Dolph Houben

63 Combined massive allograft and intramedullary vascularized fibula 3 Complications Awide variety of complications are described in literature after the reconstruction of long bone segments with the combination of a massive allograft and vascularized bone graft. A list of all complications is provided in Table 3. Significantly different complication rates were calculated (p < 0.0001) between the included articles. The complication rates ranged between 5.9 and 85.7 percent. Any complication major or minor has been taken into account. A total of 192 complications occurred in 96 patients in 15 of the included articles. Two studies were not included in the complication rate calculation because the numbers of patients with a complication were not available. We did not perform a pooled meta- analysis on complication rates, because the data on complication rates were divergent. Fractures were the largest group of complications, reported in 11 studies (n=61). These fractures included microfractures, stress fractures and re-fractures. Infections (superficial + deep) occurred in 10 studies (n=23). Nonunion was reported in nine studies (n=30) and delayed union in three studies (n=5) for which 15 additional surgical interventions were performed in order to achieve union. The use of pre or post-operative chemotherapy in oncological cases may contribute to the high non-union, infection and fracture rates [7, 13, 14, 16, 22, 23, 25] . Limb length discrepancy was reported in 37 cases, the reported length discrepancy ranged from 0.5 to 8 cm. Symptomatic Limb length discrepancies smaller than one centimeter were treated with a corrective shoe in 23 cases. Eight corrective osteotomies were performed for limb length discrepancies larger than one centimeter. Limb length discrepancy has been reported as a result of the ongoing growth of the contralateral side after the reconstruction. Two smaller but still frequently described complications were wound problems and Varus/Valgus deformity of the ankle at the fibula donor site. Wound problems occurred in six studies (n=11) and Varus/Valgus deformity’s in seven studies (n=17). Rabitsch, Maurer-Ertl, Pirker-Fruhauf, Wibmeret al. [17] showed in their series a trend (p=0.067) of more wound healing problems in the tibial reconstructions compared to femoral reconstructions. On the other hand, the femoral reconstructions showed statistically significant more fractures than the tibial group (p=0.0038). See Figure 2 for complication rates in each study. Table 3: Summary of all complications found in our study selection Infection- superficial DVT Infection-deep Arterial thrombosis Deep sepsis Flexion deformity big toe Superficial necrosis Varus deformity Wound dehiscence deformity of junction Osteomyelitis Valgus deformity Hematoma Limb length discrepancy Pain Clawed toes Re-fracture Hallux impairment Microfracture Joint instability Stress fracture Peroneal nerve palsy Plate breakage Allergic reaction Fibula-allograft non-union Recurrent tumor Non-union Amputation Pedicle loss/avulsion Metastasis