Fifty-three children who were less than thirteen years old were followed for a median of seven years and ten months (range, two years and nine mouths to fourteen years and six months) after operative treatment for overgrowth of the tibia or humerus after amputation. During the thirty-one years in which these children were managed, three operative techniques were used in successive periods. Thus, the fifty-three children could be divided into three groups: thirty-one who had had a resection and revision, nine in whom the bone had been capped with a synthetic device, and thirteen in whom the bone had been capped with an autogenous tricortical bone graft from the lilac crest. A retrospective review was performed to determine the result and complications associated with each of these techniques. Survival analysis revealed that subsequent procedures were performed in twenty-six (84 per cent) of the thirty-one patients who had had a resection and revision, in seven of the nine in whom the bone had been capped with a synthetic device, and in four of the thirteen in whom the bone had been capped with an autogenous bone graft. The estimated mean survival time (that is, the time to a subsequent procedure) was five years in the group that had had the bone capped with an autogenous graft and three years and six months in the group that had had resection and revision; the difference is significant (p = 0.003). The survival time in the group that had had a synthetic device inserted was also less than that in the group that had had an autogenous graft (p = 0.07). Although an infection (four of the nine patients) or a fracture of the implant or bone (also four of the nine patients) developed in a larger proportion of patients in the group that had been managed with a synthetic cap than in the group that had been managed with an autogenous graft (one of thirteen for either complication), the numbers were too small for the differences to be significant (p = 0.12). As a result of this study, we believe that application of a cap consisting of autogenous bone graft from the lilac crest is preferable to resection and revision or application of a synthetic cap for treatment of established overgrowth of the bone in a patient who is less than thirteen years old.
|Original language||English (US)|
|Number of pages||8|
|Journal||Journal of Bone and Joint Surgery - Series A|
|State||Published - 1995|
ASJC Scopus subject areas
- Orthopedics and Sports Medicine