Intercalary bone graft of the tibia: case series and review of the literature

• Published in: European journal of orthopaedic surgery & traumatology 2020-12, Vol.30 (8), p.1421-1427
• Main Authors: Giannini, Claudio, Sambri, Andrea, Dalla Rosa, Mattia, Zucchini, Riccardo, Bochiccio, Valerio, Fiore, Michele, Donati, Davide Maria, De Paolis, Massimiliano
• Format: Article
• Language: English
• Subjects: Bone cancer; Fractures; Infections; Medicine; Medicine & Public Health; Original Article; Skin & tissue grafts; Surgical Orthopedics; Traumatic Surgery
• ISSN: 1633-8065; 1432-1068
• DOI: 10.1007/s00590-020-02718-y

Aims We report a series of patients treated with intercalary bone graft (IBG) of the tibia diaphysis (TD) after resection of primary bone tumors. The purpose of this study was to evaluate the mid- and long-term survival of TD IBG reconstruction in children and adults, characterizing patterns of success and failure. Methods A total of 35 patients were included in this retrospective study. Median age was 22 years (range, 8–57). This series included 19 patients (54.3%) treated with homologous bone graft alone and 16 patients (45.7%) treated combining intercalary allograft with fibular autograft. Complications were recorded according to Henderson classification. Results Median follow-up was 36 months (range, 1–165). Local recurrence occurred in 2 patients (5.7%) after 12 and 60 months, respectively. Major complications included graft fracture (9 cases), non-union (5 cases) and infection (4 cases). Other complications were axial deformity (2 cases), superficial infection (2 cases), compartmental syndrome (1 case). Conclusion Intercalary bone grafts of TD have been recommended as a reliable solution with long-term success rates and good functional outcome in more than 80% of patients. However, approximately half of the patients may require further surgeries to treat major complications (deep infection, delayed or non-union and graft fracture). Additional vascularized fibula graft may ameliorate final result.