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B ackground

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B ackground

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  1. A RETROSPECTIVE STUDYEVALUATION MASSIVE BONE LOSS RECONSTRUCTION WITH MASSIVE ALLOGRAFT 6 YEARS EXPERIENCE AT DR SOETOMO GENERAL HOSPITAL - SURABAYAA.Zulkarnain1,R.vinantius Munthe1, Ferdiansyah2, M.Edward2, T.Arief Dian21 Resident of Orthopaedic and TraumatologyDepartement of Airlangga University/ Dr Soetomo Hospital, Surabaya, Indonesia2 Consultant of Orthopaedic and TraumatologyDepartement of Airlangga University/ Dr Soetomo Hospital, Surabaya, Indonesia

  2. Background • Several methods treatment of large bone defects : (Bullens P , 2011) • Bone transport • Bone shorthening and lengthening • Bone graft • prostesis

  3. Background • At Dr. soetomo hospital, we do massive allograft reconstruction as an alternative treatment for massive bone lost caused by : -trauma, - infection and -after musculoskeletal tumor resection.

  4. Objective • This study evaluated the outcomes of reconstruction operation using massive allograft .

  5. Retrospective study

  6. The patients

  7. Reconstruction of Large Bone Defect

  8. EVALUATION • Mean period of follow up 3 years (range 1 – 6 years) • We evaluated: • FUNCTIONAL OUTCOME based on: Musculoskeletal Tumor Society scoring system-(MSTS) • RADIOLOGICAL OUTCOME based on evaluation of ISOLS radiological scoring .

  9. MSTS-ISOLS for functional (Enneking F, 1993) • Musculoskeletal Tumor Society (MSTS) functional scores : • ≥ 23 : Excellent result • 15–22 : Good result • 8–14 : Fair result • < 8 : Poor result

  10. Radiological (Glasser D, 1991) • Good : 25 – 32 • Moderate : 17 – 24 • Fair : 8 - 16

  11. Result Functional score Case numbers • ≥ 23 : Excellent result • 15–22 : Good result • 8–14 : Fair result • < 8 : Poor result 90 % exellent 10% good

  12. Result Radiological score Case numbers • Good : 25 – 32 • Moderate : 17 – 24 • Fair : 8 - 16 90% good 10% moderate

  13. Female/28 y.o/GCT distal radius S 3 years follow up

  14. Male/14 y.o/fibrous displasia cruris D 2 years follow up

  15. Discussion • The functional and radiological outcome for massive allograft reconstruction is excellent. • Massive allograft offers : (Delloye C et al ,2007) • Immediate structural support • anatomical reconstruction of the skeletal defect • biological union to host bone through callus formation • soft-tissue adherence around the grafted bone • the possibility of tendon reinsertion

  16. Complications • The incidence of nonunion is 11% with large frozen allografts.(Vander Griend R, 1994) • Fracture occurs in about 16% of massive allografts and is usually seen two years after implantation.(Berrey H Jr, 1990) • The reported incidence of infection varies between 6% and 13%.(Mankin H, 2005)

  17. Conclusion • Massive bone allografts is an immediate, anatomical, and biological alternative option for reconstructing large bone defects.

  18. Reference • Bullens P : Reconstruction of Segmental Long Bone Defects (Thesis), Radboud University Nijmegen, 2011. • Delloye C et al : Aspects of Current Management BoneAllograft, JBJS (Br), 2007, p.574-9 • Glasser D, Langlais F. The ISOLS radiological implants evaluation system. In: Langlais F, Tomeno B, eds. Limb salvage: major reconstructions in oncologic and non-tumoral conditions. Berlin Heidelberg New York: Springer,1991:23–31. • Enneking F, Dunham W, Gebhardt MC. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin. Orthop 286: 241 – 246, 1993. • Vander Griend R. The effect of internal fixation on the healing of large allografts. J Bone Joint Surg [Am] 1994;76-A:657-63. • Berrey H JrLord F, Gebhardt M, Mankin H. Fractures of allografts: frequency treatment and end-results. J Bone Joint Surg [Am] 1990;72-A:825-33. • Mankin H, Hornicek F, Raskin K. Infection in massive bone allografts. ClinOrthop2005;432:210-16.

  19. THANK YOU

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