SLR - January 2019 - Michael J. Huchital
Reference: Hollawell, S., Kane, B., Heisey, C., & Greenberg, P. (2018). The Role of Allograft Bone in Foot and Ankle Arthrodesis and High-Risk Fracture Management. Foot & Ankle Specialist.Scientific Literature Review
Reviewed By: Michael J. Huchital, DPM
Residency Program: NYU Langone Hospitals, Brooklyn, NY
Podiatric Relevance: Allograft bone in use of complicated fractures has long been an acceptable treatment augmentation as part of surgical repair and joint arthrodesis. In addition to being proven just as effective as autograft, allograft forgoes the risk of autograft bone harvest and potential complications at the harvest site. This article examines 41 procedures in 40 patients in which the cohort presented as “high risk,” demonstrating the efficacy of using allograft bone as a suitable augment to fracture management.
Methods: This was a level IV retrospective study reviewing 40 patients’ medical records and radiographs undergoing consecutive joint arthrodesis or fracture management. Patient parameters were number of days from procedure to radiographic union, age, gender, tobacco use, body mass index, Diabetes Mellitus and if the patient’s injury or disability was secondary to a work-related issue. The authors recorded the amount of allograft used. Inclusion criteria were use of the bone graft material in arthrodesis in the management of high-risk fractures. Union was defined as consolidation on plain radiographs. Exclusion criteria included Charcot neuroarthropathy or lack of sufficient follow-up.
Results: Patient variables that were evaluated were BMI, tobacco use and DM. The amount of allograft bone utilized ranged from 1–20 mL. Full osseous consolidation was seen in 97.5 percent of cases. The average age was 47.3 years. Complications included a deep-vein thrombosis, and two cases of wound dehiscence with subsequent superficial infection in a tibial stress fracture were also noted and resolved with conservative care. One patient developed a nonunion.
Conclusion: The use of allograft bone in high-risk fracture management and arthrodesis was examined in 41 procedures on a cohort of 40 patients deemed as high risk due to medical comorbidities. Additionally, several of the patients were injured while working, which has been demonstrated to result in suboptimal outcomes or prolonged healing. This article concludes that allograft bone may be a suitable augment in reducing time to union in high-risk fractures or joint arthrodesis in the foot and ankle. Additionally, the authors claim that allograft is a sufficient substitute to use of autograft without incurring the risk of harvest site complications.