Failed Allograft Reconstruction (Nonunion) for Malignant Bone

Reconstruction of bone defects after malignant tumor resection is often accomplished with fibular allograft. Fracture and nonunion are known complication of this technique. The following case will illustrate a method for treating a failed structural allograft utilizing autologous bone graft and external fixation. This is an alternative to salvage with a free vascularized fibular autograft. 1 Brief Clinical History This is a 30-year-old female who had resection of an osteosarcoma of the distal tibia as an adolescent. The defect was reconstructed with a fibular allograft which fractured and was augmented with bone graft and internal fixation. She presented with a long-standing deformity of the lower leg and a nonunion of the tibia. 2 Preoperative Clinical Photos and Radiographs See Figs. 1, 2, and 3. 3 Preoperative Problem List 1. Nonunion tibia and fractured fibular allograft with deformity 2. Retained hardware 3. Tibial shortening of 3 cm 4 Treatment Strategy The strategy was for a staged approach to limb salvage. The first stage was a reconstruction of the nonunion with acute deformity correction, preservation of the allograft as a structural device, removal of the internal fixation, bone grafting with autologous iliac crest bone graft, and fixation with a circular frame that provided constant compression. The second stage was extension of the external fixator to the proximal tibia and osteoplasty of the tibia and fibula for limb length equalization. *Email: fragomena@hss.edu *Email: afragomen@gmail.com Limb Lengthening and Reconstruction Surgery Case Atlas DOI 10.1007/978-3-319-02767-8_275-1 # Springer International Publishing Switzerland 2014