title: Failed operative treatment in two cases of pseudarthrosis of the clavicle using internal fixation and bovine cancellous xenograft (Tutobone).
abstract: The most commonly reported technique of reconstructive surgery for congenital pseudarthrosis of the clavicle involves resection of the pseudarthrosis, insertion of autologous iliac crest bone graft and internal fixation. In an attempt to avoid the potential complications of iliac crest bone graft harvest we used bovine cancellous xenograft (Tutobone). Two cases of pseudarthrosis of the clavicle treated with resection of the pseudarthrosis, Tutobone graft and internal fixation are presented. Both cases resulted in treatment failures, which were associated with significant osteolysis and failure of incorporation of the graft material. This required removal of the loose metal work and debridement of the failed graft material. We would caution surgeons against the use of Tutobone as a graft material in the surgical management of pseudarthrosis of the clavicle. The level of evidence was level IV case series.
authors.affiliation: Department of Orthopaedics, Queen Alexandra Hospital, Portsmouth, UK. rre72@yahoo.co.uk
authors.forename: Robin R
authors.initials: RR
authors.lastname: Elliot
authors.forename: Robert H
authors.initials: RH
authors.lastname: Richards
mesh_terms: D000818:Animals; D016025:Bone Transplantation / Q000379:methods*; D002417:Cattle; D002675:Child, Preschool; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D016348:Osseointegration; D011475:Prosthesis Failure; D011542:Pseudarthrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D014183:Transplantation, Heterologous