Did bone union differ between the two types of fibular graft?

Details

Bone defects after removal or curettage of musculoskeletal tumors are commonly reconstructed with structural fibular autografts or allografts, with considerable success. This study compared the clinical and radiographic results of nonvascularized autografts and allografts.

After tumor resection, 57 patients received a structural fibular autograft (30 patients) or allograft (27 patients). They included 30 males and 27 females, with a mean age of 22.8 years and an age range of 5 to 57 years. The defects were segmental in 24 cases and cavitary in 33. All patients with segmental reconstruction had internal fixation; one patient undergoing femoral reconstruction also had a monolateral external fixator. The researchers evaluated union, time to union, and complications. Mean follow-up was 46 months overall, 48.4 months in the allograft group and 42.3 months in the autograft group.

Radiographic union was reported in 46 patients (80.7%) after a mean of 5.9 months: 20 autografts at a mean of 6.8 months and 26 allografts at a mean of 5.1 months. Nonunion was reported in four allografts and seven autografts (19.3%). The abstract’s group counts for union and nonunion do not reconcile with the reported group sizes. There was no significant difference between the two graft types in union (p>0.05).

Graft rupture occurred in six patients—five autografts and one allograft—and all ruptures followed minor trauma. Complications were reported in eight patients (14%): transient peroneal nerve injury in three, wrist subluxation in two, infection in two, and Madelung's deformity. The authors concluded that nonvascularized autogenous or allogenous fibular grafts are a reliable method for reconstructing cavitary and segmental bone defects, with high success rates.