Fig. 14.1
Form of bone graft. (a) Osteoarticular graft, (b) composite graft, (c) intercalary graft, (d) inlay graft, (e) pelvic graft
(d)
Fixation method: With an inlay graft, the graft bed is surrounded by fresh autogenous bone, and since the stability of the graft is good, fixation with only a screw is usually sufficient. An intercalary graft is prone to pseudarthrosis, so it is important to fix a strong bone junction and use an intramedullary nail and/or a double plate. In particular, at the junction of long bones, if there is an abundance of fresh cancellous bone, bone union is expected to be readily achieved. Therefore, in some cases, an autogenous bone graft should also be used at the junction.
(e)
Adjunct therapy: The bed of the pasteurized bone may have poor blood flow after tumor resection because of loss of soft tissue. Alternately, not only the tumor in the pasteurized bone but also the bone tissue itself may have been devitalized, resulting in poor bone union and susceptibility to infection. For this reason, and in the hope of preventing infection and achieving early resumption of blood flow to the bone, it may be necessary to also use a cover consisting of a muscle flap or musculocutaneous flap having good blood flow, or a vascularized autogenous bone graft.
14.3.2 Clinical Results with Pasteurized Bones
14.3.2.1 Subjects
We have previously applied the pasteurization method for bone grafting to 32 patients with primary malignant tumors of bones between 1989 and 2014. From these patients, the subjects of this study were those who had been followed up for at least 1 year and those who were excluded because of complications within less than 1 year. In two patients, follow-up was discontinued at less than 1 year because of local recurrence, but they were excluded because the cause of recurrence was aside from the pasteurized bone. Four other patients died less than 1 year after the surgery and were excluded. As a result, 26 patients were excluded. The median duration of follow-up was 106.5 months (Table 14.1).
Table 14.1
Summary of patient data, form of graft, and result of functional evaluation of pasteurized bone
No. | Age | Diagnosis | Affected bone | Size of graft (cm) | Form of graft | Fixation | Autobone graft | Complication | Additional surgery | Period to union (month) | Radiographic evaluation of resorption |
|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 10 | EWING | Femur | 23.5 | Osteoarticular | Intramedullary nail with cement | (–) | Infection, pseudarthrosis, resorption | TFR | Poor | |
2 | 16 | EWING | Humerus | 11 | Osteoarticular | Plate and intramedullary nail with cement | Iliac bone | Pseudarthrosis | (–) | Poor | |
3 | 28 | EWING | Humerus | 19 | Osteoarticular | Intramedullary nail with cement | Pedicled scapula and iliac bone | (–) | (–) | 13 | Poor |
4 | 17 | OS | Humerus | 17 | Osteoarticular | Intramedullary nail with cement | (–) | Infection, pseudarthrosis | Debri and LD flap | Poor | |
5 | 28 | OS | Tibia | 24 | Osteoarticular | Intramedullary nail with cement | Iliac bone | Infection | Amputation | 8 | Fair |
6 | 12 | OS | Tibia | 12 | Osteoarticular | Intramedullary nail | Iliac bone | Infection, resorption | 7 | Poor | |
7 | 18 | EWING | Humerus | 14 | Osteoarticular -> composite | Intramedullary nail with cement | Iliac bone | Resorption | Humeral head prosthesis | 15 | Poor |
8 | 11 | OS | Tibia | 12.5 | Osteoarticular -> composite | Intramedullary nail with cement | Iliac bone | Joint instability, resorption | TKR | 4 | Poor |
9 | 11 | OS | Femur | 18 | Osteoarticular -> composite | Intramedullary nail with cement | Iliac bone | Pseudarthrosis, infection | TKR -> amputation | 6 m after 2nd op. with autobone graft | Good |
10 | 13 | OS | Femur | 20 | Osteoarticular -> composite | Intramedullary nail with cement | Iliac bone | Pseudarthrosis, joint instability, loosening | TKR->TFR | 13 m after 2nd op. with autobone graft | Poor |
11 | 61 | LYMPHOMA | Femur | 25 | Composite | Femoral head prosthesis with cement fixation and plate | Iliac bone | Infection | Removal of prosthesis | 12 | Good |
12 | 14 | OS | Femur | 16 | Composite | TKA prosthesis with cement fixation | (–) | Pseudarthrosis, loosening | Rotation plasty | Poor | |
13 | 11 | OS | Femur | 4 | Composite | TKA prosthesis without cement fixation and plate | (–) | (–) | (–) | 12 | Good |
14 | 24 | Paro.OS | Femur | 10 | Composite | TKA prosthesis with cement fixation | Femoral local bone | (–) | (–) | 7 | Fair |
15 | 34 | OS | Femur | 6 | Intercalary | Intramedullary nail | FVFG and iliac bone | Pseudarthrosis | Autobone graft | 7 | Fair |
16 | 17 | OS | Tibia | 15 | Intercalary | Intramedullary nail and plate | Iliac bone | Fracture, pseudarthrosis | Autobone graft and plate | 6 m after 2nd op. with autobone graft | Good |
17 | 5 | OS | Femur | 18 | Intercalary | Plate | FVFG | Pseudarthrosis, resorption | Turnup plasty | Poor
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