The use of allografts in hand surgery

Massive bone allografts have been extensively used in orthopaedic surgery. They are mainly employed in the reconstruction of large bone defects following bone tumor resections and in prothesic surgery. They may consist either of diaphyseal or of methaepiphyseal segments and they may be provided, if requested, with ligaments and tendons. Bone allografts are very popular in large defects reconstruction, but few reports are available on their use in small segments. Authors report their experience in allografts in hand surgery consisting of two cases of intercalary reconstruction (one metacarpal bone and one proximal phalanx) and of nine cases of joint reconstruction (five MPJ and four PIPJ). In eight cases also the extensor apparatus has been reconstructed using the allograft tendon. The bone fixation has been as stable and rigid as possible in order to allow an early mobilization. Seven patients with a follow up longer than 1 year have been controlled both clinically and radiographlcally with encouraging results. All the allografts but one healed with the host bone, and the functional recovery was good in the majority of cases. To our knowledge, this series of patients is the largest ever reported in the medical literature and our experience seems to point out the validity of this procedure in osteoarticular reconstruction of the hand. Longer follow up is however mandatory in order to exclude late degenerative problems, particularly due to cartilage consumption.