A 15-year-old boy undergoes limb salvage for proximal tibial osteosarcoma using a massive osteoarticular allograft. Two years later he presents with sudden pain and inability to bear weight; radiographs show a displaced fracture through the allograft shaft. The most common long-term complication of massive structural allograft reconstruction is:

• A Growth disturbance of the contralateral limb
• B Donor-site morbidity
• C Allograft fracture ✓
• D Malignant transformation of the graft

Explanation

Massive allografts remain dead scaffolds that heal by creeping substitution, so mechanical failure is frequent. Fracture occurs in roughly 15 to 25 percent of large allografts and is the most common late complication, followed by nonunion and deep infection. Donor-site morbidity does not exist since the graft is cadaveric, growth disturbance of the opposite limb is not a recognised phenomenon, and malignant transformation of processed allograft bone is essentially unreported.

Reference: Campbell's Operative Orthopaedics, 14th ed.

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Written and medically reviewed by the StethoPrep medical team.