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Comparison of Structural Bone Autografts and Allografts in Pediatric Foot Surgery

Vining, Neil C. MD*,†,‡; Warme, Winston J. MD*,†; Mosca, Vincent S. MD*,†

doi: 10.1097/BPO.0b013e31824b6c82
Lower Extremity

Background: Autogenous bone has been the gold standard as the source for structural bone-graft material due to its osteogenic potential, nonimmunogenicity, and efficiency of incorporation. However, donor-site morbidity can lead to significant problems. Allograft bone is readily available and obviates the risks associated with bone-graft harvesting. However, its use raises concerns of disease transmission, infection, slower incorporation, and immunologic reaction. Despite these concerns, allograft use has become widespread. The few comparative studies of the 2 graft types used in spine and tumor surgery are promising. We sought to compare the speed and completeness of graft incorporation and the relative safety of autograft and allograft structural bone in pediatric foot surgery.

Methods: A retrospective analysis was performed on 161 children who underwent foot surgery requiring 182 allografts and 63 autografts from 1982 to 1994. Follow-up ranged from 2 to 146 months (mean=51.4).

Results: Graft-host union, defined as radiographic evidence of healing with a clinical lack of tenderness at graft insertion site, occurred within 12 weeks in both groups. Average time to healing in both groups was just over 7 weeks. In the allograft group, there was 1 nonunion, 3 graft displacements due to technical error requiring reoperation, and 1 partial displacement that did not require reoperation. All of these complications can be attributed to technique rather than to graft type. There were no infections or instances of disease transmission. There were no reported complications in the autograft group.

Conclusions: Small, structural bone allografts provide a safe, efficient, and cost-effective alternative to iliac crest bone autograft in pediatric foot surgery.

Levels of Evidence: Level III, therapeutic study, retrospective comparative study.

*Department of Orthopaedics, Seattle Children’s Hospital

Department of Orthopaedic Surgery, University of Washington, Seattle, WA

Raleigh Orthopaedic Clinic, Raleigh, NC

None of the authors received financial support for this study.

The authors declare no conflict of interest.

Reprints: Neil C. Vining, MD, Department of Orthopaedics, Seattle Children’s Hospital, 4800 Sand Point Way NE, PO Box 5371/W-7706, Seattle, WA 98015-0371. Email:

© 2012 Lippincott Williams & Wilkins, Inc.