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Reconstruction of large post-traumatic segmental femoral defects using vascularised bone flaps: a retrospective case series.

BMC Musculoskelet Disord

November 2024

Centre for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, V Úvalu 84, Prague, Praha, 150 06, Czech Republic.

Background: Large femoral defects after trauma, femoral non-unions, fractures complicated by osteomyelitis or defects after bone tumour resection present high burden and increased morbidity for patient and are challenging for reconstructive surgeons. Defects larger than 6 cm and smaller defects after failed spongioplasty are suitable for reconstruction using a free, eventually a pedicled vascularised bone flap. The free fibular flap is preferred but an iliac crest free flap or a pedicled medial femoral condyle flap can be also used.

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Article Synopsis
  • Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease primarily found in children and adolescents, and sacroiliitis is an inflammatory condition of the sacroiliac joint diagnosed via MRI.
  • A case study details a 17.5-year-old female patient with classical Ehlers-Danlos syndrome (EDS) who experienced joint pain, hypermobility, and morning stiffness, leading to the diagnosis of CNO and sacroiliitis after a whole-body MRI revealed inflammation.
  • The patient was successfully treated with a combination of medications including risedronate sodium and methotrexate, achieving remission, highlighting the importance of interdisciplinary cooperation for managing the overlapping conditions.
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Background: Unilateral presentation of sacroiliitis is a diagnostic dilemma, especially between infection and inflammatory sacroiliitis associated with spondyloarthritis, requiring an early and accurate diagnosis.

Objective: To assess the utility of magnetic resonance imaging (MRI) in differentiating infective versus inflammatory etiology in unilateral sacroiliitis.

Materials And Methods: Retrospective review of the MRI of 90 patients with unilateral sacroiliitis, having an established final diagnosis.

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: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct. Reconstruction is mainly based on the use of alloplastic joint prosthesis, costochondral grafting, distraction osteogenesis of the dorsal part of the mandibular ramus, or osseous microvascular flaps of various origin. With the objective of developing a method that overcomes the restrictions of these methods, we recently introduced a sequential chimeric flap consisting of a lateral femoral condyle flap (LFC) and deep circumflex iliac artery flap (DCIA) for reconstruction of up to half of the mandible and the condylar head and neck.

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