FRACTURES IN LARGE-SEGMENT ALLOGRAFTS

Sixteen of thirty-rive large-segment allografts that had been implante d after resection for neoplastic conditions, and had been followed for a minimum of thirty-six months, were found to have fractured at a mea n of twenty-six months after the implantation. Thirteen of the fractur es were treated operatively, and we found a lack of vascularization an d soft-tissue attachments to the graft at the fracture site. For seven fractured grafts, there were radiographic and clinical signs of union with the host bone. Eight of the sixteen grafts that had fractured we re salvaged with one or more autogenous bone grafts, and two healed sp ontaneously. Thus, twenty-nine of the thirty-five grafting procedures were considered to have been successful in that the initial objective - provision of a functional segment for skeletal replacement - had bee n achieved. Multivariate analysis revealed a significant correlation f or fracture in patients who were receiving chemotherapy when internal fixation of the graft had included devices that penetrated the cortice s of the graft (p < 0.05).