Reconstructing humerus defects after tumor resection using an intramedullary cortical allograft strut

Abstract

Background: The humerus is a frequent involvement site of benign bone lesions. Various reconstruction methods have been adopted to restore the defect after excavating the lesion and/or to treat associated pathological fractures. In this study, we reviewed the clinical outcomes of using allogenous cortical struts to the treatment of patients with large humeral defects resulting from benign bone lesions, and investigated the mid-term fate of implanted allografts.

Methods: From 1988 through 1997, 29 patients with space-occupying humeral lesions were treated by eradication of the tumor and reconstruction with an intramedullary allogenous cortical strut. No additional internal fixation was needed for support. Clinical data were recorded, and functional and radiographic results were evaluated.

Results: The sizes of defects after eradication of the lesions ranged from 61 to 122 ml (mean, 92 ml). The patients were followed for a mean of 8.8 years. One local recurrence was noted and was successfully treated by repeating the procedure. All patients achieved good to excellent functional results. Follow-up radiographs showed complete healing of the defects, with partial to complete incorporation of the allografts into the host bones. Children had a better chance of complete allograft incorporation than adults.

Conclusion: Intramedullary allogenous cortical struts act as internal splint mechanically and bone graft material biologically. The combined use of intramedullary allogenous cortical struts and chipped cancellous bone grafts provided good stability and healing probability for large osseous defects in the humerus without the need for implant fixation. Allograft incorporation occurred slowly in adults and might not achieve complete incorporation in adults.