Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta

Abstract

Background: Patients with osteogenesis imperfecta often develop nonunions, as internal fixation has limited applicability in this condition. We report the outcomes of a modified "sandwich technique" in the treatment of long-bone nonunions in patients with osteogenesis imperfecta; this technique brings circumferential stabilization and normal collagen to the nonunion site. Methods: From May 2003 through February 2012, twelve patients (eight females, four males; median age, 39.0 years; range, eleven to seventy-eight years) who had osteogenesis imperfecta (Sillence type I [three], type III [eight], and type IV [one]) and a combined total of thirteen nonunions (two humeral, two radial, three femoral, four tibial, and two ulnar; median duration, 15.0 months; range, six to 204 months) were treated at our institution with compressed sandwich allograft cortical struts. The struts were fashioned to be wide enough to allow for increased osteoconductive surface area and to approximate a hemicylindrical shape. Treatment history and demographics data were acquired through retrospective chart review. Follow-up radiographs were analyzed by two attending orthopaedic surgeons to determine radiographic findings. The median follow-up time was 4.6 years (range, 2.1 to 10.3 years).Results: All thirteen nonunions, including one requiring a second graft procedure, healed with abundant, smooth allograft incorporation, resulting in an initial healing rate of 92% because of a refracture in one patient. This patient's nonunion ultimately healed with additional allograft struts and a new intramedullary rod. One patient required removal of prominent screws. The final follow-up examinations revealed no pain or refracture at the original nonunion site. All patients regained their prefracture level of function.Conclusions: Sandwich allograft struts constitute a durable, safe method for the stabilization and healing of persistent long-bone nonunions in patients with osteogenesis imperfecta. All patients showed incorporation of the allograft to the native diaphysis.

Pathophysiology and therapeutic options in osteogenesis imperfecta: an update

“…105 Recently, stabilization of long-bone nonunion fractures was performed through compressed sandwich allograft cortical struts method in 12 OI patients (aged 11-78 years) at 13 sites of nonunion fractures. 106 All nonunions healed with allograft incorporation to the bone diaphysis, with all patients recovering to the prefracture level of function, thus reinforcing this approach as durable and safe. 106 …”

“…106 All nonunions healed with allograft incorporation to the bone diaphysis, with all patients recovering to the prefracture level of function, thus reinforcing this approach as durable and safe. 106 …”

“…The majority of these fractures occur in early childhood, directly affecting the child's motor development. [106][107][108] The clinical type and severity of OI have a major bearing on functional status, including motor development, range of joint motion, and muscle strength. 107 Children with moderate to severe forms of OI have greater functional limitation, which negatively affects the development of motor function and the level of ambulation when compared to children with mild forms of OI.…”

Scaphoid non-union in osteogenesis imperfecta

“…Another group had disappointing results, with all three humeral non-unions failing to unite 5. An alternative and more recently described surgical technique involves the use of sandwich allograft with or without supplementary intramedullary nailing 6. A section of long bone fresh frozen allograft is cut longitudinally, and reassembled around the debrided and opposed long bone non-union site.…”

Surgery of False Joints of Long Tubular Bones in Children Using the Shape Memory Materials

“…radkevich.andrey@yandex.ru combination with cell technologies) as well as fixation by means of intramedullary osteosynthesis, plate metal structures in combination with the external fixation devices or without them [1,[4][5][6][7][8][9][10][11][12][13][14]. The results of these technologies' application are often not efficient due to insufficient bone regeneration properties in the damage area, the inevitability of the partial or complete transplant resorption.…”