Benjamin J Miller1, Walter W Virkus. 1. Rush Orthopaedic Oncology, Rush University Medical Center, Chicago, IL, USA. bmiller4764@gmail.com
Abstract
BACKGROUND: Although intercalary allograft reconstructions are commonly performed using intramedullary devices, they cannot generate compression across host-allograft junctions. Therefore, they sometimes are associated with gap formation and suboptimal healing conditions. QUESTIONS/PURPOSES: We describe a new technique and present preliminary results for intercalary allograft reconstructions for tumors using a compressible intramedullary nail. PATIENTS AND METHODS: We retrospectively reviewed 10 patients (19 host-allograft junctions) who underwent intercalary allograft reconstruction using the compression nailing technique. Two patients were excluded as they had additional vascularized fibular autografts, leaving 15 junctions in eight patients for analysis. Three of the intercalary reconstructions had supplemental plate fixation at one junction. All patients received host bone reamings and cancellous allograft and one had bone marrow aspirate and demineralized bone matrix in addition to the cancellous allograft. The minimum followup was 3 months (mean, 18 months; range, 3-39 months). RESULTS: Thirteen of 15 junctions healed without additional surgery. Two diaphyseal-diaphyseal junctions did not unite after allograft arthrodeses. One patient underwent revision for nonunion 8 months after the initial procedure, with subsequent healing. The second patient had no evidence of union at 6 months, after which he was lost to followup. There were no allograft fractures or infections in any reconstruction. One patient died of metastatic renal cell carcinoma, and one patient had multicentric local soft tissue recurrences of a periosteal osteosarcoma requiring resection. CONCLUSIONS: Our early observations indicate newer compressible intramedullary nails reliably address junctional gap formation, providing for a high rate of union while retaining the long-term benefits of intramedullary stabilization. LEVEL OF EVIDENCE: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
BACKGROUND: Although intercalary allograft reconstructions are commonly performed using intramedullary devices, they cannot generate compression across host-allograft junctions. Therefore, they sometimes are associated with gap formation and suboptimal healing conditions. QUESTIONS/PURPOSES: We describe a new technique and present preliminary results for intercalary allograft reconstructions for tumors using a compressible intramedullary nail. PATIENTS AND METHODS: We retrospectively reviewed 10 patients (19 host-allograft junctions) who underwent intercalary allograft reconstruction using the compression nailing technique. Two patients were excluded as they had additional vascularized fibular autografts, leaving 15 junctions in eight patients for analysis. Three of the intercalary reconstructions had supplemental plate fixation at one junction. All patients received host bone reamings and cancellous allograft and one had bone marrow aspirate and demineralized bone matrix in addition to the cancellous allograft. The minimum followup was 3 months (mean, 18 months; range, 3-39 months). RESULTS: Thirteen of 15 junctions healed without additional surgery. Two diaphyseal-diaphyseal junctions did not unite after allograft arthrodeses. One patient underwent revision for nonunion 8 months after the initial procedure, with subsequent healing. The second patient had no evidence of union at 6 months, after which he was lost to followup. There were no allograft fractures or infections in any reconstruction. One patient died of metastatic renal cell carcinoma, and one patient had multicentric local soft tissue recurrences of a periosteal osteosarcoma requiring resection. CONCLUSIONS: Our early observations indicate newer compressible intramedullary nails reliably address junctional gap formation, providing for a high rate of union while retaining the long-term benefits of intramedullary stabilization. LEVEL OF EVIDENCE: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
Authors: Gene R DiResta; Mark W Manoso; Anwar Naqvi; Pat Zanzonico; Peter Smith-Jones; Wakenda Tyler; Carol Morris; John H Healey Journal: Clin Orthop Relat Res Date: 2008-04-26 Impact factor: 4.176