Combined Massive Allograft and Intramedullary Vascularized Fibula as the Primary Reconstruction Method for Segmental Bone Loss in the Lower Extremity

Houben, Rudolph H.; Rots, Mathijs; Heuvel, Stefanie C. M. van den; Winters, H.A.H.

doi:10.2106/jbjs.rvw.18.00166

Cited by 17 publications

(14 citation statements)

References 35 publications

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“…In case of missing data, an attempt to contact the corresponding author was made; in case of studies with data upon request, they were asked to the corresponding author. Delayed union was defined as the failure to reach bone union within 6 months after reconstruction, whereas non-union was defined as the failure to reach bone union at the time of the last follow-up after 6 months 12 . After independent data collection, the reviewers compared the extracted data.…”

Section: Methodsmentioning

confidence: 99%

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

Feltri¹,

Solaro

Martino

et al. 2022

Sci Rep

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To understand the potential and limitations of the different available surgical techniques used to treat large, long-bone diaphyseal defects by focusing on union, complication, re-intervention, and failure rates, summarizing the pros and cons of each technique. A literature search was performed on PubMed, Web of Science, and Cochrane databases up to March 16th, 2022; Inclusion criteria were clinical studies written in English, of any level of evidence, with more than five patients, describing the treatment of diaphyseal bone defects. The primary outcome was the analysis of results in terms of primary union, complication, reintervention, and failure rate of the four major groups of techniques: bone allograft and autograft, bone transport, vascularized and non-vascularized fibular graft, and endoprosthesis. The statistical analysis was carried out according to Neyeloff et al., and the Mantel–Haenszel method was used to provide pooled rates across the studies. The influence of the various techniques on union rates, complication rates, and reintervention rates was assessed by a z test on the pooled rates with their corresponding 95% CIs. Assessment of risk of bias and quality of evidence was based on Downs and Black’s “Checklist for Measuring Quality” and Rob 2.0 tool. Certainty of yielded evidence was evaluated with the GRADE system. Seventy-four articles were included on 1781 patients treated for the reconstruction of diaphyseal bone defects, 1496 cases in the inferior limb, and 285 in the upper limb, with trauma being the main cause of bone defect. The meta-analysis identified different outcomes in terms of results and risks. Primary union, complications, and reinterventions were 75%, 26% and 23% for bone allografts and autografts, 91%, 62% and 19% for the bone transport group, and 78%, 38% and 23% for fibular grafts; mean time to union was between 7.8 and 8.9 months in all these groups. Results varied according to the different aetiologies, endoprosthesis was the best solution for tumour, although with a 22% failure rate, while trauma presented a more composite outcome, with fibular grafts providing a faster time to union (6.9 months), while cancellous and cortical-cancellous grafts caused less complications, reinterventions, and failures. The literature about this topic has overall limited quality. However, important conclusions can be made: Many options are available to treat critical-size defects of the diaphysis, but no one appears to be an optimal solution in terms of a safe, satisfactory, and long-lasting outcome. Regardless of the bone defect cause, bone transport techniques showed a better primary union rate, but bone allograft and autograft had fewer complication, reintervention, and failure rates than the other techniques. The specific lesion aetiology represents a critical aspect influencing potential and limitations and therefore the choice of the most suitable technique to address the challenging large diaphyseal defects.

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Section: Methodsmentioning

confidence: 99%

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

Feltri¹,

Solaro

Martino

et al. 2022

Sci Rep

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show abstract

“…This technique is supposed to combine the benefits of a ‘real biological’ reconstruction, the vascularized fibula, with the immediate mechanical properties of a massive allograft. 30 The vascularized fibula can be placed inside a femoral allograft or by using the so called ‘hot dog’ technique. Osteosynthesis is performed by a lateral plate bridging the allograft.…”

Section: Biological Reconstructionmentioning

confidence: 99%

“…Many mechanical complications occurred requiring numerous revisions with the least number of reoperations in vascularized fibula augmented with allograft. 30 …”

Section: Biological Reconstructionmentioning

confidence: 99%

Lower limb reconstruction for malignant bone tumours in children

Wirth

Manfrini

Mascard

2021

Journal of Children's Orthopaedics

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Malignant bone tumours of the lower limb represent the majority of cases in both osteosarcoma and Ewing sarcoma in the growth period. Surgical treatment represents a key element of treatment. Different localizations and age groups require a differentiated surgical approach. Life and limb salvage are first on the list of treatment goals, followed by functional and cosmetic considerations. This review article delivers and discusses current surgical treatment strategies and outcomes for lower limb malignant bone tumours in children.

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“…Among these techniques, autologous bone grafts [4], arthroplasties, induced membrane technique with secondary bone grafting [5,6] and vascularized bone transfers are the most commonly used for large bone defects. Those techniques can be used alone or in combination [7][8][9]. However, despite this wide range of reconstructive options, all these methods have drawbacks: morbidity of the donor site [10][11][12], infections, implant failure, fracture, nonunion, necrosis and poor functional results [2,10].…”

Section: Introductionmentioning

confidence: 99%

Decellularized vascularized bone grafts as therapeutic solution for bone reconstruction: A mechanical evaluation

et al. 2023

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Introduction Large bone defects are challenging for surgeons. Available reimplanted bone substitutes can’t properly restore optimal function along and long term osteointegration of the bone graft. Bone substitute based on the perfusion-decellularization technique seem to be interesting in order to overcome these limitations. We present here an evaluation of the biomechanics of the bones thus obtained. Material and methods Two decellularization protocols were chosen for this study. One using Sodium Dodecyl Sulfate (SDS) (D1) and one using NaOH and H2O2 (D2). The decellularization was performed on porcine forearms. We then carried out compression, three-point bending, indentation and screw pull-out tests on each sample. Once these tests were completed, we compared the results obtained between the different decellularization protocols and with samples left native. Results The difference in the means was similar between the tests performed on bones decellularized with the SDS protocol and native bones for pull-out test: +1.4% (CI95% [-10.5%– 12.4%]) of mean differences when comparing Native vs D1, compression -14.9% (CI95% [-42.7%– 12.5%]), 3-point bending -5.7% (CI95% [-22.5%– 11.1%]) and indentation -10.8% (CI95% [-19.5%– 4.6%]). Bones decellularized with the NaOH protocol showed different results from those obtained with the SDS protocol or native bones during the pull-out screw +40.7% (CI95% [24.3%– 57%]) for Native vs D2 protocol and 3-point bending tests +39.2% (CI95% [13.7%– 64.6%]) for Native vs D2 protocol. The other tests, compression and indentation, gave similar results for all our samples. Conclusion Vascularized decellularized grafts seem to be an interesting means for bone reconstruction. Our study shows that the decellularization method affects the mechanical results of our specimens. Some methods seem to limit these alterations and could be used in the future for bone decellularization.

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Combined Massive Allograft and Intramedullary Vascularized Fibula as the Primary Reconstruction Method for Segmental Bone Loss in the Lower Extremity

Cited by 17 publications

References 35 publications

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis

Lower limb reconstruction for malignant bone tumours in children

Decellularized vascularized bone grafts as therapeutic solution for bone reconstruction: A mechanical evaluation

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