on tissue donation could probably increase the number of tissue donors. [ABSTRACT FROM AUTHOR]

At the Tampere Bone Bank, all the discarded femoral heads from September 1997 to May 2000 were recultured. The grafts had been washed with pulse lavage at harvesting. 48 grafts had been discarded because of a positive culture and 85 with negative cultures because of positive or insufficient serological information. The femoral heads were split into halves, which were recultured as a whole in thioglycolate broth for 14 days. The contamination of previously culture positive and negative femoral heads did not differ. In only 2 cases did we find the same type of bacteria in the primary as in the new culture. Most of the primary contamination proved to be false positive. The real contamination seems to be very low, at least after pulse lavage washing of the femoral head. [ABSTRACT FROM AUTHOR]

Background: Allograft donations are not uncommonly found to be contaminated. The issue of contaminated donations from live donors at the time of surgery, and the significance of this to the patient in terms of subsequent sepsis of the arthroplasty, were examined. Methods: The donations of femoral heads to the Queensland Bone Bank over a 9-year period were reviewed, and the incidence and bacteriology of contamination were detailed. Clinical outcomes were determined for donors who had positive cultures at the time of retrieval and they were compared with those of culture-negative donors. Results: Between March 1987 and February 1996, 232 femoral heads were donated to the Queensland Bone Bank. Four specimens were sent for culture with each femoral head (surface swab of femoral head, acetabular swab, bone biopsy and capsule). In 51 cases, one or more positive cultures were obtained (22% contamination rate). The majority of organisms cultured were Staphylococcus epidermidis. One hundred and seventy donations came from surgery performed at the Princess Alexandra Hospital, and 40 femoral heads were considered contaminated. Deep infection was recorded in one of the 40 cases with contaminated donations and three out of 130 non-contaminated donations had subsequent septic episodes. Conclusion: The contamination rate detailed in the present report is higher than in most series. This may be due to the fact that four bacteriological specimens are taken to assess contamination. Two of these specimens are tissue samples which yielded more positive results than did the two swabs. All other series take no more than two bacteriological specimens, which are usually bone swabs. These are shown to have a poor yield of positive cultures. Therefore there is a significant underestimation of contamination rates by other bone banks. This has implications for the recipients of bone from those banks, particularly when the allograft material is not secondarily sterilized. This is impo... [ABSTRACT FROM AUTHOR]