Allograft fractures revisited

A retrospective review of patients with allograft fractures was done at the authors' institution. Between 1974 and 1998, 185 of 1046 (17.7%) structura l allografts fractured in 183 patients at a mean of 3.2 years after transpl antation. Initial allograft fixation included internal fixation with plates and screws in 181 patients. Patients with grafts that were longer than the average length (15.5 cm) tended to have worse results. Adjuvant therapy ha d no effect on fracture rate. Seventy-three patients with fractures had oth er allograft complications. Infection and nonunion with allograft fracture significantly worsened the outcome. The incidence of fracture in the patien ts with osteoarticular and arthrodesis transplants was significantly higher than those patients who had intercalary and composite reconstructions. Tre atment of the allograft fractures included open reduction and internal fixa tion in 41 patients, reconstruction with a new allograft in 38, allograft-p rosthesis composite in five, oncologic prosthesis in 19, amputation in 15, arthroscopic removal of loose bodies in three, resurfacing of fractured ost eoarticular allograft surfaces in 39, allograft removal and cement spacer p lacement in 15. Twenty patients did not receive treatment. Eight of the fra ctures in patients who were not treated healed spontaneously. Outcomes were judged as excellent in nine patients (4.9%), good in 72 patients (38.9%), fair in 17 patients (9.2%), and in 85 patients (45.9%) the allograft recons truction failed.