Orthopedics

Nowicki PD, Tylkowski CM, Iwinski HJ, Talwalkar V, Walker JL, Milbrandt TA.: “Structural bone allograft in pediatric foot surgery.” Am J Orthop, 39(5): 238-40, 2010

Structural bone allografts are used in a variety of surgical procedures, but only a few investigators have examined their use and associated complications in the pediatric population specifically. In a retrospective review of pediatric foot procedures, we sought to determine types and rates of complications associated with structural bone allografts as well as time to incorporation of these allografts. Minimum follow-up was 12 months. Eighteen patients with 31 structural allografts were reviewed. The total complication rate was 7.1%, and the allograft incorporation rate was 90% (mean time after surgery, 9 months). Mean follow-up was 22 months. There were no pseudarthroses, nonunions, or fractures at the bone-graft sites. Structural bone allografts can be safely used in foot procedures in pediatric neuromuscular patients without major risk for complications, and their use can reduce autograft-harvest morbidity in pediatric patients with neuromuscular conditions

Eastlack RK, Kesman TJ, Patel R, Huddleston PM.: “Infection not associated with use of human musculoskeletal tissue allografts.” Cell Tissue Bank, 2010 Sep 29. [Epub ahead of print]

The deaths of otherwise healthy patients that are attributable to contaminated allografts have heightened concerns about the screening, processing, and use of such tissues. We present one tertiary care institution’s experience with musculoskeletal allografts and determine the frequency of postoperative Clostridium infection. We used an institutional microbiology database to identify all records of culture-confirmed Clostridium infection from January 1990 through July 2006. A comprehensive musculoskeletal database was cross-referenced to include all possible allograft samples surgically collected or implanted from January 1990 through July 2004 to determine the frequency of Clostridium infection associated with use of allograft musculoskeletal tissue. Musculoskeletal allografts were implanted in 16,314 patients during the study period. After a minimum follow-up of 2 years, no patient had development of a definite Clostridium infection that was attributable to the use of musculoskeletal allograft tissue. These outcomes can be achieved with established screening and processing techniques for donor tissue.