Structural bone allograft has been used in bone defect reconstruction during the last fifty years with acceptable results. However, allograft selection methods were based on 2-dimensional templates using X-rays. Thanks to preoperative planning platforms, three-dimensional (3D) CT-derived bone models were used to define size and shape comparison between host and donor. The purpose of this study was to describe the workflow of this virtual technique in order to explain how to choose the best allograft using a virtual bone bank system. We measured all bones in a 3D virtual environment determining the best match. The use of a virtual bone bank system has allowed optimizing the allograft selection in a bone bank, providing more information to the surgeons before surgery. In conclusion, 3D preoperative planning in a virtual environment for allograft selection is an important and helpful tool in order to achieve a good match between host and donor. 1. Introduction The uses of bone allograft after bone tumor resection have been described with acceptable results in osteoarticular, transepiphyseal, and intercalary reconstructions [1–4]. Selection of the closest anatomical match between the host and the donor is crucial in order to obtain adequate joint stability, alignment, appropriate wound closure, and minor degenerative changes of the articular surface in osteoarticular allograft. Since 1950, bone allograft selection according to size and shape for limb reconstruction was made by comparing X-ray images between donors and patient [5]. This method had inaccuracies between the X-ray magnification scale and real bone, altering the final selection [6]. In the 1970s, CT scanner allowed to refine these inaccuracies taking into account one image slice in two dimensions [7]. The previous two decades have seen an increase in the use of virtual scenarios and informatics developments for preoperative planning [8–10]. Three-dimensional patient-specific anatomical models can be constructed from medical image data. We described a virtual technique capable of selecting a suitable allograft according to size and shape through a three-dimensional virtual model. The aim of this paper was to describe the workflow of this technique in different cases in order to explain how to choose the best allograft using a virtual bone bank system. 2. Material and Methods Three-dimensional (3D) virtual bone models from host and donor were obtained following these steps: image acquisition, image segmentation, and 3D bone reconstruction, described in detail below. Once this workflow was
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