Allograft bone for metacarpal reconstruction

Banked allograft bone has been used for metacarpal reconstruction in 10 patients. In one patient, allograft replaced the shafts of the fourth and fifth metacarpals that were lost as the result of an injury from an explosion. In the remaining nine, allograft was used as an intercalary bone after distraction lengthening of the metacarpal. The first metacarpal was lengthened in seven patients; four had hypoplasia of the thumb and three had partial thumb amputation. One patient with hypoplasia of the ulnar side of the hand had the fourth and fifth metacarpals lengthened, and the fifth metacarpal was lengthened in another. Of the 12 allografts used, radiographic and clinical evidence of bone union occurred at 23 of the 24 allograft/recipient bone interface sites. Most patients had no callus formation. This suggested primary bone healing. Recipient new bone appeared to cross the recipient/donor interface and replace the allograft by "creeping substitution" within 6 months to 1 year. The density and trabecular pattern of the allograft bone gradually assumed that of the recipient's bone. There was no clinical or radiographic evidence of rejection and no evidence of infection, abnormal swelling, or bone resorption. Nine of the 10 patients had improved function as determined by objective and subjective evaluation. Banked allograft bone offers two advantages over autogenous bone for reconstructive hand surgery: There is no donor site morbidity, and large defects can be filled with cylindric cortical bone of appropriate size and shape, which offers excellent stability as an intercalary graft.