A technique for enhancing union of allograft to host bone.
The aim of limb-salvage surgery in malignant bone tumours in children is to restore function and eradicate local disease with as little morbidity as possible. Allografts are associated with a high rate of complications, particularly malunion at the allograft-host junction. We describe a simple technique which enhances union of allograft to host bone taking advantage of the discrepancy in size between the adult allograft and the child's bone. This involves lifting a flap of periosteum before resection from the host bone, which is then telescoped into the allograft medullary canal, which may require internal burring or splitting, for a distance of 1.5 to 2 cm and covering the bone junction with the periosteal flap. This is more stable than conventional end-to-end opposition. For each centimetre of telescoping the surface area available for bony union is increased more than three times. The periosteal flap also augments union. Additional surface fixation with a plate and screws is not necessary. We have used this technique in nine children, in eight of whom there was complete union at a mean of 16 weeks. Delayed union, associated with generalised limb osteoporosis, occurred in one. Early mobilisation, with weight-bearing by three weeks, was possible. There was only one fracture of the allograft.
Kumta
S M
SM
Prince of Wales Hospital, Chinese University of Hong Kong, New Territories, Shatin.
Leung
P C
PC
Griffith
J F
JF
Roebuck
D J
DJ
Chow
L T
LT
Li
C K
CK
D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D005260:Female; D005266:Femoral Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D012516:Osteosarcoma / Q000601:surgery*; D011183:Postoperative Complications; D013977:Tibia; D014184:Transplantation, Homologous