Predictors of complications in heat‐treated autograft reconstruction after intercalary resection for malignant musculoskeletal tumors of the extremity

Abstract

Our results can provide useful information to devise possibly novel clinical approaches to patients requiring intercalary reconstruction of the extremity.

Factors Influencing Nonunion and Fracture Following Biological Intercalary Reconstruction for Lower‐Extremity Bone Tumors: A Systematic Review and Pooled Analysis

“… 22 Several authors have previously recommended using vascularized fibula grafts in combination with allografts or devitalized autografts to reduce nonunion rate. 7 , 21 , 38 In our study, a lesser proportion of reconstructions had nonunion with a vascularized fibula graft than without one (OR = 0.6, 95% CI: 0.34–1.07, p = 0.086), although this failed to reach statistical significance.…”

“…A comparative study with a small sample size (29 patients) reported that vascularized fibula grafts reduced the risk of allograft revision although there were no statistically significant differences in union rate or time to union between reconstruction with or without such a graft 22 . Several authors have previously recommended using vascularized fibula grafts in combination with allografts or devitalized autografts to reduce nonunion rate 7,21,38 . In our study, a lesser proportion of reconstructions had nonunion with a vascularized fibula graft than without one (OR = 0.6, 95% CI: 0.34–1.07, p = 0.086), although this failed to reach statistical significance.…”

“…The definition of nonunion is inconsistent across studies; in most cases, union is defined radiologically (bone bridging at least three of the four cortices in biplanar X‐rays), while some studies 14,49,50 have included a clinical requirement (absence of pain on full weight‐bearing). Nonunion is regarded as a failure of union 1 year after operation 2,11,21,40 ; however, some studies defined nonunion as no progression of union at 6 months after operation 29,46 or when surgical intervention is needed to facilitate union 33,34,38 . Because of the variability in follow‐up times (mean, 82 months; range: 16–313 months) across included studies, fractures may be underreported because they were overlooked in studies with a shorter follow‐up duration.…”

“…Nonunion is regarded as a failure of union 1 year after operation 2 , 11 , 21 , 40 ; however, some studies defined nonunion as no progression of union at 6 months after operation 29 , 46 or when surgical intervention is needed to facilitate union. 33 , 34 , 38 Because of the variability in follow‐up times (mean, 82 months; range: 16–313 months) across included studies, fractures may be underreported because they were overlooked in studies with a shorter follow‐up duration. These discrepancies between studies could undermine the validity of comparisons of nonunion rates and fracture rates.…”

Joint-preservation surgery for bone sarcoma in adolescents and young adults

“…Tumor-devitalized autograft reconstruction is a unique biological procedure involving reimplantation of tumor-bearing bone after the following devitalized treatment: extracorporeal irradiation [45][46][47][48][49][50][51], pasteurization [52][53][54][55][56][57], and freezing [58][59][60][61][62][63][64][65][66]. The advantages of the autograft include a perfect fit to the original site, no risk of viral transmission or immune response problems, easy attachment of capsules, ligaments and tendons, preservation of bone stock, biological stability after graft union, and absence of donor-site morbidity.…”