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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 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](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d6e5503460f94a4eb7f/html5/thumbnails/2.jpg)
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](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d6e5503460f94a4eb7f/html5/thumbnails/3.jpg)
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](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d6e5503460f94a4eb7f/html5/thumbnails/4.jpg)
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](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d6e5503460f94a4eb7f/html5/thumbnails/5.jpg)
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](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d6e5503460f94a4eb7f/html5/thumbnails/6.jpg)
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](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d6e5503460f94a4eb7f/html5/thumbnails/7.jpg)
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](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d6e5503460f94a4eb7f/html5/thumbnails/8.jpg)
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](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d6e5503460f94a4eb7f/html5/thumbnails/9.jpg)
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](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d6e5503460f94a4eb7f/html5/thumbnails/10.jpg)
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](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d6e5503460f94a4eb7f/html5/thumbnails/11.jpg)
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](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d6e5503460f94a4eb7f/html5/thumbnails/12.jpg)
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](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d6e5503460f94a4eb7f/html5/thumbnails/13.jpg)
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](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d6e5503460f94a4eb7f/html5/thumbnails/14.jpg)
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.