Intramedullary Allograft Research Articles

Open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with locking plate and intramedullary allograft: A retrospective study

Background This retrospective clinical study aims to compare the functional and radiological outcomes after open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with both locking plate and intramedullary graft. Methods Forty-seven patients with proximal humerus fractures were treated with either open reduction and internal fixation (25 cases) or minimally invasive plate osteosynthesis (22 cases) and evaluated retrospectively with a minimum follow-up of 12 months. Thirty-one fresh-frozen fibulae and 16 lyophilized tibia allografts were used for augmentation. Change of both neck-shaft angle and humeral head height were evaluated radiologically. Functional outcomes were assessed using Disabilities of the Arm, Shoulder and Hand Score (DASH), Absolute Constant–Murley Score (CSabs), Relative Constant–Murley Score (CSrel), and Individual Relative Constant–Murley Score (CSindiv). Results Follow-up period and age for open reduction and internal fixation/minimally invasive plate osteosynthesis were 27.4 ± 16.2/29.6 ± 17.6 months and 60.5 ± 13.7/66.3 ± 11.7 years. CSabs, CSrel, and CSindiv were 57.3 ± 21.2/52.4 ± 18.9, 73 ± 24.1/73.9 ± 23.4, and 69.6 ± 24.8/64 ± 25.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, p ≥ 0.409. DASH was 14.8 ± 12.5/18.7 ± 14.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, p = 0.324. Decrease of neck-shaft angle and humeral head height was 7.8 ± 9.4/8.2 ± 15.6° and 0.6 ± 5.5/1.4 ± 2.6 mm for open reduction and internal fixation/minimally invasive plate osteosynthesis, p ≥ 0.380. Surgical time was 165.8 ± 77.6/84.7 ± 38.1 min for open reduction and internal fixation/minimally invasive plate osteosynthesis, p < 0.001. Conclusions Locked plating with intramedullary graft augmentation of unstable proximal humerus fractures demonstrates similar functional and radiological outcomes when comparing open reduction and internal fixation with minimally invasive plate osteosynthesis. However, minimally invasive plate osteosynthesis is related to significantly shorter surgical time versus open reduction and internal fixation.

Revision total elbow arthroplasty using intramedullary strut allograft for aseptic loosening of the humeral stem

Total elbow arthroplasty (TEA) has become a well-accepted treatment option for many pathologies of the elbow joint. Its use in distal humerus fractures in elderly patients has become increasingly popular and has good clinical results. However, with the aging population and the increasing number of TEAs performed, so comes the potential for an increasing number of revision TEA cases. Revision TEA can be extremely challenging. In addition to the technical difficulties of safe exposure and implant removal, reimplantation of a cemented humeral component with loss of bone stock can be a challenging step in this procedure. The purpose of this article was to describe a novel technique to address aseptic loosening of the humeral stem and loss of humeral bone stock with revision of the humeral component using a long-stemmed cemented implant and intramedullary allograft fibular strut bone grafting.

Reverse Shoulder Arthroplasty for Failed Proximal Humerus Osteosynthesis With Intramedullary Allograft: A Case Series

Introduction The presence of retained intramedullary fibular allograft presents many challenges during reverse shoulder arthroplasty (RSA), which have been discussed in limited fashion. This case series presents a single-surgeon experience with 6 patients treated with RSA following failed osteosynthesis of proximal humerus fractures using intramedullary allografts. Methods A retrospective review was conducted of RSA patients with a minimum of 2-year follow-up (exception of 1 deceased patient) for failed plate fixation of proximal humerus fractures. Two cohorts were created based on the presence of an intramedullary allograft during the procedure. Patient-reported outcome measures, active range of motion, time to revision, surgical time, complications, and case descriptions were obtained from chart review and radiographic analysis. Results When treating patients with a retained allograft, the surgeon used a guide pin from a cannulated screw set to advance through the graft, and a cannulated drill was used to ream and bypass the allograft, contributing to a 22% increase in surgical time (151 vs 124 min). Intraoperative complications were observed only in the allograft cohort (50%; 3 of 6), including cortical perforation with cement extrusion, humeral loosening, and proximal humerus bone loss. Patients treated with a retained allograft experienced pain relief ( P = .001) but did not gain significant functional improvements. Conclusion RSA for failed proximal humerus fixation with healed intramedullary allograft is associated with increased operative time and intraoperative complications, and patients can mostly expect pain relief. Techniques for humeral canal preparation and stem placement to bypass the allograft are helpful in managing these revisions.

Medium-term curative effect of extensively coated non-modular femoral stem in two-stage infection revision after joint replacement

Objective To determine medium-term curative effect of extensively coated non-modular femoral stems in twostage infection revision after joint replacement. Methods We retrospectively analyzed 33 patients (33 hips) who had a two-stage infection revision after total hip replacement arthroplasty from March 2005 to December 2006. Among of them, there were 20 men (20 hips) and 13 women (13 hips). Their mean age was 66.1±7.2 years with a range from 52 to 80. The two-stage revision protocol consisted of joint prosthesis taken out in the first stage, thorough debridement, hand-molded antibiotic bone cement spacer, and two-stage joint revision after anti-infective therapy. Anti-infective therapy included intravenous antimicrobial therapy for 4 weeks and oral antibiotics for 6 weeks. Harris hip score (HHS) was used to evaluate functions of hip joint. X-ray films were used to perform clinical and radiological evaluations of prosthesis stability, displacement and looseness. Reinfection criteria were the same as the criteria used to diagnose the joint infection. Results Follow-up visit was carried out for all patients for 5-9 years (6.1±1.7 years on the average). No infection or prosthesis looseness happened after two-stage revision. Microculture of samples taken during two-stage revision or pathological examination was negative. Harris hip joint score rose to 89.1±8.5 in the last follow-up visit from preoperative 42.3±6.5. 30 patients achieved stable bone ingrowths and the remaining three had stable fibrous ingrowths. Impacted bone graft at acetabulum side for 11 patients and all impacted bone graft in marrow cavity were fused well with the host bones. Allogeneic cortical bone plate grafts were used in 10 hips on the femoral side. Nine of these cortical bone plates fused with the host bones after postoperative 1 year, whereas one fused after 2 years. Conclusion Using extensively coated nonmodular femoral stems combined with intramedullary allograft in two-stage revision for treating infection can achieve satisfactory medium-term survival rate of prosthesis and infection clearance rate. Key words: Arthroplasty, replacement, hip; Prosthesis-related infections; Reoperation

Intramedullary Allograft Fibula as a Reduction and Fixation Tool for Treatment of Complex Proximal Humerus Fractures With Diaphyseal Extension

In this study, we present a novel technique for reduction and fixation of complex, unstable proximal humerus fractures with diaphyseal extension with the assistance of fibula allograft. We treated 14 patients using this technique since 2009 and found that it improves the reduction and enhances fixation while making the surgical procedure technically more manageable, and allows for early postoperative motion. In the first part of this study, we describe in detail the indications and surgical technique applied to these fractures. In the second part, we review the clinical and radiographic outcomes of these patients. Using this new technique, we have achieved an excellent union rate with minimal incidence of complications when treating these challenging fractures.

Finite element comparison of retrograde intramedullary nailing and locking plate fixation with/without an intramedullary allograft for distal femur fracture following total knee arthroplasty

PurposePeriprosthetic distal femur fracture after total knee arthroplasty due to the stress-shielding phenomenon is a challenging problem. Retrograde intramedullary nail (RIMN) or locking plate (LP) fixation with/without a strut allograft has been clinically used via less invasive stabilization surgery (LISS) for the treatment of these periprosthetic fractures. However, their biomechanical differences in construct stability and implant stress have not been extensively studied, especially for the osteoporotic femur. MethodsThis study used a finite-element method to evaluate the differences between RIMN, LP, and LP/allograft fixation in treating periprosthetic distal femur fractures. There were sixteen variations of two fracture angles (transverse and oblique), two loading conditions (compression and rotation), and four bony conditions (one normal and three osteoporotic). Construct stiffness, fracture micromotion, and implant stress were chosen as the comparison indices. ResultsThe LP/allograft construct provides both lateral and middle supports to the displaced femur. Comparatively, the LP and RIMN constructs, respectively, transmit the loads through the lateral and middle paths, thus providing more unstable support to the construct and high stressing on the implants. The fracture pattern plays a minor role in the construct stabilization of the three implants. In general, the biomechanical performances of the RIMN and LP constructs were comparable and significantly inferior to those of the LP/allograft construct. The bone quality should be evaluated prior to the selection of internal fixators. ConclusionsThe LP/allograft construct significantly stabilizes the fracture gap, reduces the implant stress, and serves as the recommended fixation for periprosthetic distal femur fracture.

Proximal Humeral Nonunions Treated With Fixed-Angle Locked Plating and an Intramedullary Strut Allograft

To determine if the use of a fixed-angle locked plate plus an intramedullary allograft in the treatment of proximal humeral nonunions resulted in improved union. Retrospective clinical analysis of patients' medical charts and radiographs. Clinical practice of senior authors. Eighteen patients who presented to the senior authors' clinic between 2001 and 2007 with clinical and radiographic evidence of symptomatic proximal humeral nonunions that were treated with the described method were included for analysis. Patients with severe humeral head bone loss, avascular necrosis, evidence of arthrosis, and less than 12-month clinical follow-up were excluded. All patients with a symptomatic viable nonunion of the proximal humerus were treated with a fixed-angle locked plate and an intramedullary cortical allograft. Patients were followed until radiographic union was achieved, with this being the principle determinant of a successful outcome. Radiographic union was achieved in 17 of 18 patients (94%). The average follow-up was 26.5 months (range 12-49 months). The average time from surgery to radiographic union was 5.4 months (range 2.5-8.8 months). There was 1 failure of fixation, and 2 patients developed transient neurologic sequelae. Range of motion measurements obtained from the most recent clinical follow-up were 115 degrees (range 20-180 degrees) active forward elevation, 37 degrees (range 0-70 degrees) passive external rotation, and active internal rotation was to the 10th thoracic vertebrae. American Shoulder and Elbow Surgeon scores improved from a level of 40 preoperatively to 81 postoperatively, and visual analog scale scores improved from 6.7 to 1.5. Intramedullary strut allograft insertion combined with fixed-angle plating is an effective technique for treating viable nonunions of the proximal humerus and was successful in achieving union in 94% of our patients.

Endosteal Allograft Plating for the Treatment of Recalcitrant Nonunions

Summary This is a descriptive manuscript reporting variations of a technique named Endosteal Allograft Plating, which is an evolution of the Endosteal Substitution concept. The described allograft substitution method provides the advantage of a biologic substitute in areas of marked bone loss, and yields structural integrity to provide a rigid fixed angle, in an attempt to decrease healing times and prevent fixation failure. Summary The technique includes placement of an intramedullary allograft strut in the area of bone loss. A conventional plate is utilized on the exterior bone surface, and screws are directed through the native and allograft bone. The allograft strut is first fixed in compression to the native bone. Iliac crest autograft is used to supplement the allograft. Five variations on intramedullary strut design are defined for different circumstances. These named variations of the Endosteal Substitution technique include: Endosteal Plating, Endosteal Allograft Plating, Endosteal Allograft Distraction, Endosteal Allograft Suspension, Endosteal Allograft Suspension Arthrodesis and Endosteal Allograft Inlay. Summary Recalcitrant bone nonunions pose a challenging treatment problem. Such nonunions are associated with multiple operative interventions and significant disability, and frequently with significant bone loss, infection, hardware failure and severe osteopenia. Innovative techniques have been described to address such situations. The biologic buttress provided by the endosteal allograft plate has proved to be a useful solution in the treatment of recalcitrant nonunions and long bone defects.