A quantitative CT analysis of fibula inlayed in a massive allograft for femoral diaphysis reconstruction

• Published in: Journal of bone oncology 2023-08, Vol.41, p.100488, Article 100488
• Main Authors: Lesensky, Jan, Belzarena, Ana C., Masek, Martin, Matejovsky jr, Zdenek
• Format: Article
• Language: English
• Subjects: Allograft; CT densitometry; Femur diaphysis reconstruction; Research Paper; Tumor; Vascularized fibula
• ISSN: 2212-1374; 2212-1366; 2212-1374
• DOI: 10.1016/j.jbo.2023.100488

•In diaphyseal reconstructions for bone tumor resection, massive bone allografts (MBA) the gold standard.•However, they present an elevated risk of infection, nonunion and structural failure.•A viable fibula enhances incorporation of the allograft and decreases the risk for both structural failure and infection.•Consecutive CT scans proved to be a reliable method for assessing fibular vitality. In diaphyseal reconstructions for bone tumor resection, massive bone allografts (MBA) are historically regarded as the gold standard. However, these are not without complications, and they present an elevated risk of infection, nonunion and structural failure that increases over time as the graft remains largely avascular. To counteract this disadvantage, a combination of allograft with a vascularized fibula has been proposed. The aim of our study was to objectively review the results of combined vascularized fibula-allograft constructs compared to plain allograft reconstruction for bone defects in tumor patients and to assess fibular vitality predictive factors from imaging studies. Our data was retrospectively reviewed for patients with femoral diaphysis reconstructions in the past ten years. Ten patients (six males and four females) with a mean average follow-up time of 43.80 months (range 20–83, SD 18.17) with combined graft (Group A) were included in the study. As a control group 11 patients (six males and five females) with a mean average follow-up of 56.91 months (range 7–118, SD 41.33) with a simple allograft reconstruction were analyzed (Group B). Demographic and surgical data, adjuvant therapy as well as complications were analyzed in both groups. Both groups were assessed with plain radiographs for bony fusion at the osteotomy sites. Patients in “Group A” had consecutive CT scans at 6 months and then annually to check for potential bone stock and bone density changes. We analyzed total bone density as well as incremental changes in three different areas of the reconstruction. This was done at two defined levels for each patient. Only patients with at least two consecutive CT scans were included in the study. There were no statistical differences between the groups in terms of demographics, diagnosis or adjuvant therapy (p = 1.0). The mean average surgical time (599.44 vs 229.09) and mean average blood loss (1855.56 ml vs. 804.55 ml) were significantly higher in the combined graft group A (p