Three-Dimensional Virtual Bone Bank System Workflow for Structural Bone Allograft Selection: A Technical Report

Abstract

Structural bone allograft has been used in bone defect reconstruction during the last fifty years with acceptable results. However, allograft selection methods were based on 2-dimensional templates using X-rays. Thanks to preoperative planning platforms, three-dimensional (3D) CT-derived bone models were used to define size and shape comparison between host and donor. The purpose of this study was to describe the workflow of this virtual technique in order to explain how to choose the best allograft using a virtual bone bank system. We measured all bones in a 3D virtual environment determining the best match. The use of a virtual bone bank system has allowed optimizing the allograft selection in a bone bank, providing more information to the surgeons before surgery. In conclusion, 3D preoperative planning in a virtual environment for allograft selection is an important and helpful tool in order to achieve a good match between host and donor.

Does Intraoperative Navigation Assistance Improve Bone Tumor Resection and Allograft Reconstruction Results?

“…In addition, if the surgeon chooses an allograft to reconstruct the bone loss, these computerized techniques may help to decrease relevant complications two different ways. First, virtually selecting the appropriate donor bone with the use of a virtual bone bank will provide the surgeon with the most suitable graft to obtain the best anatomical fitting [13]. Second, the allograft can be precisely cut using intraoperative navigation techniques to perform osteotomies with extreme accuracy with what was previously virtually planned [9].…”

“…The fused images were reconstructed in a 3-D virtual platform and, according to the tumor, a virtual osteotomy was planned (Video 1) [14,15]. Allografts were selected from our digital bone bank to match the resected bone [13]. The selected allograft was fused in the tumor preoperative planning, and the osteotomies were also planned for the allograft in a 3-D virtual scenario (Video 2).…”

“…However, it will likely become more extensively used if it decreases the time of the procedures and shows that clinical outcomes are improved [4,16]; to date, these remain open questions. Navigation of both the tumor resection and the intraoperative manipulations of the allograft [15] as well as the preoperative allograft selection with a virtual bone bank may increase accuracy of the whole procedure [13]. This is aimed to reduce local tumor recurrences as a result of inaccuracies between the planned osteotomies and the osteotomies finally performed [14] and allograft complications resulting from technical errors during implantation; however, again, these purported advantages have been the subject of relatively little research to date [2,6].…”

Hemicortical Resection and Inlay Allograft Reconstruction for Primary Bone Tumors

“…First, perfect fitting of allografts may reduce fracture rates 26 . Three-dimensional CT scanning of allografts may aid in the selection of better-fitting grafts 27 . Second, osteotomies with sharp angles and screw fixation perpendicular to the bone axis (Figs.…”

CORR Insights®: Proximal Tibia Reconstruction After Bone Tumor Resection: Are Survivorship and Outcomes of Endoprosthetic Replacement and Osteoarticular Allograft Similar?

“…The chance to retain the native meniscus of the host might play an additional role in protecting the joint surface of the allograft from early degeneration [7]. Three-dimensional (3-D) CT scan-based planning and a virtual bone bank system have been proposed to achieve precise allograft matching [8].…”