title: The stability of impacted morsellized bone grafts in a metal cage under dynamic loaded conditions: an in vitro reconstruction of a segmental diaphyseal bone defect.
abstract: BACKGROUND
  Reconstructions of segmental diaphyseal bone defects with massive allografts are related to complications like nonunion and fractures. A reconstruction of these defects with a cage filled with an impacted morsellized bone graft could be an alternative. The bone graft in these cages should ideally be loaded to prevent resorption. Loading of morsellized bone grafts however can cause instability. The goal of this study was to assess the stability of an impacted morsellized bone graft in a cage under dynamic loaded conditions in an in vitro reconstruction of a segmental diaphyseal bone defect. The second goal was to assess the influence of cage type, washing of the graft and bone-cage fit.
  
  
  METHODS
  Two different cage types were filled with impacted morsellized bone graft. The grafts were used washed and unwashed and in variable bone-cage fit conditions. We recorded the bone graft deformation in the cage under dynamic loaded conditions.
  
  
  RESULTS
  Stability appeared to be not very sensitive to the cage type and whether the bone chips were washed or not. However, quality of the fit of the cage with the bone segment was an important parameter and should be optimized during surgery.
  
  
  CONCLUSIONS
  Morsellized impacted bone graft in a cage is stable in dynamic loaded conditions in an in vitro reconstruction of a segmental diaphyseal bone defect. We believe that this method of reconstruction is a promising alternative for the reconstruction of large diaphyseal bone defects and should be tested relative to its biological merits in animal experiments.
authors.affiliation: Orthopaedic Research Laboratory and Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, 9101, 6500 HB Nijmegen, The Netherlands. P.Bullens@orthop.umcn.nl
authors.forename: Pieter H J
authors.initials: PH
authors.lastname: Bullens
authors.forename: Bart H W
authors.initials: BH
authors.lastname: Schreuder
authors.forename: Maarten C
authors.initials: MC
authors.lastname: de Waal Malefijt
authors.forename: Rene P H
authors.initials: RP
authors.lastname: Veth
authors.forename: Pieter
authors.initials: P
authors.lastname: Buma
authors.forename: Nico
authors.initials: N
authors.lastname: Verdonschot
mesh_terms: D000818:Animals; D001858:Bone Nails; D016025:Bone Transplantation / Q000379:methods; D002417:Cattle; D018483:Diaphyses / Q000601:surgery; D005269:Femur / Q000601:surgery*; D016348:Osseointegration; D019651:Plastic Surgery Procedures