DOI: 10.1148/rg.262055039
Imaging Characteristics of Bone Graft Materials1
Francesca D. Beaman, MD,
Laura W. Bancroft, MD,
Jeffrey J. Peterson, MD,
Mark J. Kransdorf, MD,
David M. Menke, MD and
James K. DeOrio, MD
1 From the Departments of Radiology (F.D.B., L.W.B., J.J.P., M.J.K.), Pathology (D.M.M.), and Orthopedics (J.K.D.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224-3899; and Department of Radiologic Pathology, Armed Forces Institute of Pathology, Walter Reed Army Medical Center, Washington, DC (M.J.K.). Recipient of Cum Laude and Excellence in Design awards for an education exhibit at the 2004 RSNA Annual Meeting. Received March 4, 2005; revision requested May 2 and received July 1; accepted July 5. All authors have no financial relationships to disclose.
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Figure 1a. Osteochondral autograft transfer in a 27-year-old man. (a) Coronal reconstruction CT image of the left ankle shows a talar dome osteochondral defect (arrow). (b) Anteroposterior radiograph, obtained 2 months after surgical osteochondral autograft transfer, shows the graft as a bone fragment in the talar dome (arrowheads).
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Figure 1b. Osteochondral autograft transfer in a 27-year-old man. (a) Coronal reconstruction CT image of the left ankle shows a talar dome osteochondral defect (arrow). (b) Anteroposterior radiograph, obtained 2 months after surgical osteochondral autograft transfer, shows the graft as a bone fragment in the talar dome (arrowheads).
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Figure 2a. Osteochondral autograft transfer in a 52-year-old woman. Sagittal turbo spin-echo proton density–weighted MR images (repetition time msec/echo time msec, 2500/26) obtained after osteochondral autograft transfer show minimal signal heterogeneity and cartilage thickening over the right medial femoral condylar defect (arrowheads in a) and the donor site of the osteochondral autograft (arrow in b).
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Figure 2b. Osteochondral autograft transfer in a 52-year-old woman. Sagittal turbo spin-echo proton density–weighted MR images (repetition time msec/echo time msec, 2500/26) obtained after osteochondral autograft transfer show minimal signal heterogeneity and cartilage thickening over the right medial femoral condylar defect (arrowheads in a) and the donor site of the osteochondral autograft (arrow in b).
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Figure 3a. Vascularized fibular autograft in a 20-year-old man. (a) Anteroposterior radiograph of the left humerus shows humeral bone loss from multiple débridements for a nonunited grade 2 open fracture secondary to a motor vehicle accident, as well as osteomyelitis. The external fixator was placed at an outside institution. (b) Anteroposterior radiograph obtained 18 days after placement of a vascularized fibular autograft (arrow) shows new bone bridging the damaged native humeral segments. (c) Anteroposterior radiograph obtained 2 months after the procedure shows increased consolidation of the new periosteal bone (arrows).
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Figure 3b. Vascularized fibular autograft in a 20-year-old man. (a) Anteroposterior radiograph of the left humerus shows humeral bone loss from multiple débridements for a nonunited grade 2 open fracture secondary to a motor vehicle accident, as well as osteomyelitis. The external fixator was placed at an outside institution. (b) Anteroposte-rior radiograph obtained 18 days after placement of a vascularized fibular autograft (arrow) shows new bone bridging the damaged native humeral segments. (c) Anteroposterior radiograph obtained 2 months after the procedure shows increased consolidation of the new periosteal bone (arrows).
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Figure 3c. Vascularized fibular autograft in a 20-year-old man. (a) Anteroposterior radiograph of the left humerus shows humeral bone loss from multiple débridements for a nonunited grade 2 open fracture secondary to a motor vehicle accident, as well as osteomyelitis. The external fixator was placed at an outside institution. (b) Anteroposte-rior radiograph obtained 18 days after placement of a vascularized fibular autograft (arrow) shows new bone bridging the damaged native humeral segments. (c) Anteroposterior radiograph obtained 2 months after the procedure shows increased consolidation of the new periosteal bone (arrows).
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Figure 4a. Iliac crest autografts. (a) Sagittal reconstruction CT image of the right foot shows subtalar fusion (arrows) 1 year after iliac crest autograft placement in a 71-year-old man. (b) Axial spin-echo T1-weighted MR image (550/13) shows solid fusion of the posterior vertebral arch from L4 to S1 in a 68-year-old woman, 22 years after placement of an iliac crest autograft. Note the normal marrow signal (*) that extends throughout the surgical site and the intact cortical margin.
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Figure 4b. Iliac crest autografts. (a) Sagittal reconstruction CT image of the right foot shows subtalar fusion (arrows) 1 year after iliac crest autograft placement in a 71-year-old man. (b) Axial spin-echo T1-weighted MR image (550/13) shows solid fusion of the posterior vertebral arch from L4 to S1 in a 68-year-old woman, 22 years after placement of an iliac crest autograft. Note the normal marrow signal (*) that extends throughout the surgical site and the intact cortical margin.
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Figure 5a. Proximal femoral allograft in a 40-year-old woman. (a) Anteroposterior radiograph of the left proximal femur shows a grade 1 chondrosarcoma. (b) Postoperative anteroposterior radiograph of the left femur shows an allograft-prosthesis composite.
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Figure 5b. Proximal femoral allograft in a 40-year-old woman. (a) Anteroposterior radiograph of the left proximal femur shows a grade 1 chondrosarcoma. (b) Postoperative anteroposterior radiograph of the left femur shows an allograft-prosthesis composite.
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Figure 6a. Onlay allograft in a 73-year-old woman. (a) Photograph shows a syringe that contains demineralized bone matrix putty (MTF DBX Putty; Dentsply) used to secure the allograft to the fractured femur. (b) Anteroposterior radiograph shows the allograft (arrowheads) and cerclage wires placed to correct a right periprosthetic femur fracture distal to the tip of the femoral stem (arrow).
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Figure 6b. Onlay allograft in a 73-year-old woman. (a) Photograph shows a syringe that contains demineralized bone matrix putty (MTF DBX Putty; Dentsply) used to secure the allograft to the fractured femur. (b) Anteroposterior radiograph shows the allograft (arrowheads) and cerclage wires placed to correct a right periprosthetic femur fracture distal to the tip of the femoral stem (arrow).
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Figure 7a. Radial osteochondral allograft in a 24-year-old woman. (a) Anteroposterior radiograph of grade 1 osteosarcoma of the distal right radius. (b) Coronal spin-echo T1-weighted MR image (483/23) shows heterogeneity and hypointensity of signal in the mass relative to that in skeletal muscle, information useful for defining the tumor extent within the diaphysis. (c) Immediate postoperative anteroposterior radiograph shows placement of the radial osteochondral allograft (arrowhead), with middle and distal radial plate and screw fixation and with suture anchors in the radial styloid. (d) Ten-month follow-up anteroposterior radiograph shows interval fracture of the distal radial graft (arrowhead) with half-shaft anterior displacement of the distal fracture fragment and moderately severe anterior angulation at the fracture site.
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Figure 7b. Radial osteochondral allograft in a 24-year-old woman. (a) Anteroposterior radiograph of grade 1 osteo-sarcoma of the distal right radius. (b) Coronal spin-echo T1-weighted MR image (483/23) shows heterogeneity and hypointensity of signal in the mass relative to that in skeletal muscle, information useful for defining the tumor extent within the diaphysis. (c) Immediate postoperative anteroposterior radiograph shows placement of the radial osteo-chondral allograft (arrowhead), with middle and distal radial plate and screw fixation and with suture anchors in the radial styloid. (d) Ten-month follow-up anteroposterior radiograph shows interval fracture of the distal radial graft (arrowhead) with half-shaft anterior displacement of the distal fracture fragment and moderately severe anterior an-gulation at the fracture site.
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Figure 7c. Radial osteochondral allograft in a 24-year-old woman. (a) Anteroposterior radiograph of grade 1 osteo-sarcoma of the distal right radius. (b) Coronal spin-echo T1-weighted MR image (483/23) shows heterogeneity and hypointensity of signal in the mass relative to that in skeletal muscle, information useful for defining the tumor extent within the diaphysis. (c) Immediate postoperative anteroposterior radiograph shows placement of the radial osteo-chondral allograft (arrowhead), with middle and distal radial plate and screw fixation and with suture anchors in the radial styloid. (d) Ten-month follow-up anteroposterior radiograph shows interval fracture of the distal radial graft (arrowhead) with half-shaft anterior displacement of the distal fracture fragment and moderately severe anterior an-gulation at the fracture site.
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Figure 7d. Radial osteochondral allograft in a 24-year-old woman. (a) Anteroposterior radiograph of grade 1 osteo-sarcoma of the distal right radius. (b) Coronal spin-echo T1-weighted MR image (483/23) shows heterogeneity and hypointensity of signal in the mass relative to that in skeletal muscle, information useful for defining the tumor extent within the diaphysis. (c) Immediate postoperative anteroposterior radiograph shows placement of the radial osteo-chondral allograft (arrowhead), with middle and distal radial plate and screw fixation and with suture anchors in the radial styloid. (d) Ten-month follow-up anteroposterior radiograph shows interval fracture of the distal radial graft (arrowhead) with half-shaft anterior displacement of the distal fracture fragment and moderately severe anterior an-gulation at the fracture site.
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Figure 8a. Cancellous bone allograft resorption with hardware loosening and failure in a 46-year-old woman. (a) Lateral radiograph obtained on postoperative day 1 shows the allograft (*) as an area of high opacity in the C4-C5 interspace and C4-C5 anterior cervical plate (Atlantis Vision; Medtronic Sofamor Danek, Memphis, Tenn). The graft was coated with injectable bone paste (Osteofil; Regeneration Technologies. (b) One-year follow-up radiograph shows focal allograft resorption, hardware loosening, and failure of the inferior screw (arrow).
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Figure 8b. Cancellous bone allograft resorption with hardware loosening and failure in a 46-year-old woman. (a) Lateral radiograph obtained on postoperative day 1 shows the allograft (*) as an area of high opacity in the C4-C5 interspace and C4-C5 anterior cervical plate (Atlantis Vision; Medtronic Sofa-mor Danek, Mem-phis, Tenn). The graft was coated with injectable bone paste (Osteofil; Regeneration Technologies. (b) One-year follow-up radiograph shows focal allograft resorption, hardware loosening, and failure of the inferior screw (arrow).
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Figure 9a. Cancellous bone allograft and autologous platelet-rich product used for left ankle fusion in a 53-year-old man. (a) Photograph shows the autologous blood concentrate product (Symphony; DePuy/Johnson & Johnson). (b, c) Lateral radiographs of the left ankle, obtained 2 months (b) and 4 months (c) after graft placement, show progressive resorption of the graft material (arrowhead) and deposition of bone (arrow).
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Figure 9b. Cancellous bone allograft and autologous platelet-rich product used for left ankle fusion in a 53-year-old man. (a) Photograph shows the autologous blood concentrate product (Symphony; DePuy/Johnson & Johnson). (b, c) Lateral radiographs of the left ankle, obtained 2 months (b) and 4 months (c) after graft placement, show progressive resorption of the graft material (arrowhead) and deposition of bone (arrow).
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Figure 9c. Cancellous bone allograft and autologous platelet-rich product used for left ankle fusion in a 53-year-old man. (a) Photograph shows the autologous blood concentrate product (Symphony; DePuy/Johnson & Johnson). (b, c) Lateral radiographs of the left ankle, obtained 2 months (b) and 4 months (c) after graft placement, show progressive resorption of the graft material (arrowhead) and deposition of bone (arrow).
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Figure 10a. Demineralized bone matrix putty used in tibial plateau reconstruction in a 55-year-old man. (a) Photograph shows the putty. (b) Anteroposterior postoperative radiograph, obtained 1 month after reconstruction of the tibial plateau with mechanical elevation of native bone fragments and putty placement, shows slight opacity at the graft site (*) in the lateral tibia.
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Figure 10b. Demineralized bone matrix putty used in tibial plateau reconstruction in a 55-year-old man. (a) Photograph shows the putty. (b) Anteroposterior postoperative radiograph, obtained 1 month after reconstruction of the tibial plateau with mechanical elevation of native bone fragments and putty placement, shows slight opacity at the graft site (*) in the lateral tibia.
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Figure 11a. Cancellous bone allograft and demineralized bone matrix putty used to repair the hip bone in a 77-year-old man. (a) Anteroposterior radiograph of the left hip shows superior acetabular osteolysis (*) due to particle disease (polyethylene osteolysis). (b) Anteroposterior radiograph, obtained 1 year after placement of a cancellous bone allograft and putty (Grafton DBM Putty; Osteotech) in the bone void (*), shows opacity at the site of the graft that is similar to that of adjacent bone.
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Figure 11b. Cancellous bone allograft and demineralized bone matrix putty used to repair the hip bone in a 77-year-old man. (a) Anteroposterior radiograph of the left hip shows superior acetabular osteolysis (*) due to particle disease (polyethylene osteolysis). (b) Anteroposterior radiograph, obtained 1 year after placement of a cancellous bone allograft and putty (Grafton DBM Putty; Osteotech) in the bone void (*), shows opacity at the site of the graft that is similar to that of adjacent bone.
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Figure 12a. Cancellous bone allograft and putty used to repair the left femur in a 29-year-old man. (a) Sagittal reconstruction CT image, obtained on postoperative day 1, shows bone graft material placed in a void in the left medial femoral condyle after giant cell tumor curettage. Note that the attenuation of the graft is similar to that of bone. (b) Anteroposterior radiograph, obtained 1 month after graft placement, shows faint callus formation (arrowheads), a nondisplaced fracture that extends through the articular surface (arrow), and K-wires that traverse the epiphysis. (c) Anteroposterior radiograph, obtained 3 years after graft placement, shows solid bone bridging the medial defect (arrowheads) and the near invisibility of the fracture.
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Figure 12b. Cancellous bone allograft and putty used to repair the left femur in a 29-year-old man. (a) Sagittal reconstruction CT image, obtained on postoperative day 1, shows bone graft material placed in a void in the left medial femoral condyle after giant cell tumor curettage. Note that the attenuation of the graft is similar to that of bone. (b) Anteroposterior radiograph, obtained 1 month after graft placement, shows faint callus formation (arrowheads), a nondisplaced fracture that extends through the articular surface (arrow), and K-wires that traverse the epiphysis. (c) Anteroposterior radiograph, obtained 3 years after graft placement, shows solid bone bridging the medial defect (arrowheads) and the near invisibility of the fracture.
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Figure 12c. Cancellous bone allograft and putty used to repair the left femur in a 29-year-old man. (a) Sagittal reconstruction CT image, obtained on postoperative day 1, shows bone graft material placed in a void in the left medial femoral condyle after giant cell tumor curettage. Note that the attenuation of the graft is similar to that of bone. (b) Anteroposterior radiograph, obtained 1 month after graft placement, shows faint callus formation (arrowheads), a nondisplaced fracture that extends through the articular surface (arrow), and K-wires that traverse the epiphysis. (c) Anteroposterior radiograph, obtained 3 years after graft placement, shows solid bone bridging the medial defect (arrowheads) and the near invisibility of the fracture.
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Figure 13a. Cancellous bone allograft placement in the hand of a 16-year-old girl. (a) Anteroposterior radiograph, obtained 7 months after surgery for a recurrent giant cell tumor, shows a persistent region of lucency (*) despite bone ingrowth in part of the void (arrows). To aid bone repair, demineralized bone matrix putty (Grafton DBM Putty; Osteotech) was used along with a demineralized bone matrix graft (Opteform; Exactech, Gainesville, Fla, and Regeneration Technologies, Alachua, Fla) that contains a collagen gelatin for thermoplasticity of the graft. (b) Coronal fast spin-echo inversion recovery MR image (3480/39), obtained 4 months after graft placement, shows the heterogeneous signal of the bone graft materials and vascularized granulation tissue (*). (c) Contrast material–enhanced coronal spin-echo fat-saturation T1-weighted image (444/16) from the same MR examination as b shows heterogeneous enhancement of the graft materials and vascularized granulation tissue (*).
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Figure 13b. Cancellous bone allograft placement in the hand of a 16-year-old girl. (a) Anteroposterior radiograph, obtained 7 months after surgery for a recurrent giant cell tumor, shows a persistent region of lucency (*) despite bone ingrowth in part of the void (arrows). To aid bone repair, demineralized bone matrix putty (Grafton DBM Putty; Osteotech) was used along with a demineralized bone matrix graft (Opteform; Exactech, Gainesville, Fla, and Regeneration Technologies, Alachua, Fla) that contains a collagen gelatin for thermoplasticity of the graft. (b) Coronal fast spin-echo inversion recovery MR image (3480/39), obtained 4 months after graft placement, shows the heterogeneous signal of the bone graft materials and vascularized granulation tissue (*). (c) Contrast material–enhanced coronal spin-echo fat-saturation T1-weighted image (444/16) from the same MR examination as b shows heterogeneous enhancement of the graft materials and vascularized granulation tissue (*).
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Figure 13c. Cancellous bone allograft placement in the hand of a 16-year-old girl. (a) Anteroposterior radiograph, obtained 7 months after surgery for a recurrent giant cell tumor, shows a persistent region of lucency (*) despite bone ingrowth in part of the void (arrows). To aid bone repair, demineralized bone matrix putty (Grafton DBM Putty; Osteotech) was used along with a demineralized bone matrix graft (Opteform; Exactech, Gainesville, Fla, and Regeneration Technologies, Alachua, Fla) that contains a collagen gelatin for thermoplasticity of the graft. (b) Coronal fast spin-echo inversion recovery MR image (3480/39), obtained 4 months after graft placement, shows the heterogeneous signal of the bone graft materials and vascularized granulation tissue (*). (c) Contrast material–enhanced coronal spin-echo fat-saturation T1-weighted image (444/16) from the same MR examination as b shows heterogeneous enhancement of the graft materials and vascularized granulation tissue (*).
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Figure 14a. Calcium sulfate ceramic bone graft substitute used for joint repair in a 42-year-old man. (a) Photograph of the ceramic graft material. (b) Preprocedural axial CT image shows a unicameral bone cyst (*) in the right posterior ilium at the level of the superior sacroiliac joint. (c) Axial CT image, obtained 1 month after graft placement, shows partial resorption of the graft material (arrow). (d) Axial CT image, obtained 2 years after graft placement, shows complete resorption of the graft material and minimal ingrowth of bone (arrows).
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Figure 14b. Calcium sulfate ceramic bone graft substitute used for joint repair in a 42-year-old man. (a) Photograph of the ceramic graft material. (b) Preprocedural axial CT image shows a unicameral bone cyst (*) in the right posterior ilium at the level of the superior sacroiliac joint. (c) Axial CT image, obtained 1 month after graft placement, shows partial resorption of the graft material (arrow). (d) Axial CT image, obtained 2 years after graft placement, shows complete resorption of the graft material and minimal ingrowth of bone (arrows).
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Figure 14c. Calcium sulfate ceramic bone graft substitute used for joint repair in a 42-year-old man. (a) Photograph of the ceramic graft material. (b) Preprocedural axial CT image shows a unicameral bone cyst (*) in the right posterior ilium at the level of the superior sacroiliac joint. (c) Axial CT image, obtained 1 month after graft placement, shows partial resorption of the graft material (arrow). (d) Axial CT image, obtained 2 years after graft placement, shows complete resorption of the graft material and minimal ingrowth of bone (arrows).
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Figure 14d. Calcium sulfate ceramic bone graft substitute used for joint repair in a 42-year-old man. (a) Photograph of the ceramic graft material. (b) Preprocedural axial CT image shows a unicameral bone cyst (*) in the right posterior ilium at the level of the superior sacroiliac joint. (c) Axial CT image, obtained 1 month after graft placement, shows partial resorption of the graft material (arrow). (d) Axial CT image, obtained 2 years after graft placement, shows complete resorption of the graft material and minimal ingrowth of bone (arrows).
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Figure 15a. Calcium sulfate pellets used to repair a calcaneal defect in a 79-year-old woman. (a) Photograph shows the graft material. (b) Intraoperative radiograph obtained after placement of the pellets (arrows) in the left foot, in a posterior calcaneal defect that resulted from resection for osteomyelitis. (c) Lateral radiograph, obtained 5 months after graft placement, shows complete resorption of the pellets and resultant remodeling of the calcaneus, with minimal ingrowth of bone (*).
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Figure 15b. Calcium sulfate pellets used to repair a calcaneal defect in a 79-year-old woman. (a) Photograph shows the graft material. (b) Intraoperative radiograph obtained after placement of the pellets (arrows) in the left foot, in a posterior calcaneal defect that resulted from resection for osteomyelitis. (c) Lateral radiograph, obtained 5 months after graft placement, shows complete resorption of the pellets and resultant remodeling of the calcaneus, with minimal ingrowth of bone (*).
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Figure 15c. Calcium sulfate pellets used to repair a calcaneal defect in a 79-year-old woman. (a) Photograph shows the graft material. (b) Intraoperative radiograph obtained after placement of the pellets (arrows) in the left foot, in a posterior calcaneal defect that resulted from resection for osteomyelitis. (c) Lateral radiograph, obtained 5 months after graft placement, shows complete resorption of the pellets and resultant remodeling of the calcaneus, with minimal ingrowth of bone (*).
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Figure 16a. Calcium sulfate pellets mimic recurrent pigmented villonodular synovitis in a 51-year-old woman. (a, b) Sagittal T1-weighted spin-echo (589/18) (a) and sagittal fat-saturated T2-weighted turbo spin-echo (4000/78) (b) MR images show a large ill-defined area with hypointense T1 and T2 signal (arrow) that mimics recurrent PVNS, adjacent to the calcaneus and the cuboid, navicular, middle cuneiform, and lateral cuneiform bones. (c) Photomicrograph (original magnification, x40; hematoxylineosin stain) shows foci of calcium deposition (arrows) surrounded by new bone with surface osteoblastic activity (arrowhead).
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Figure 16b. Calcium sulfate pellets mimic recurrent pigmented villonodular synovitis in a 51-year-old woman. (a, b) Sagittal T1-weighted spin-echo (589/18) (a) and sagittal fat-saturated T2-weighted turbo spin-echo (4000/78) (b) MR images show a large ill-defined area with hypointense T1 and T2 signal (arrow) that mimics recurrent PVNS, adjacent to the cal-caneus and the cuboid, navicular, middle cuneiform, and lateral cuneiform bones. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) shows foci of calcium deposition (arrows) surrounded by new bone with surface osteoblastic activity (arrowhead).
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Figure 16c. Calcium sulfate pellets mimic recurrent pigmented villonodular synovitis in a 51-year-old woman. (a, b) Sagittal T1-weighted spin-echo (589/18) (a) and sagittal fat-saturated T2-weighted turbo spin-echo (4000/78) (b) MR images show a large ill-defined area with hypointense T1 and T2 signal (arrow) that mimics recurrent PVNS, adjacent to the cal-caneus and the cuboid, navicular, middle cuneiform, and lateral cuneiform bones. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) shows foci of calcium deposition (arrows) surrounded by new bone with surface osteoblastic activity (arrowhead).
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Figure 17a. Tricalcium phosphate granules combined with demineralized bone matrix putty in a 61-year-old woman. (a) Photograph shows the tricalcium phosphate granules (Conduit; DePuy/Johnson & Johnson) before they were mixed with the putty (Grafton DBM; Osteotech). (b) Axial CT image obtained 1 day after the graft placement shows the individual high-attenuation granules (arrow) filling the bone void. (c) Anteroposterior radiograph of the left distal femur, obtained 1 month after enchondroma curettage and insertion of the combined graft materials, shows individual tricalcium phosphate granules (arrow).
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Figure 17b. Tricalcium phosphate granules combined with demineralized bone matrix putty in a 61-year-old woman. (a) Photograph shows the tricalcium phosphate granules (Conduit; DePuy/Johnson & Johnson) before they were mixed with the putty (Grafton DBM; Osteotech). (b) Axial CT image obtained 1 day after the graft placement shows the individual high-attenuation granules (arrow) filling the bone void. (c) Anteroposterior radiograph of the left distal femur, obtained 1 month after enchondroma curettage and insertion of the combined graft materials, shows individual tricalcium phosphate granules (arrow).
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Figure 17c. Tricalcium phosphate granules combined with demineralized bone matrix putty in a 61-year-old woman. (a) Photograph shows the tricalcium phosphate granules (Conduit; DePuy/Johnson & Johnson) before they were mixed with the putty (Grafton DBM; Osteotech). (b) Axial CT image obtained 1 day after the graft placement shows the individual high-attenuation granules (arrow) filling the bone void. (c) Anteroposterior radiograph of the left distal femur, obtained 1 month after enchondroma curettage and insertion of the combined graft materials, shows individual tricalcium phosphate granules (arrow).
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Figure 18. Failure of an autograft in the wrist of a 24-year-old man. Anteroposterior radiograph shows a Herbert screw that bridges an old nonunited scaphoid fracture deformity (arrow), accompanied by evidence of scapholunate advanced collapse. The autograft that was initially placed to aid in fracture union has failed and cannot be seen. The proximal pole of the scaphoid is diminutive and not well defined, and there is marked cystic change of the capitate (*) and distal radius, with ulnar positive variance.
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Figure 19a. Failure of a vascularized fibular autograft in a 49-year-old man. Anteroposterior radiograph (a) and coronal reconstruction CT image (b) show a subtrochanteric transverse fracture of the right femur and an associated fracture of the vascularized fibular autograft (*). The linear area of opacity in a is a K-wire placed for graft fixation.
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Figure 19b. Failure of a vascularized fibular autograft in a 49-year-old man. Anteroposterior radiograph (a) and coronal reconstruction CT image (b) show a subtrochanteric transverse fracture of the right femur and an associated fracture of the vascularized fibular autograft (*). The linear area of opacity in a is a K-wire placed for graft fixation.
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Figure 20a. Extrusion of a cortical allograft and failure of fusion in a 61-year-old woman. (a) Lateral radiograph of the right foot, obtained 9 months after graft placement, shows the bone graft (*) and a screw bridging the subtalar joint fragments. (b) Sagittal reconstruction CT image, obtained 4 days after a, shows extrusion of the bone graft (*) into the sinus tarsi and persistence of the subtalar joint fracture, with no osseous union.
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Figure 20b. Extrusion of a cortical allograft and failure of fusion in a 61-year-old woman. (a) Lateral radiograph of the right foot, obtained 9 months after graft placement, shows the bone graft (*) and a screw bridging the subtalar joint fragments. (b) Sagittal reconstruction CT image, obtained 4 days after a, shows extrusion of the bone graft (*) into the sinus tarsi and persistence of the subtalar joint fracture, with no osseous union.
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Copyright © 2006 by the Radiological Society of North America.
