Vascularised bone grafting for fibrous dysplasia of the upper limb

Vascularized Bone Grafting Versus the 2-Stage Masquelet Technique for Upper-Extremity Bone Reconstruction: A Meta-Analysis

PURPOSE

Vascularized bone grafting (VBG) has been described as the technique of choice for larger bone defects in bone reconstruction, yielding excellent results at the traditional threshold of 6 cm as described in the literature. However, we hypothesize that the 2-stage Masquelet technique provides equivalent union rates for upper-extremity bone defects regardless of size, while having no increase in the rate of patient complications.

METHODS

A systematic literature review was conducted using PubMed and Scopus for outcomes after VBG and the Masquelet technique for upper-extremity bone defects of the humerus, radius, ulna, metacarpal, or phalanx (carpal defects were excluded). A meta-analysis was performed to compare outcomes following VBG and the Masquelet technique at varying defect sizes.

RESULTS

There were 77 VBG (295 patients) and 25 Masquelet (119 patients) studies that met inclusion criteria. Patients undergoing the Masquelet technique had defect sizes ranging from 0-15 cm (average 4.5 cm), while patients undergoing VBG had defect sizes ranging from 0-24 cm (average 5.9 cm). The union rate for Masquelet patients was 94.1% with an average time to union of 5.8 months, compared to 94.9% and 4.4 months, respectively, for VBG patients. We did not identify a defect size threshold at which VBG demonstrated a significantly higher union rate. No statistically significant difference was found in union rates between techniques when using multivariable logistic regression analysis.

CONCLUSION

There was no statistically significant difference in union rates between VBG and the Masquelet technique in upper-extremity bone defects regardless of defect size. Surgeons may consider the Masquelet technique as an alternative to VBG in large bone defects of the upper extremity.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Massive allograft of the tibia for a child with McCune-Albright syndrome: case presentation and surgical intervention

We hereby present a case of massive allografting of the tibia in a 9-year-old girl with McCune-Albright syndrome. Total replacement of the diaphysis and preservation of growth plates on both ends of the tibia was performed. After 5 years of follow-up, the graft is still intact and growth plates are active. We discuss the current knowledge about this syndrome, intervention modalities, as well as advantages and disadvantages of massive allografting.

Free vascularized fibular grafts have a high union rate in atrophic nonunions

Free vascularized fibular grafting currently is an extremely useful tool in the armamentarium of the orthopaedic, reconstructive surgeon. Certain problematic nonunions, aseptic or infected, have to be treated by vascularized bone grafts when previous operations are not successful. The common characteristics of these nonunions are several previous operations and fixations, bone atrophy and damage of the surrounding soft tissue, and frequently focal, active infection. After the bone and soft tissue debridement, the bony defect is bridged by a vascularized fibula strut. Depending on the recipient bone, different methods of internal fixation can be used, usually plates and external fixators. Free vascularized fibular grafts in recalcitrant, atrophic nonunions provide a high success rate. According to the results, this is a safe, reliable method that is indicated when a fracture does not heal after several surgeries, when there is an associated bone lost, and when infection is present.