Page 109 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

intercalary allografts provide a reasonable solution in the reconstruction of large osseous defects, with the possibility of preserving native joints while avoiding donor site morbidity13-18,21-26. In our study, a considerable percentage of graft- related failures was observed (15%), and 76% of the patients had one or more complications. The major complications were nonunion (40%), fracture (29%), and infection (14%). In addition, 26% of patients had a complication related to the osteosynthesis implants.
Our 17% failure rate was comparable with prior studies, ranging from 10% to
39% (see appendix). Although it is conceivable that adverse events are in uenced
by techniques and implants used in the earlier period of our study compared with
modern techniques, we found no di erences in graft survival and complication
rates between patients undergoing operations from 1989 to 1995 and those undergoing operations after 1995. 5
The most important risk factors for failure and complications in our study population were anatomical site other than tibia, patient age of eighteen years or older, allograft length of ≥15 cm, intramedullary nail-only xation, and diaphyseal localization. Four of seven humeral reconstructions failed. Previous studies did not show signi cant di erences in outcome between di erent anatomical sites14,17,19.
Tibial reconstructions are often thought to be demanding because of limited possibilities of soft-tissue coverage and poor vascularity22,27,28. Nevertheless, we found lower complication and nonunion rates for tibial reconstructions. The fact that femoral allografts displayed lower infection rates might be explained by the better soft-tissue coverage of the femur as compared with the tibia.
In our population, adult age was associated with a higher risk of failure. Previous studies have also shown associations between increasing age and higher incidences of delayed union or nonunion20,29.
Nail-only xation was associated with a higher risk of nonunion and the reoperation rate was lower after plate xation. Previous studies have shown that xation providing rigid stability might improve allograft incorporation13,30. Vander Griend stated that there is an important association between achieving stable xation, more easily done using plates, and decreasing nonunion30.
Previously, allograft length has been described as a risk factor for fracture20. Although associated with a higher risk of both failure and nonunion, we were unable to identify an association between graft length and fracture rate.
Diaphyseal localization was adversely related to the time to failure. Previously, unfavorable results have been reported for diaphyseal junctions13,15. These
Intercalary allografts
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