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In a prospective study, we used the nanocrystalline hydroxyapatite paste Ostim (Osartis, Obernburg, Germany) in combination with a palmar plate to treat comminuted radius fractures with a metaphyseal and articular component in order to examine the clinical use of Ostim as a bone substitute. Twenty-one patients with 22 radius fractures of AO types C2 and C3 were included in the study. The measurements, taken 10.2+/-1.3 months after the initial treatment, revealed a dorsopalmar tilt of 8.8+/-3.7 degrees , a radioulnar inclination of 18.8+/-2.8 degrees and an ulnar variance of 0.8+/-1.8mm. According to the Gartland and Werley evaluation, eight of the treated fractures attained an excellent, 11 a good and the remaining three a fair result. The study demonstrates that Ostim, in combination with angularly stable osteosynthesis, can be used as an acceptable bone substitute for the treatment of type C2 and C3 radial fractures.

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Objectives:To evaluate the utility and complications of using carbon fiber implants (CFIs) compared with standard titanium alloy (TI) intramedullary implants for stabilization of impending or existing pathologic fractures.Design:Retrospective comparison.Patients/Participants:Ninety-four patients undergoing intramedullary fixation of 100 impending or existing pathologic fractures between 2014-2019 were identified for inclusion.Main Outcome Measurements:The primary outcome was postoperative complications. Other outcomes included implant type, pathology, indication, and adjuvant therapy.Results:Fifty-three percent of cases used a CFI, whereas 47% of cases used a TI. There were no differences between groups with regard to anatomic location (P = 0.218), indication for surgery (P = 0.066), histology (P = 0.306), or postoperative adjuvant therapy (P = 0.308). Nineteen percent of cases incurred a postoperative complication in each group (P = 0.530), and no differences were noted with regard to complication type including implant failure (P = 0.442) and wound complications (P = 0.322). There was a cost saving of $400 with TI implants compared with CFI.Conclusions:This is a high-risk population for postoperative complications after stabilization of pathologic fractures. Although there were no statistical differences in complications between CFI and TI, implant choice depends on patient characteristics and surgeon preference.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Case: A 69-year-old woman with a history of breast cancer, on long-term antiresorptive medications, was treated with carbon fiber cephalomedullary nails for bilateral atypical femur fractures. Her thigh pain was presumed to be from metastatic lesions and was treated with radiation without standard imaging. The index procedure was complicated by a left nail fracture. The patient underwent exchange cephalomedullary nail fixation with plate augmentation. At 1 year, the patient was asymptomatic with radiographs demonstrating healing. Conclusion: This case highlights the importance of appropriate imaging in all patients with thigh pain on antiresorptive therapy and features an uncommon complication of carbon fiber cephalomedullary nail fixation.