Intercalary bone graft of the tibia: case series and review of the literature

Abstract

Aims: We report a series of patients treated with intercalary bone graft (IBG) of the tibia diaphysis (TD) after resection of primary bone tumors. The purpose of this study was to evaluate the mid- and long-term survival of TD IBG reconstruction in children and adults, characterizing patterns of success and failure.

Methods: A total of 35 patients were included in this retrospective study. Median age was 22 years (range, 8-57). This series included 19 patients (54.3%) treated with homologous bone graft alone and 16 patients (45.7%) treated combining intercalary allograft with fibular autograft. Complications were recorded according to Henderson classification.

Results: Median follow-up was 36 months (range, 1-165). Local recurrence occurred in 2 patients (5.7%) after 12 and 60 months, respectively. Major complications included graft fracture (9 cases), non-union (5 cases) and infection (4 cases). Other complications were axial deformity (2 cases), superficial infection (2 cases), compartmental syndrome (1 case).

Conclusion: Intercalary bone grafts of TD have been recommended as a reliable solution with long-term success rates and good functional outcome in more than 80% of patients. However, approximately half of the patients may require further surgeries to treat major complications (deep infection, delayed or non-union and graft fracture). Additional vascularized fibula graft may ameliorate final result.

Keywords: Allograft; Autograft; Biological reconstructions; Graft; Infection; Tibia diaphysis.