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Allograft nonunion
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Table 3. Overview of literature on allograft reconstructions and reported information on allograft-host nonunions
Data
Aponte-Tinao (2012)
Ortiz-Cruz (1997)
Bus (2014)
Frisoni (2012)
Muscolo (2004)
Current study
No. of patients Type of reconstruction Localizations (%)
83
ICA (100)
100
ICA (100)
87
ICA (93)
HGR (7)
FEM (51), TIB (39), HUM (8), RAD (2)
Median 84 months (25- 262)
101
ICA (74) HGR (26) FEM (100)
59
ICA (100)
57
ICA (100)
Follow-up (range, unless otherwise speci ed)
Fixation method (%)
Median 61 months (24-182)
Median 112 months (24-238)
Median 60 months (24-262)
Median 103 months (95% CI 73-134)
Osteotomy type (%) Reconstruction length (range)
N/R
<10 cm: 16%;
TRV (80), STC (20) N/R
De nition of nonunion
N/R
10-18 cm: 15%
>18 cm: 28% Radiographically; presence of radiolucent line or absence of smooth external continuity of cortical bone at 12 months.
30
Radiographically; lack of continuity in three cortices after 12 months.
Clinically; reoperation for nonunion.
Radiographic; lack of continuity in three cortices after 12 months.
N/R
Radiographically; lack of continuity in two or more cortices after 12 months. Clinically; reoperation for nonunion.
Nonunion - patients (%)
Nonunion -osteotomies (%) Notes regarding nonunion
24 13
Radiographic; 26. Clinical; 40.
N/R
45
15 9
27
FEM (100)
FEM (38), TIB (37), HUM (18), RAD (3), FIB (3), ULN (3) Median 67 months (24-220)
FEM (68), TIB (32)
FEM (68), TIB (32)
PLT (65), IMN (19), SCR (16)
TRV (100)
N/R
S-PLT (80), D-PLT (13), IMN (7)
PLT (71), IMN + PLT (14), IMN (9), SCR (6)
TRV (100)
Median 14 (5-30)
PLT (90), IMN (10)
PLT (52), IMN (33), SCR (16)
TRV (100)
N/R
S-PLT (55), D-PLT (41), IMN + PLT (5)
TRV (100)
Median 14 (5-30)
Higher risk for diaphyseal than for metaphyseal junctions. No in uence of xation type. All nonunions were salvaged with secondary surgery.
Only nonunions that were associated with other complications (infection, fracture) resulted in failure. No signi cant in uence
Lower risk in tibial reconstructions. Higher risk after xation with an intramedullary nail.
Patient age >18 years, use of postoperative chemotherapy, and osteotomy line distance >5 cm from the joint line were individual risk factors for nonunion.
Higher risk for diaphyseal than for metaphyseal junctions. Slightly higher risk for diaphyseal junctions xed with
The degree of contact at the junction was the most important factor.
15
N/R
18
of junction localization or xation type.
nails than for diaphyseal junctions xed with plates.
tibia; HUM, humerus; RAD, radius; FIB, bula; ULN, ulna. Fixation method: S-PLT, single plate (one long plate); D-PLT, double plates (one long plate combined with a separate smaller plate). Osteotomy type: TRV, transverse; STC, step cut. N/R, not reported.
Type of reconstruction: ICA, intercalary allograft; HGR, hybrid graft reconstruction (allograft + vascularized bular graft). Localizations: FEM, femur; TIB,