Outcome of bone allografts in orthopaedic patients

Objective: The objective of this study is to determine the outcome of bone allograft in orthopaedics patients.

Material and Methods: This descriptive case series was conducted in the Department of Orthopaedic and Trauma, Northwest General  Hospital  Peshawar  from  August  10,  2018  –  February  10,  2019.  Thirty-six  patients  were  selected  using  non-prob-ability consecutive sampling technique. Patients between ages 18-60 years, of either gender with confirmed diagnosis of structural bone defect requiring bone grafting were included. However, patients with metabolic bone disorders associated with poor bone healing, active infection at grafting site and terminally ill patients were excluded.

Results: Of the thirty-six patients included, there were 27 (75%) males and 9 (25%) females with a mean age of 38.4 ± 15.4 years.  The  most  common  diagnosis  among  the  study  patients  was  traumatic  femur  shaft  defect,  which  comprised  of  10  (27.8%) patients followed by traumatic tibial shaft defect with 6 (16.7%) patients and traumatic femoral subtrochanteric de-fects were in 5 (13.9%) patients. Other indications for allograft placement in our study population was femoral shaft defect after tumor resection (n = 4, 11.1%), neck of femur non-union (n = 3, 8.3%), tibial plateau fracture (n = 2, 5.6%), femoral sub-trochanteric defect after tumor resection (n = 1, 2.8%). The most common surgical procedures included Dynamic Condylar Screw in 9 (25%) patients, external fixation in 8 (22.2%), plating in 7 (19.4%), 5 (13.9%) Interlocking Nail, 3 cases (8.3%) each of dynamic Hip Screw and scraping and one (2.8%) case of posterior spinal fixation. Postoperatively, infection was noted in 4 (11.1%) of cases, instability in 5 (13.9%) cases, non-union in 4 (11.1%) and tumor recurrence in 3 (8.3%) of patients.

Conclusion: Increase in treatment modalities (use of chemotherapy in combination with radiotherapy) leads to significant increase in complications associated with the use of structural allograft including infection and non-union. A great deal of ef-fort is required to prevent these complications that adversely affect the survival of grafted tissue including infection, fracture, recurrence of disease and non-union.Key words: Outcome, bone allograft, orthopaedic patients.