Complications and Survivorship of Distal Humeral Allograft Reconstruction After Tumor Resection: Literature Review and Case Series

Primary bone sarcomas of the proximal humerus represent most bone sarcomas in the upper extremity. However, limited literature exists on the survival and complications of distal humeral allograft reconstruction because of the relative rarity of disease at the distal end. METHODS: We performed a literature review in PubMed and EMBASE using the terms“Humerus,””Distal,” “Allograft,” and “Reconstruction” to include all the patients with distal humeral reconstructions. In addition, a retrospective review of all patients who underwent distal humerus tumor resection and allograft reconstruction at our tertiary care center over a 23-year period was performed. RESULTS: Fourteen patients in four different case series have been reported previously with an allograft survival rate of 86%. Thirty-six percent of patients experienced complications, most commonly nonunion (3) and allograft subluxation (2). In a retrospective review at our institution, six met the inclusion criteria and were found to have similar complications. CONCLUSION: Based on our experience and the review of the literature, nonunions are the most frequent complication and junctional fractures are the most common cause of revision of allografts in this location. Larger sample studies are required to identify potential correctable predictors of these complications. In addition, complications should be correlated with functional outcome data.