Biologic osteosynthesis in the treatment of benign and malignant bone tumors.

Abstract

Mechanical augmentation with metal implants in the treatment of bone tumors limits magnetic resonance imaging and computerized tomography scan imaging due to the scattering effect. In addition, modulus of elasticity differences may cause chronic pain. We present a surgical technique in which cortical allografts are used as plates. This is a two-center experience focusing on functional and radiographic outcomes and complications. Under IRB approval, we performed a retrospective patient review. Demographics, treatment indications, tumor characteristics, and complications were collected. Radiographic studies were reviewed to determine the time to osseous incorporation. The last follow-up functional evaluation included the Musculoskeletal Tumor Society (MSTS) score, the Karnofsky scale, and Eastern Cooperative Oncology Group (ECOG). Thirty patients, seventeen female and thirteen male, 16-year-old in average were included. The most common diagnoses were the humeral aneurysmal bone cyst and unicameral bone cyst. The Median follow-up was 6 years. Cortical allograft incorporation median time was 8.8 months whereas allograft void bone incorporation was 3 months. The average time to full weight-bearing without impact activity was 3.1 months. The most common complication was symptomatic hardware. Other complications included a superficial infection successfully treated with antibiotics, a temporary radial nerve neuropraxia, and an allograft fracture requiring revision surgery. Most patients had an MSTS score higher than 90 (excellent). Patients with malignant tumors had ECOG of 0 and a Karnofsky score of 100. Biological osteosynthesis is a bone preserving and effective modality for mechanical augmentation with excellent functional results and low complication rates.