Strut Graft Research Articles

Functional outcome of free fibula grafting in benign non-reconstructable bone tumours involving the hand

BACKGROUND: Bone tumours involving hands are usually benign but can be locally aggressive. Several treatments have been described. Usual modalities of treatment include curettage and bone grafting. In more advanced stages when short bones of the hand are involved with more than 70% cortical destruction, or when such treatment option is not possible (as with non-contained tumours with cortical breaches, pathological fracture), only the resection or amputation of the affected segment can offer an effective cure. We studied the role of the free fibula graft (non-vascularised) in such types of benign non-reconstructable (by conventional methods) hand tumours. The aims and objectives were to study the functional outcome of free fibula grafting in benign non-reconstructable bone tumours involving the hand and to analyse the complications, if any, and assess the causes and solutions for them METHODS: We prospectively studied 15 patients with different types of benign, non-reconstructable bone tumours involving the hand operated by free fibula grafting. The study period ranged from January 2014 to December 2021. Follow-up ranged from 2 to 8 years (average of 4.26 years RESULTS: Results were analysed by the QuidkDASH-9 score system. There was no recurrence. One case of superficial infection was treated with antibiotics and dressing. All patients were happy with the treatment and resumed their normal duties and functional movements CONCLUSION: Use of the free fibula graft can be a good option for benign non-reconstructable bone tumours involving the hand to avoid amputation. The free fibula graft gives better results due to total excision of the lesion and strut graft support for good functional outcomes Level of evidence: Level 3

Study on role of fibular graft in non-union and complex fractures of long bone

Background: Road traffic injuries are the seventh most common cause of long bone fractures. Following high velocity limb trauma, the defects in the long bone are usually associated with appreciable soft-tissue losses. These open long bone injuries always require multidisciplinary managements to reconstruct the composite defects of bone and soft tissue. Aims and Objectives: The aim of the study was to find out radiological and clinical outcome, complications, and union time in complex and non-union fractures of long bone managed by fibular graft. Materials and Methods: Out of 50 cases, 40 cases were of complex fractures and ten cases were of non-union. We used Fibular strut grafts in reconstruction of bone defects and soft tissue injury. Results: Thirty (60.0%) had excellent functional outcome, 10 (20.0%) had good, 6 (12.0%) had satisfactory, and 4 (8.0%) patients had poor outcome. Main complications were non-union 2 cases and 3 cases of superficial wound infection, which subsided by wound dressing and intravenous antibiotic treatment. Conclusion: Free fibular grafting has been proven to be an ideal choice in the management of large segmental bone defects as well as in situations of biological failure of bone healing.

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.

Orthopaedic Diagnoses in the Black Pediatric Population.

The Black pediatric population is one that has been historically underserved and continues to have unmet needs. Factors including lack of diversity in orthopaedic studies and in historical standards, such as bone age, may inadvertently lead to inferior care. There are certain conditions in this population for which the practicing orthopaedic surgeon should have a higher degree of suspicion, including slipped capital femoral epiphysis, Blount disease, and postaxial polydactyly. Systemic diseases with higher rates in this population have orthopaedic manifestations, including sickle cell disease, vitamin D deficiency, and obesity. Racial discrepancies in access to prenatal care can have orthopaedic consequences for babies, especially cerebral palsy and myelodysplasia. Racial discrepancy exists in evaluation for nonaccidental trauma. Increased awareness of these issues better prepares practitioners to provide equitable care.

Y-Columellar Strut Graft: A Method for Reconstructing the Nasal Tip in Primary and Revision Rhinoplasty.

Several techniques have been proposed to modify tip shape and projection, both in congenital and in acquired nasal tip deformities. The authors describe a novel technique, the Y-columellar strut graft (Y-strut), which uses auricular cartilage to increase tip projection and restore contour in primary or revision rhinoplasty. Thirty-seven patients with congenital, acquired, or iatrogenic nasal tip malformation underwent reconstruction with Y-strut using short or long upper limbs ("wings"). The short wing variant was used to increase tip projection in primary rhinoplasty, and the long wing variant was used to corrected iatrogenic deformities of alar cartilages in revision rhinoplasty, improving contour and projection. Frontal, oblique, and lateral views before and after surgery were analyzed in blinded fashion at 1 year for tip shape and projection. Statistical analyses compared demographic characteristics, deformity type, and nasolabial angle before and after surgery to evaluate aesthetic outcome. All patients demonstrated improved nasal tip position. The Y-strut increased the nasolabial angle, reflecting tip rotation, and findings were independent of type or location of deformity ( P < 0.00001). No statistically significant differences were observed in comparisons of the short- versus long-wing technique. Three patients with congenital nasal tip malformations showed mild tip deviation at 1-year follow-up, and one had mild dorsal irregularity unrelated to grafting; no negative outcomes were observed in revision rhinoplasty patients. The Y-columellar strut graft is a reliable and versatile rhinoplasty technique using paired, symmetric grafts fashioned from auricular cartilage to correct tip deformities. Therapeutic, IV.

A CASE REPORT ON SALVAGE OF FAILED INTERNAL FIXATION OF PROXIMAL HUMRUS FRACTURE USING FIBULAR STRUT GRAFT.

Proximal humerus fractures are common problems plaguing in geriatric population. Approximately half of all proximal humeral fractures occur due to fall usually at ground level. (Low velocity trauma). In younger individuals fractures occurring because of higher-energy trauma such as a fall from a height, motor vehicle accidents, sports, or assaults. The proximal humerus fracture because of three loading modes: compressive loading of the glenoid onto the humeral head, bending forces at the surgical neck, and tension forces of the rotator cuff at the greater and lesser tuberosities. Most proximal humeral fractures are treated nonoperatively. However, surgical treatment is becoming more popular, with development of modern implant (PHILOS plate). Implant failure is common complication occur due to improper xation, osteoporotic bone, early mobilization, non-union and varus malalignment. Various modality available for its management i.e., Hemiarthroplasty, reverse shoulder arthroplasty and ORIF + bone graft. IN this case report 60-year male patient with right side proximal humerus fracture treated with PHILOS plating. At 6 week follow up radiograph suggest implant failure. Patient was posted for revision surgery ORIF + platting and bular strut graft was done.

A novel classification of alar retraction based on nostril exposure in Asian rhinoplasty

ObjectiveAlar retraction is considered a challenge in rhinoplasty. The classification of alar retraction remains poorly defined, especially in Asia. Patients with alar retraction are associated with excessive exposure to the nostrils in Asia. This study aimed to introduce a classification method of alar retraction based on nostril exposure. Materials and methodsMedical records of patients who had undergone rhinoplasty with alar retraction based on nostril exposure between January 2015 and December 2020 were retrospectively reviewed. The corrections of alar retraction were categorized into three groups according to a classification method of alar retraction based on nostril exposure: mild alar retraction, moderate alar retraction, and severe alar retraction. The visual analog scale (VAS) and rhinoplasty outcomes evaluation (ROE) were used to evaluate the satisfaction rate. ResultsWithin a median period of 13.3 months, 45 patients (51.14%) with mild alar retraction were corrected by alar contour graft. 23 patients (26.14%) with moderate alar retraction were treated with the alar contour graft(n=10), the lateral crural strut graft (n = 6), and the alar projection graft (n = 7). 20 patients (22.73%) with severe alar retraction were corrected by lateral crural strut graft combined with composite graft (n = 6), lateral crural strut graft (n = 10), and composite graft (n = 4). The severe alar retraction group had a higher satisfaction rate in ROE(P<0.05) and VAS (P<0.05) than moderate alar retraction and mild alar retraction at a follow-up of 12 months after surgery. ConclusionsThe classification of alar retraction based on nostril exposure is more practical for rhinoplasty in Asia.

A Longitudinal Study of Improvement in Nasal Airway Obstruction after Secondary Cleft Rhinoplasty.

Nasal airway obstruction is an increasingly recognized phenomenon in patients with cleft lip and/or palate and has the potential to significantly affect quality of life in this patient population. To date, the effect of secondary cleft rhinoplasty on cleft-related nasal airway obstruction has not been studied. Patients undergoing secondary cleft rhinoplasty at the Children's Hospital of Philadelphia from 2015 to 2021 were identified. Preoperative and postoperative Nasal Obstruction Symptom Evaluation scores were recorded. Alterations in scores were evaluated for variation depending on patient characteristics, operative maneuvers, and postoperative nasal stenting. Nasal airway obstruction was present in mild to moderate severity in patients before secondary cleft rhinoplasty. Postoperatively, obstruction improved or resolved in the domains of nasal blockage/obstruction, trouble breathing through the nose, and ability to get enough air through the nose during exertion (P < 0.05). Overall composite Nasal Obstruction Symptom Evaluation scores improved (P < 0.05). Lateral crural strut grafting was associated with improvement in nasal blockage, whereas alar revision and tip sutures were associated with worsening in specific nasal symptoms. Patients who underwent nasal stenting were found to report less trouble breathing after surgery than patients who did not (P < 0.05). Nasal airway obstruction is present in mild to moderate severity in patients with cleft lip and/or palate, and the subjective severity of obstruction is decreased by secondary cleft rhinoplasty. Specific operative maneuvers are associated with alterations in nasal airway obstructive symptoms, and nasal stenting is associated with an improvement in trouble breathing after secondary cleft rhinoplasty. Therapeutic, IV.

What's New in Musculoskeletal Tumor Surgery.

What's New in Musculoskeletal Tumor Surgery.

Lateral Suspension Technique in Treatment of Lateral Crus Malposition Belada Technique.

Lateral crus malposition can cause health problems from both functional and esthetic perspectives. Recently many techniques are developed to solve this problem. One of the failures that can be seen in these surgical techniques is that the lateral crus placed in its new position is shifted to the cephalic and is dislocated. Our aim in this study is to introduce the technique authors developed to prevent complications. 16 patients (10 female and 6 male) with a lateral crus malposition during rhinoplasty surgery were included in the study to have a reposition. The suture placed on the caudal end of the lateral crural strut graft attached to the lateral crus, which authors freed from the vestibule skin for repositioning in our patients operated with an open technique, is fixed by taking it out from the skin through the newly created pocket. The lateral crus, which was fixed with a suture in its new pocket, did not dislocate, did not shift to cephalic and no infection developed in any of our patients. In 1 of our patients, a second surgery was planned because the inserted lateral crural strut graft caused a narrowing in the nasal cavity.

Fixation by Autogenous Cortical Plate Technique on Sites of Subtrochanteric Shortening Osteotomy Contributes to Early Bone Union in Total Hip Arthroplasty for Crowe Type IV Developmental Dysplasia of the Hip

Subtrochanteric shortening osteotomy (SSO) is often applied during total hip arthroplasty (THA) in high hip dislocations. The aim of the present paper was to evaluate the results of fixation by autogenous cortical plate technique on sites of SSO in THA for patients with Crowe type IV developmental dysplasia of the hip (DDH). We conducted a historical prospective cohort study and reviewed 67 patients (82 THAs) with SSO performed between March 2016 and May 2020. Thirty-nine patients (48 hips) obtained stability by intramedullary pressure provided by the S-ROM modular prostheses and with or without prophylactic binding by stainless-steel wire after osteotomy and before stem implantation (group A). Twenty-eight patients (34 hips) were fixed with autogenous cortical plate technique and stainless-steel wire or cables (group B). Time of operations, complications, radiographic results and clinical scores were compared. One intraoperative fracture and a dislocation occurred, while component loosening, ectopic ossification and osteolysis were not observed. Group B had a higher union rate at the 4th month than group A (P = 0.015) while there were no significant differences of union rates at the 8th (P = 0.811) and the 12th month (P = 0.722) and of the average healing time (P = 0.181). No significant differences were found in hip function scores (HHS and WOMAC Osteoarthritis Index) between two groups. Fixation with autogenous cortical plate from the cylinder of femoral bone contributes to early bone union of osteotomy ends in Crowe type IV DDH patients compared to those who do not apply the technique. Besides of application of autogenous cortical strut grafts, relevant measures are as well recommended to prevent nonunion after SSO.

Fixation of Fresh Femoral Neck Fractures Using Fibular Strut Graft Along with Cannulated Screws

Intracapsular femoral neck fractures can result from trivial trauma in the elderly or high-energy trauma in younger age-groups. In younger patients aged &lt;60 years, the femoral head should be conserved to avoid the long-term complications of replacement arthroplasty. The options of osteosynthesis include closed/ open reduction and internal fixation with/without bone grafting. Internal fixation alone does not provide rigid fixation, owing to cavities in the posterior part of the femoral head and neck. Fibular grafts augment union and provide strength to the posterior cortex during reconstruction of the femoral neck. We evaluated the use of fibular grafting for fresh femoral neck fractures with posterior comminution. Between November 2019 and March 2022, 20 women and 12 men aged 20 to 60 years underwent osteosynthesis and fibular strut grafting supplemented with 7.0-mm cannulated hip screws for Garden grades III (n=19) and IV (n=13) femoral neck fractures. Clinical and radiological outcomes were evaluated. Patients were followed up for a period of 15 months. According to the Harris hip score, outcome was good to excellent in 23, fair in 7, and poor in 2. 30 of the 32 patients achieved bone union after a mean of 4.5 (range 3.5-5.5) months. In 2 patients, the bone was united with a mean of 10º of varus collapse. Two patients had non-union. Other complications included screw migration in the joint space (n=1) and screw pullout (n=2). No patient had avascular necrosis of the femoral head. Fixation with cancellous screws and fibular strut grafts for femoral neck fractures is cost-effective and technically less demanding, and associated with good outcomes.

Interprosthetic and interimplant femoral fractures: is bone strut allograft augmentation with ORIF a validity alternative solution in elderly?

Nowadays orthopedic surgeons have a new challenge to treat the interimplants fractures. Although fixation strategies exist for periprosthetic hip and knee fractures, there is no standard of care regarding the more complex interprosthetic and interimplants fractures. The aim of our study is targeting the focus on the bone strut grafting to avoid the metal hardware failure and to achieve the bone healing in these injuries. A prospective case note review of all interprosthetic or interimplants femoral fractures admitted to our trauma center. There were 11 patients (2 males and 9 females) with a mean age over 85 years old. We treated all the patients by ORIF and medial graft strut allograft to reduce the main complication leading to re-operations and morbidity or mortality is the nonunion or delayed union. The criteria to evaluate the patients during the follow-up were: the survival and complication after the surgery; the objective quality of life measured by Activities of Daily Living Score (ADL). The bone healing was measured by X-rays control as the alignment was measured by radiographic UNION SCORE, and postoperative complications. All the patients reduced their ADL. In the most of cases we had a good x-rays reduction. We had not: No nonunion or Not delayed union. All patients died within 2 years from the surgery but not due by surgical complications. According us, the purpose of this surgery is to limit comorbidities and early mortality not to improve optimal restoration of lower limb function.

Increasing Nasal Tip Projection Using Structural Grafts: A Review of Outcomes.

Nasal tip projection (NTP) is an important criterion when evaluating the result of rhinoplasties. Increasing NTP is essential for nasal function and visual aesthetics. Grafts such as columellar strut grafts (CSGs) and septal extension grafts (SEGs) are commonly used. We analyzed the safety and efficacy of the most commonly used grafts for increasing NTP during surgical rhinoplasty. The authors reviewed all English-language articles in PubMed, Embase, and Web of Science between 2000 and 2020 that reported original outcomes on structural grafts used to increase NTP. We recorded and analyzed the following at 6 months postoperatively: NTP change, Goode ratio, nasolabial/columellar-labial angle, postoperative complications, and subjective patient assessments. A total of two structural grafts in 35 studies (21 CSG, 14 SEG) were included. Of the 2290 included patients, 1707 received CSGs (21 studies) and 583 received SEGs (14 studies). Overall NTP increased after using either graft. Subgroup analysis showed that more patients experienced postoperative complications after receiving SEGs (23.7%) than CSGs (9.7%). For patient satisfaction, three CSG studies found 83.3% of patients rated their satisfaction high, 12.1% moderate, and 4.5% not satisfied (n = 66). Most patients reported improvement in tip projection (97.0%), breathing (86.4%), and olfaction (83.3%). There was a significant increase in average patient satisfaction on the Visual Analog Scale (n = 39). Findings show that CSG and SEG grafts were safe and effective at increasing NTP. We suggest that CSG may be safer and more effective than SEG at increasing NTP in rhinoplasties. Further prospective studies may elucidate the mechanisms underlying the differences between CSGs and SEGs in patient safety and satisfaction when increasing NTP in surgical rhinoplasty.

Autologous Bone Graft vs PEEK Cage in Patients with Cervical Spondylotic Myelopathy

Background: Cervical spine stenosis is one of the most common degenerative changes of cervical spondylotic myelopathy (CSM) and results in severe dysfunction of the cervical spinal cord. The conventional treatment of such degenerative cervical spine conditions is anterior cervical discectomy and fusion (ACDF). Strut graft remains the gold standard in ACDF with excellent patient recovery but has many shortcomings. Polyetheretherketone (PEEK) cages have recently become popular as a replacement for strut grafts in patients undergoing ACDF.&#x0D; Objective: This study was carried out to compare the clinical and radiographic outcomes of autologous bone grafts versus PEEK cages in patients undergoing ACDF surgery.&#x0D; Materials and Methods: It was a randomized controlled trial conducted at the Neurosurgery Department Punjab Institute of Neurosciences for three years. Patients who consented to be a part of this study and fulfilled our predefined inclusion criteria were recruited and randomized into 2 groups. One group underwent ACDF with auto bone graft whereas the other group underwent ACDF with PEEK cage.&#x0D; Results: A total of 198 subjects were included in this study. The mean age was calculated as 47.60 ± 9.17 years in the PEEK cage group and 46.74 ± 8.87 years in the Autologous bone graft group. Males accounted for 59.6% of the study population. The fusion rate was found to be higher in the PEEK cage group with a p-value of 0.002.&#x0D; Conclusion: PEEK cages are superior to strut grafts as they have lesser morbidity after ACDF surgery in patients with CSM.&#x0D;

Functional Outcomes of Patients Treated with Fibula Strut Graft and Double Plate in the Treatment of Recalcitrant Humerus Nonunions

Objective: Recalcitrant humerus nonunion is challenging to treat, and plate fixation is a common treatment choice. This study aimed to determine the efficiency of double plating combined with nonvascularized autologous fibular strut allograft in the treatment of atrophic and defective humerus nonunions.Methods: Fourteen patients were surgically treated for recalcitrant humerus malunions. Demographic data (age, gender, dominant side), clinical features, and previous surgical records of the patients were recorded preoperatively. Preoperative Visual Analogous Scale (VAS) and Constant-Murley scores of the patients were recorded before the surgery.Results: 10 (71.4%) of the patients were female, and 4 (28.5%) were male. The mean age was 53.07±9.69 (range, 39-67). 9 (64.3%) of the patients had nonunions on the dominant side. The mean follow-up was 11.14±1.9 months. The complete union was observed in all patients, and the mean union time was 5.1±0.63 months (range, 4.2-6.0). The mean preoperative VAS score was 7.29 ± 0.91 (range, 6-9), and the mean postoperative VAS score was 0.93 ± 0.92 (range, 0-3). VAS scores improved after the surgery (p&amp;lt;0.001). The mean preoperative Constant-Murley score was 53.57 ± 12.17 (range 34-72), and the mean postoperative Constant-Murley score was 86.00 ± 9.21. Constant-Murley scores improved after the surgery (p&amp;lt;0.001). Gender (p=0.635), dominant side involvement (p=0.112), and age (p=0.925) did not correlate with union time.Conclusion: Double plating with autologous nonvascularized fibular grafts is a successful treatment option for recalcitrant humerus atrophic nonunions, especially with bony defects.

Reorienting Lower Lateral Cartilages With Lateral Crural Struts: Aesthetic and Functional Benefits

Nasal tip shape and position play a major role in the aesthetic appearance of the nose. Cephalically oriented lower lateral cartilages (LLC) are associated with a broad boxy nasal tip. Reorienting cephalically positioned LLC with lateral crural strut grafts is a technique used to correct the nasal tip. An open approach surgical technique is described to evaluate the true orientation of the LLC and correct the boxy nasal tip. Five cases are shown with pre- and post-op pictures. The identical surgical technique is used in all cases with a variation in grafts necessary to create the desired esthetic result. All 5 described cases are on female patients. In all cases, reorientation of the lateral crura with lateral crural strut grafts were performed. In all, 4 of the 5 cases required a columellar strut graft, 3 cases required a shield graft to increase nasal tip projection and control the columellar-lobular angle, and 2 cases required spreader grafts for internal nasal valve support. All 5 cases required a variation of inter and intra-domal suture techniques to refine the nasal tip. A boxy nasal tip with supra-tip fullness is commonly associated with cephalically oriented LLC. Changing the orientation of the LLC to a more favorable angle and using lateral crural strut grafts can be used to not only correct the nasal tip deformity, but also facilitate projecting/de-projecting the nose, changing the rotation of the tip, and also supporting the external nasal valve. Reorienting cephalically oriented LLC is a versatile approach to reshaping the nasal tip. It is a technically demanding maneuver that when executed, allows complete control of the nasal tip complex. We have used this approach in many cases involving a boxy nasal tip with long ptotic tips and poorly supported external valves.

A Modified Technique in Rhinoplasty: A Septal Extension Graft Complex Using Septal Cartilage, Ethmoid Bone, and Auricular Cartilage.

Due to the small and weak septal cartilage of Asians, it is a challenge to obtain ideal tip projection and nose lengthening in this population by performing septal extension grafts with only septal cartilage. The aim of this study was to introduce a septal extension graft complex incorporating nasal septal cartilage, the perpendicular plate of the ethmoid bone, and bilateral auricular cartilage, and to examine its effectiveness in terms of morphological and mechanical support. Septal cartilage was harvested under an endoscope according to standard techniques. Two pieces of the perpendicular plate of the ethmoid bone, placed on either side of the "L" strut, served as 2 spreader grafts. A double layer of auricular cartilage was fixed as columellar strut grafts. Three-dimensional facial scanning was used to examine the change of 3 parameters. Nasal tip resistance was evaluated by a digital Newton meter. In total, 25 patients were followed up postoperatively for a mean of 25.9 months. The analysis showed significant differences in both contour parameters and nasal resistance: nasal length (mean [standard deviation], 41.4 [4.0] vs 46.2 [3.4] mm, P < 0.05) and nasal tip projection (21.3 [3.2] vs 24.4 [2.7] mm, P < 0.05) appeared to increase postoperatively, whereas nasolabial angle (117.6° [5.9°] vs 109.5° [5.3°], P < 0.05) showed a significant decrease after surgery. The resistance of the nasal tip also increased significantly (P < 0.05) at displacements of 1, 2, and 3 mm. All patients were satisfied with the aesthetic results, and no serious complications occurred. This kind of modified septal extension graft technique can effectively adjust nasal morphology for short-nose East Asians.

Results of using intramedullary autogenous fibular strut graft as an adjunct to dynamic plating in atrophic non-union of humeral mid-shaft fracture

Introduction: Atrophic nonunion of the humerus is rare and complex condition to treat. Several surgical techniques have been used for the treatment of non-union, which include compression plating, intramedullary nailing and use of external fixators, with or without bone grafts. Use of autogenous fibular as a strut graft is proposed to achieve good union and functional recovery. The aim of this study was to assess the clinical result of the intramedullary fibular graft adjunct to dynamic plate fixation in diaphyseal atrophic non-union of the humerus.Methods: The present prospective study was carried out within the period of January 2019 to December 2021 in the Department of Orthopedic Surgery of Bangabandhu Sheikh Mujib Medical University. Fifteen patient (09 male and 06 female) with atrophic non-union of the humerus midshaft fracture within the age range of 41-60 years were selected. All the case had non-union of the fracture of the middle third of humerus with a delay in commencement of specific treatment. The clinical and radiological outcome of Surgery has been assessed using definite recommendation. Statistical results were obtained by using the SPSS program.Result: The mean union time was 5.65 months. Post-operative complications were noticed in 3 patients, infection in 01 patient and 02 patients had persistent pain due to failure of union. Regarding the final outcome, satisfactory results were found in 86.66% case and unsatisfactory result in 13.33% case.Conclusion: The intramedullary fibular auto graft with dynamic plating results in satisfactory clinical outcome in atrophic osteoporotic diaphyseal non-unions of the humerus.

Assessment of management of fracture neck of femur with internal fixation alone or with fibular graft

Background: Intracapsular femoral neck fractures are commonly seen in the elderly population after a trivial fall. The present study was conducted to assess management of fracture neck of femur with internal fixation alone or with fibular strut graft. Materials & Methods: 52 patients of fracture neck of femur treated by close / open reduction and internal fixation using cannulated cancellous screws along with strut fibular graft of both genders were enrolled. Parameters such as mode of injury, range of movement and complications were recorded. Results: Out of 52 patients, males were 32 and females were 20. Mode of accident was RTA in 28, fall in 16 and domestic violence in 8 cases. Range of motion flexion > 100 degrees was seen in 40 and < 100 degrees in 12 cases. Extension > 10 degrees was seen in 38 and < 10 degrees in 14 cases. Abduction > 25 degrees was seen in 44 and < 25 degrees in 8 cases. Complications observed were swelling in four, shortening of the affected limb in two and superficial infection in case. Conclusion: Management of fracture neck of femur with cancellous cannulated screw and fibular strut graft is a reliable method of fixation.