Cortical Strut Allografts Research Articles

Exploring Individualized Approaches to Managing Vancouver B Periprosthetic Femoral Fractures: Insights from a Comprehensive Case Series Analysis.

The increasing prevalence of periprosthetic femoral fractures, specifically in the vicinity of the hip, has emerged as a significant issue in recent times. Consequently, there is a need for a thorough examination to enhance the effectiveness of management and treatment approaches. The findings of this study emphasize a significant disparity in the occurrence and characteristics of these fractures, and the multiple cases have highlighted the efficacy of various treatment strategies, such as open reduction and internal fixation, as well as the utilization of cortical strut allografts. Furthermore, the study has identified potential risk factors that have an impact on the characteristics of fractures, providing valuable insights that could be crucial in the development of preventive strategies. This study provides a thorough examination of periprosthetic femoral fractures, highlighting the importance of a cohesive treatment algorithm to improve the handling of such fractures. Moreover, it promotes the need for a collaborative endeavor in conducting research in this field, cultivating a more profound comprehension that has the potential to drive progress in therapeutic approaches, ultimately enhancing patient results over an extended period of time. It is crucial that forthcoming research endeavors persist in expanding upon these discoveries, striving towards a unified methodology in tackling this substantial clinical obstacle.

Hybrid Fixation of Failed Internally Fixed Distal Femoral Fracture with an Extramedullary Locking Plate and an Intramedullary Cortical Strut Allograft Construct- A Case Report

Abstract Introduction: Fractures in osteoporotic bones present a surgical challenge for fixation and are often associated with significant morbidity. Case presentation: We present a case of failed internal fixation of fracture femoral shaft in a 74-year-old patient with osteoporosis. Fracture fixation was undertaken using an extra medullary locking plate and an intramedullary cortical strut graft, a hybrid fixation technique, a Locking Plate Allograft Construct. Discussion: Bone grafts are often used to support the native bone. By using a hybrid technique, the locking plate allograft construct achieves an enhanced stability of fracture fixation compared to plate alone, thus improving the outcome of surgery in osteoporotic bone fractures. Conclusion: Hybrid fixation using locking plate allograft constructs are relatively easy to perform and provide superior fixation to routine methods in osteoporotic bone fractures.

Treatment of Vancouver Type B Periprosthetic Femoral Fractures Using Cortical Strut Allografts.

IntroductionThe optimal surgical treatment for Vancouver B2 and B3 fractures has not been determined, and bone defects and delays in fracture healing significantly affect treatment outcomes. Some authors have argued that when a serious bone defect is present, the use of cortical strut allografts for the treatment of type B2 and B3 periprosthetic femoral fractures (PFFs) after hip joint replacement may be beneficial. This study aimed to determine the usefulness of cortical strut allografts based on mid-to long-term clinical radiologic results after surgical treatment of Vancouver B-type PFFs.MethodsWe retrospectively reviewed the outcomes of 48 patients with postoperative PFFs. The mean duration of follow-up was 6.7 years. The 22 patients were treated with cortical strut allograft. Each case was characterized and described in detail, including the length of allograft and the union period, and possible correlations between allograft length and strut-to-host bone union were analyzed. Clinical evaluations included Parker mobility and Harris hip scores. At the final follow-up, we assessed the radiological results using the Beals and Tower’s criteria, stem subsidence, and fracture union time.ResultsAll 48 fractures united at an average of 21.5 weeks, and strut-to-host bone union was typically observed within 32 months. No positive correlation was identified between the allograft length and incorporation period. There was one deep infection and four cases of dislocation, but there was no fracture or malunion of the cortical strut allografts. No evidence of femoral loosening was observed in any of the patients.ConclusionCortical strut allografts used to treat type B PFFs showed high rates of bone union and survival. In mid-to long-term follow-up, the cortical strut allograft length did not affect to incorporation time. The author concluded that cortical strut allografts are useful treatment for PFFs regardless subtype classification of the Vancouver type B.

The effect of onlay cortical fibula strut grafts on biomechanical features of Vancouver type B1 periprosthetic femoral fractures.

This study aimed to investigate biomechanically the effects of onlay fibula grafts on Vancouver Type B1 Periprosthetic Femoral Fractures (PPFs). Vancouver Type B1 PFF models were created in 25 fourth-generation synthetic femurs and fixed with locking plates using bicortical, unicortical screws, and cables. While no graft was used in group 1, onlay fibula grafts were placed anteriorly in group 2 and medially in group 3. In group 4, the cortical strut allograft was placed on the medial femoral cortex, and a locking compression plate (LCP) was applied to the lateral femoral cortex. In group 5, the strut allograft was placed over the anterior cortex of the femur and fixed with the same technique as in group 4. All models were then subjected to rotational and axial cyclical stiffness tests and load to failure to measure and compare the mechanical strengths of the constructs. The mean stiffness values of group 4 with medial allograft, before and after cyclical loading, were higher than all other groups, under both rotational and axial forces. The mean stiffness values of fibula autografts (groups 2 and 3) were similar to that of anterior allografts (group 5) in each test except that the mean initial axial stiffness of group 5 was higher than group 2. Failure loads were also not different between the groups. Although the rigidity of Vancouver type B1 periprosthetic femur fractures is highest if allografts are placed medially, fibula autografts can also provide similar fixation strengths to allografts if locking plates with unicortical and bicortical screws and cables are used.

Load Sharing in the Femur Using Strut Allografts: A Biomechanical Study.

BackgroundFemoral strut allografts are used in revision hip arthroplasty for management of bone loss associated with implant failure or periprosthetic fractures. They have also been used to treat unremitting thigh pain in well-fixed cementless femoral stems, to address the differential in structural stiffness between the stem and femoral shaft. Our study used an in vitro biomechanical model to measure the effect of placement of allografts on femoral strains, to determine their load-sharing capacity.Material and methodsThree rosette strain gauges were applied to the femoral surface of each of 6 cadaveric femurs, at the stem tip level on anterior, medial, and lateral cortices. After stem implantation, cortical strut allografts were applied to the lateral femoral shaft and secured with 4 Dall-Miles cables. A fourth gauge was placed on the midpoint of the allograft. Strains were recorded in the intact femur, then the implanted femur with and without the allograft under simulated physiologic loading in a load frame.ResultsReduction in distal femoral principal strains, between 12% and 59%, was seen in all cortices following placement of the allograft. Under axial loading, 30% of the strain in the lateral cortex was borne by the allograft. Greater reductions in strain, by as much as 59%, occurred under axial load and torque.ConclusionThe results of this biomechanical model indicate that by placement of an allograft, cortical strains can be reduced to levels approaching those in an intact femur, supporting this technique for treatment of unremitting thigh pain in well-fixed prostheses.

Long-Term Follow-Up of Management of the Hypoplastic Femur With Femoral Episiotomy and Onlay Allograft During Total Hip Arthroplasty

BackgroundTo insert the regular-sized stem for a dysplastic femoral canal, controlled episiotomy of the femur can be performed. The purpose of this study is to determine the long-term (up to 19 years) results of total hip arthroplasties (THAs) using strut allografts combined with an episiotomy over an extensively porous-coated stem. MethodsWe reviewed the results of 65 total hip arthroplasties in 63 patients (mean age 42.1 years; range 21-61) with dysplastic femur after childhood sepsis. The patients were treated using controlled episiotomy of the femur to widen the femoral canal, extensively porous-coated femoral stems, and cortical strut allografts because primary axial or rotational stability could not be achieved without grafting. The mean follow-up was 17.1 years (range 15-19). ResultsThe mean Harris Hip Score at the final follow-up was 85 ± 15 points (range 45-100). The mean Western Ontario and McMaster Universities Osteoarthritis Index score was 23 ± 15 points (range 13-53). The mean University of California, Los Angeles score was 6.3 points (range 5-8). A Kaplan-Meier survivorship analysis at 19 years of follow-up showed that the survival rate of the femoral components was 92% (95% confidence interval 89-98), and it was 88% (95% confidence interval 85-92) for the acetabular component with aseptic loosening or revision for any reason. ConclusionWe found good results in terms of longevity and functional outcome using this technique. Future mechanical studies, in addition to controlled clinical studies, are warranted.

Open reduction and locked compression plate fixation, with or without allograft strut, for periprosthetic fractures in patients who had a well-fixed femoral stem: a retrospective study with an average 2-year follow-up

BackgroundThe use of cortical strut allograft has not been determined for Vancouver type B1 or C fracture. This study aimed to evaluate the short-term efficacy of locking compression plating with or without cortical strut allograft in managing these types of fractures.MethodsWe retrospectively assessed 32 patients (17 males, 15 females; 23–88 years, mean: 67.2 years) with Vancouver type B1 or C fractures. Seventeen patients (Group A; B1 fractures in 15 hips, C fractures in 2 hips) were treated with open reduction and internal fixation with locking compression plates (group A). The other 15 patients (Group B; B1 in 14 hips, C in 1 hip) were fixed by locking compression plating combined with cortical strut allografting (group B). The fracture healing rate, healing time, complications and function were compared between these two groups.ResultsThe mean follow-up time was 32.4 months (12 to 66), and the overall fracture union rate of the 32 patients was 96.9%. Group B had a higher fracture union rate than Group A, but the difference was not statistically significant. Group A had one case of nonunion of type B1 fracture and one case of malunion; the mean time to fracture healing was 5.3 months (3 to 9). In group B, all patients reached bony union without malunion, with a mean time of fracture healing of 5.1 months (3 to 8).ConclusionTreatment of Vancouver type B1 or C fractures by locking compression plating, with or without cortical strut allografting, resulted in similar union rates in these patients. This suggest that, the use of cortical strut allografting should be decided cautiously.

Clinical and radiological outcomes of combined modular prothesis and cortical strut for revision proximal femur in giant cell tumor of bone patients.

Femoral bone deficiency is a challenging problem in revision proximal femoral replacement. The purpose of this study is to evaluate the clinical and radiological outcomes of revision proximal femoral replacement as a salvage treatment for severe bone loss after oncologic proximal replacement surgery in patient with benign giant cell tumor of bone. 16 patients (6 men and 10 women) were included in this retrospective study, with a mean age of 46.6year at the time of revision surgery. All patients underwent revision proximal femoral replacement with the use of modular prosthesis and cortical strut allografts. The modified Harris Hip Score, Short Form 36, and musculoskeletal Tumor Society Score were used for patient evaluation. Regular follow-up was performed to evaluate the recurrence and metastases rate, limb function, and long-term complications of patients. The average follow-up was 46.3months (range, 26-75months), during which there was no local recurrence and metastases of patient. At the latest follow-up, the mean modified Harris Hip Score was 70.6 points, which was significantly improved compared with that of preoperative (p < 0.05). The final follow-up results of Short Form 36, Musculoskeletal Tumor Society Score, and limb-length discrepancy were also significantly improved compared to that of preoperative (p < 0.05). At the latest follow-up, the implanted femoral stems were all stable and all cortical strut allografts were also incorporated to their own bone. Using modular prosthesis and cortical strut allografts in revision, proximal femur replacement is an acceptable procedure for relatively young patient with severe proximal femoral bone loss after oncologic surgery with benign giant cell tumor of bone. More attentions should be paid to reduce the risk of complications in these complex reconstructions.

Efficacy of 2-stage revision using a prosthesis of antibiotic-loaded acrylic cement spacer with or without cortical strut allograft in infected total elbow arthroplasty.

We aimed to evaluate the efficacy of a self-manufactured prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) spacer with or without cortical strut allograft in infected total elbow arthroplasty. Between March 2009 and February 2018, we enrolled 18 patients (mean age, 66.9 years) who underwent 2-stage revision arthroplasty for prosthetic infection following total elbow arthroplasty. After implant removal in the first stage, we performed débridement and PROSTALAC insertion. During the second stage, we performed reimplantation using a cortical strut allograft for patients with a considerably severe bone defect. The mean follow-up period was 34 months (range, 25-60 months), during which we evaluated the Mayo Elbow Performance Score (MEPS), range of motion (ROM), and blood markers. In all 18 patients, infection control was ensured using intravenous (IV) antibiotic therapy for 6 weeks or IV antibiotics for 4 weeks converting to oral antibiotics for 2 weeks following PROSTALAC insertion. The mean visual analog scale score improved from 8 points preoperatively to 2 points postoperatively, and the mean MEPS improved from 32 points preoperatively to 82 points postoperatively (P < .05). The average ROMs at the last follow-up were 9° to 132° from extension to flexion, respectively. Two patients experienced ulnar nerve neuropraxia after surgery, from which they were resolved. Moreover, 2 and 4 patients developed superficial wound infection and triceps insufficiency, respectively, and there was no infection recurrence. In the management of elbow prosthetic infection, 2-stage revision arthroplasty using PROSTALAC spacer insertion in the first stage and cortical strut allograft in the second stage for patients with severe bone defect revealed good clinical results and relatively low infection recurrence rates. However, the complication rate is substantial.

Cortical strut allografts in salvage revision arthroplasty: Surgical technique and clinical outcomes

BackgroundThe aim of this study was to present our clinical outcomes and surgical technique in strut allografts preparation using staggered holes to enhance osteointegration and demineralised bone matrix (DBM) as an adjunct to cortical strut allografts in salvage revision arthroplasty patients. MethodsRetrospective consecutive series of patients who required strut allograft femoral reconstructions with minimum 2 years follow up between 2012 and 2018. Frozen washed irradiated, cortical struts were used and prepared adding 2 mm staggered drill holes along the length of the strut and applying DBM paste on the graft-host interface. Outcome measures included radiographic strut union, graft resorption, infection and complications. Results15 patients included; 3 males and 12 females with median age 72 years (range 60–93). All had significant bony defects (Paprosky III/IV in 12 cases including 3 cases of periprosthetic hip fractures and further 3 cases of periprosthetic knee fractures around revision hinged implants). At final follow up, median 3.8 years (range 2.7–7.2), 14/15 (93.3%) struts had united at a median 6 months (range 5–8), complete incorporation with cortical round-off was seen at median 12 months (range 8–48) in 12/15 (80%) struts, 2/15 (13.3%) show radiographic evidence of proximal minimal graft resorptions although the remainder of the strut had integrated and were asymptomatic. There were no cases of infection. ConclusionsUse of strut allografts helps to reconstruct bone defects, restore bone stock, and provide stable fixation for complex patterns of periprosthetic fractures around hip/knee implants and salvage revision cases with 93.3% union rate at median 6 months.

High Incidence of Irradiated Cortical Strut Allograft Resorption Following Revision of Femoral Stems

BackgroundDespite the widespread use of revision total hip arthroplasties using cementless stems and cortical strut allografts, graft resorption has not been explicitly studied. MethodsBetween 2010 and 2018, 40 femoral strut grafts were used in the revision of femoral stems of 36 patients (18 males and 18 females; average age, 51.9 ± 12.9 years). The mean follow-up was 78.9 ± 37.3 months. Failure was defined as revision surgery for any reason and subsidence of greater than 5 mm. ResultsThe survival rate of the stem without the need for revision at 5 years was 95% (mean graft survival time, 10.8 [95% CI, 9.414-12.234] years). Overall survival with graft resorption as the endpoint was 90% at 5 years (mean graft survival time, 8.8 [95% CI, 7.5-10.2] years). Survival with graft nonunion as the endpoint was 90% at 3 years (mean survival time, 11.7 [95% CI, 10.5-12.8] years). ConclusionThe resorption rate increases proportionally to the follow-up duration and can be very severe in a high percentage of cases. Long-term multicenter studies are required to assess the effect of resorption on prosthesis longevity.

Strut graft vs. traditional plating in the management of periprosthetic humeral fractures: a multicentric cohort study.

Aim The gradual increase in shoulder implants in active elderly patients has appeared in a parallel increase in periprosthetic humeral fractures. The aim of this study was to investigate the advantages of using strut grafting with plate fixation during periprosthetic humerus fractures. Methods Thirty patients diagnosed with periprosthetic humeral fracture were divided into two groups. The first group of 15 patients (PS) underwent plate, ring, screws and strut allografts. The second group with resting 15 patients (PWS) was treated with only plate and screws. The criteria to evaluate the groups during followup were the Constant Shoulder Score (CSS) and Oxford Shoulder Score (OSS); the bone healing was measured by X-rays, controls measured by radiographic union score (RUS), and complications. The follow up was terminated at 12nd month in both groups. Results The difference between the two groups in all parameters was not significant. However, all patients gained adequate shoulder motor skills for normal daily living activities. All fractures were healed. Only two complications were registered, and blood loss was minimal. Conclusion We believe a revision to reverse shoulder prosthesis with a long-stem implant with or without cortical strut allograft augmentation to be safe and appropriate in the management of these complex injuries, though technically challenging, and having good results for normal activities daily life.

Bone restoration after revision hip arthroplasty with femoral bone defects using extensively porous-coated stems with cortical strut allografts

BackgroundStress shielding and bone loss of the femur are of great concern after revision total hip arthroplasty (THA) with extensively porous-coated stems, especially in a femur with already bone loss. The femoral bone remodeling patterns after revision THA with femoral bone defects using extensively porous-coated stems with cortical strut allografts remain unclear.MethodsWe retrospectively reviewed 47 patients who underwent revision THA using extensively porous-coated stems combined with cortical strut allografts and 75 patients without allografts. The minimum follow-up was 2 years. Femoral bone remodeling signs, including stress shielding, bone restoration in bone defect area, distal cortical hypertrophy, and femoral width, were compared between patients with and without cortical strut allografts. Clinical outcomes were also compared between two groups.ResultsPatients with cortical strut allografts showed less severe stress shielding (P = 0.01) than patients without allografts. Patients with allografts had more osseous restoration in bone defect area than patients without allografts (63.8% vs 30.7%, P < 0.001). Femoral width was significantly higher in femur with allografts than in femur without allografts at the immediate postoperative stage and latest follow-up (both P < 0.001). The hip function score, re-revision rate, and complications were comparable between two groups.ConclusionThe application of cortical strut allografts can decrease the severity of stress shielding, augment osseous restoration in bone defect area and improve femoral bone stock after revision THA using extensively porous-coated stems.

Cortical Strut Graft for Enigmatic Thigh Pain in Uncemented Total Hip Replacement.

AimsEnigmatic thigh pain in uncemented femoral components of a total hip replacement can be severe and disabling. Treatment can be conservative or surgical with cortical strut graft or revision of the femoral stem. Cortical strut grafting may offer good results with reduced morbidity. The aim of this study was to report the functional and radiographic outcomes of four patients with enigmatic thigh pain treated with cortical strut allograft.Materials and MethodsBetween 2016 and 2018, four women underwent cortical strut allografting at two centres. All patients had an uncemented, proximally porous S-ROM femoral implant (DePuy, Warsaw, In, USA). All other causes of anterolateral thigh pain were excluded. The mean age was 36.7 years (range: 29-51 years). Patients were followed up for a minimum of 14 months (range: 14-38 months). The University of California, Los Angles (UCLA) activity score, pain scores, complications, and radiographs at six weeks, three months, six months, nine months and one year were recorded.ResultsMean UCLA activity scores increased from 3.2 (range: 2-4) to 6.2 (range: 6-7) post-operatively. Radiologically, all four patients had complete osseointegration of their strut grafts. Pain scores decreased at six weeks and at six months. One deep venous thrombosis occurred. One patient experienced recurrence of anterolateral thigh pain 26 months post-strut graft, which resolved with protected weight-bearing and analgesia for three months.ConclusionsIn uncemented femoral prostheses, cortical strut grafting to treat enigmatic thigh pain can reduce symptoms and increase activity without the need to revise a well-fixed femoral stem. We add to the growing body of evidence that this can be a successful surgical technique.

Minimum 8-year follow-up of revision THA with severe femoral bone defects using extensively porous-coated stems and cortical strut allografts

BackgroundRevision total hip arthroplasty (THA) with severe femoral bone defects remains a major challenge. The purpose of this study is to report the minimum 8-year clinical and radiographic results of revision THA with severe femoral bone defects treated with extensively porous-coated stems and cortical strut allografts.MethodsWe retrospectively identified 44 patients diagnosed with Paprosky type III and IV femoral bone defects between January 2006 and July 2011. The exclusion criteria were patients not eligible for surgery, revised with extensively porous-coated stems alone, lost to follow-up and deceased. A total of 31 patients treated with extensively porous-coated stems and cortical strut allografts were finally included in this study. The degree of femoral bone defects was categorized as Paprosky type IIIA in 19 patients, type IIIB in 9 patients and type IV in 3 patients. The mean duration of follow-up was 11.0 ± 1.5 (range, 8.1–13.5) years.ResultsThe mean Harris Hip Score improved significantly from 43.4 ± 10.5 points to 85.2 ± 6.6 points (P < 0.001). Similarly, WOMAC and SF-12 scores also significantly improved. Twenty-eight stems achieved stable bone ingrowth, two stems showed stable fibrous ingrowth, and one stem was radiologically unstable. Complete union and bridging between cortical strut allografts and host bone was achieved in all 31 patients. The femoral width was augmented with cortical strut allografts after revision surgery (an increase of 10.5 ± 0.5 mm) and showed a slight decrease of 2.5 ± 4.8 mm after the 10-year follow-up. Using re-revision for any reason as an endpoint, the Kaplan-Meier cumulative survival rate of the stem was 96.2% (95% confidence interval, 75.7–99.5%) at 10 years.ConclusionOur data demonstrate that the use of extensively porous-coated stems combined with cortical strut allografts in revision THA with Paprosky type III and IV femoral bone defects can provide satisfactory clinical and radiographic outcomes with a minimum follow-up of 8 years.

Prognostic Factors and Clinical Outcomes after Treatment of Periprosthetic Femoral Fractures Using a Cable-plate.

PurposeTo analyze prognostic factors for the treatment of periprosthetic femoral fractures (PFFs) using the cable-plate construct.Materials and MethodsA retrospective review of a consecutive series of 41 PFFs treated by osteosynthesis using the cable-plate system. The mean age of patients was 67.3±12.1 years (range, 42-86 years) and the mean follow-up period was 31.5±11.6 months (range, 12–58 months). Fresh frozen cortical strut allografts were leveraged in three cases for additional stability. Prognostic factors that may potentially affect clinical outcomes were analyzed.ResultsAt the time of final follow-up, fracture union was obtained in 29 hips (70.7%; Group I) after an average of 13.5 weeks (range, 12–24 weeks). Healing failure after surgical treatment was observed in 12 cases (29.3%; Group II), including delayed union (n=10) cases and nonunion (n=2). Factors significantly associated with fracture union included fracture pattern (P=0.040), plate overlap percentage to stem length (P<0.001) and T-score at the preoperative bone mineral density (P=0.011). Transverse-type fractures around or just distal to a well-fixed femoral stem were observed in six cases (50.0%) of Group II.ConclusionThe cable-plate osteosynthesis of PFFs should be performed with caution in transverse-type fractures or in cases with severe osteoporosis. Fixation with sufficient plate overlap to stem length may be critical to prevent healing failure.

A Novel Technique for Single-stage Correction of Severe Shepherd Crook Deformity of a Femur With the Large Cystic Lesion and Pathologic Fracture

Fibrous dysplasia with severe proximal femur deformity and multiple large cystic lesions associated with a pathologic fracture is an orthopedic challenge. Correction is often impossible with conventional fixation methods. We report a technique to address the deformity and fracture simultaneously in these scenarios. A 32-year-old man, a case of polyostotic fibrous dysplasia with severe shepherd crook deformity and the pathologic fracture was managed by curettage, multilevel osteotomy, tibial strut allograft, extramedullary fixed-angle implant, and augmentation with cortico-cancellous bone grafting in a single stage. The mechanical axis of the femur was corrected, with an increase in the neck-shaft angle from 70.6 to 121 degrees. Union was achieved with good outcomes in cosmetic and functional status without recurrence at 18 months follow-up. In proximal femur fibrous dysplasia, critical analysis of the bone stock for implant purchase especially in the proximal femur with large cystic lesions is essential. Augmentation of the head, neck, and calcar region with cortical strut allograft provide stable fixation and decreases the deformity recurrence. This technique is particularly useful in severe forms of the disease; wherein there would be an impaired implant purchase in the weak pathologic bone, deficient lateral wall, and a wide medullary canal.

Uncemented extensive porous titanium-coated long femoral stem prostheses are effective in treatment of Vancouver type B2 periprosthetic femoral fractures: A retrospective mid- to long-term follow-up study.

The aim of this study was to evaluate the mid- to long-term outcomes of revision surgery for Vancouver type B2 periprosthetic femoral fractures (PFFs) after total hip arthroplasty using an uncemented extensive porous titanium-coated long femoral stem prosthesis (solution prosthesis) with or without cortical strut allograft. A total of 34 patients with Vancouver type B2 PFFs who underwent revision hip arthroplasty using a posterolateral approach and received a solution prosthesis at our institution from December 2006 to January 2014 were retrospectively recruited. Patients were asked to assess their walking ability and pain status using a questionnaire. Limb function, pain, and physical and mental health were assessed using the Harris Hip score, University of California-Los Angeles score, Western Ontario and McMaster Universities osteoarthritis index, and Short Form-12 Health Survey score. Patients were also asked to rate their satisfaction with the surgery. Fracture union and stress shielding were assessed by radiography, and computed tomography was used to assess stem fixation. Single-photon emission computed tomography performed to assess radionuclide distribution in patients given cortical strut allografts. Patients were asked about their condition before PFF and evaluated at 6 weeks, 3 months, 6 months, 1 year, and annually after surgery. Any complications during follow-up were recorded. Of the 34 patients, 29 completed follow-up. There was no significant difference in patient's health before PFF or at the last follow-up. Fracture union was achieved in all patients. Mild-to-moderate stress shielding occurred in three patients, and no patients exhibited femoral stem loosening or obvious subsidence. Radionuclides were concentrated in the cortical strut transplantation area, and the cortical strut was integrated with the host femur. The incidence of postoperative complications was low. Revision surgery using the solution prosthesis with or without cortical strut allograft is effective in treating Vancouver type B2 PFFs, with satisfactory mid- and long-term clinical and radiological outcomes.

Treatment of diaphyseal pathological fractures in children with monostotic fibrous dysplasia using cortical strut allografts and internal plating: A retrospective clinical study.

Children with fibrous dysplasia (FD) chronically suffer from pain, pathological fractures, and limb deformities. The most effective methods for managing the associated pathological fractures remain controversial. The purpose of this study was to evaluate the clinical results of the treatment of diaphyseal pathological fractures in children with monostotic fibrous dysplasia (MFD) using cortical strut allografts and internal plating.We retrospectively analyzed outcomes in nine children (5 boys, 4 girls) with diaphyseal pathological fractures due to MFD, who were treated with cortical strut allografts and internal plating (6 femoral fractures and 3 humeral fractures) between July 2007 and November 2012. The median age of patients in our study was 10 years (range 6–14 years). The fracture healing time, pain, extremity function, refracture, graft resorption, and complications were recorded to evaluate treatment effects.The median time of follow-up was 69 months (range 60–75 months). All patients had good postoperative fracture healing with a median healing time of 14 weeks (range 12–16 weeks). None experienced refracture, graft resorption, nerve injury, or limitation of extremity function or other complications. The fixation remained stable in all patients, with no evidence of loosening screws after surgery.In pediatric patients, the described surgical approach is an effective and reliable treatment method for diaphyseal pathological fractures caused by MFD. Cortical strut allografts, which act as biological bone plates, can provide good mechanical support while increasing the rate of fracture union.

Reconstructed the bone stock after femoral bone loss in Vancouver B3 periprosthetic femoral fractures using cortical strut allograft and impacted cancellous allograft.

This study was performed to evaluate the efficacy of reconstructing bone stock in Vancouver B3 periprosthetic femoral fractures (PFFs) using an impacted cancellous allograft cortical or combined with cortical strut allograft. We retrospectively assessed 39 Vancouver-type B3 periprosthetic fractures in 39 patients. Having different bone defects in the femur, 20 patients were treated with intramedullary impacted cancellous allograft, and 19 patients were treated with impacted cancellous allograft combined with cortical strut allograft. The median follow-up time was 58months. Thirty-three patients completed the follow-up as scheduled, and three of them underwent re-operation (9.1%, 3/33). The last evaluated mean hip Harris score was 81.8; WOMAC pain, stiffness, and function scores were 82.3, 79.0, and 81.3, respectively. The satisfaction score was 86.6, and the SF-12 mental and physical scores were 40.4 and 51.1, respectively, for all patients. These outcomes were without significant difference between the two treatment groups (p > 0.05). The facture union was achieved in all the hips (100%). The stem was fixed with bone ingrowth in 24 patients and with fibrous fixation in eight, while stem fixation was not achieved for the remaining patient. The stem subsided less than 3mm in 23 patients and 3-5mm in nine patients. One patient had > 5mm subsidence. The femoral bone stock was improved in 18 patients and remained unchanged in 14 patients; only one patient suffered a diminished bone stock. The radiographic assessment outcomes exhibited little difference between the two treatment groups (p > 0.05). Osseous union of the cortical strut to the host femur occurred in six patients with partial union and ten with complete union. There was moderate and mild graft resorption in three and 13 hips, respectively. The use of impacted cancellous allograft and cortical strut allograft to reconstruct bone stock can provide reliable options and satisfactory results.