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Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone Joint Surg Am Volume 97(4):318-325 February 18, 2015 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

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Page 1: Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta

by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller

J Bone Joint Surg AmVolume 97(4):318-325

February 18, 2015

©2015 by The Journal of Bone and Joint Surgery, Inc.

Page 2: Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

Exposure of the nonunion site.

Varun Puvanesarajah et al. J Bone Joint Surg Am 2015;97:318-325

©2015 by The Journal of Bone and Joint Surgery, Inc.

Page 3: Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

Creation of allograft struts.

Varun Puvanesarajah et al. J Bone Joint Surg Am 2015;97:318-325

©2015 by The Journal of Bone and Joint Surgery, Inc.

Page 4: Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

Fitting of allograft struts within wound envelope and securing of the construct with wires (left) or screws (right).

Varun Puvanesarajah et al. J Bone Joint Surg Am 2015;97:318-325

©2015 by The Journal of Bone and Joint Surgery, Inc.

Page 5: Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

Preoperative internal rotation radiograph showing a large nonunion gap.

Varun Puvanesarajah et al. J Bone Joint Surg Am 2015;97:318-325

©2015 by The Journal of Bone and Joint Surgery, Inc.

Page 6: Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

Radiograph made one day after the procedure, showing the extent of the construct.

Varun Puvanesarajah et al. J Bone Joint Surg Am 2015;97:318-325

©2015 by The Journal of Bone and Joint Surgery, Inc.

Page 7: Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

Radiograph made four years and seven months after the procedure, at last follow-up, showing incorporation of the allograft medially and laterally.

Varun Puvanesarajah et al. J Bone Joint Surg Am 2015;97:318-325

©2015 by The Journal of Bone and Joint Surgery, Inc.

Page 8: Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

Original deformity before surgical correction.

Varun Puvanesarajah et al. J Bone Joint Surg Am 2015;97:318-325

©2015 by The Journal of Bone and Joint Surgery, Inc.

Page 9: Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

Preoperative radiograph showing two nonunions.

Varun Puvanesarajah et al. J Bone Joint Surg Am 2015;97:318-325

©2015 by The Journal of Bone and Joint Surgery, Inc.

Page 10: Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

Immediate postoperative radiograph showing the extent of the construct.

Varun Puvanesarajah et al. J Bone Joint Surg Am 2015;97:318-325

©2015 by The Journal of Bone and Joint Surgery, Inc.

Page 11: Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

Radiograph made 6.5 years after surgery, showing incorporation of the allograft and healing of the nonunion.

Varun Puvanesarajah et al. J Bone Joint Surg Am 2015;97:318-325

©2015 by The Journal of Bone and Joint Surgery, Inc.

Page 12: Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

Preoperative radiograph showing the nonunion.

Varun Puvanesarajah et al. J Bone Joint Surg Am 2015;97:318-325

©2015 by The Journal of Bone and Joint Surgery, Inc.

Page 13: Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

Radiograph made 1.5 months after the procedure, showing the extent of the construct.

Varun Puvanesarajah et al. J Bone Joint Surg Am 2015;97:318-325

©2015 by The Journal of Bone and Joint Surgery, Inc.

Page 14: Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis Imperfecta by Varun Puvanesarajah, Jay R. Shapiro, and Paul D. Sponseller J Bone

Radiograph made two years after surgery, showing allograft incorporation and healing of the nonunion.

Varun Puvanesarajah et al. J Bone Joint Surg Am 2015;97:318-325

©2015 by The Journal of Bone and Joint Surgery, Inc.