A report of a novel technique: The comprehensive fibular autograft with double metal locking plate fixation (cFALP) for refractory post-operative diaphyseal femur fracture non-union treatment

J-bone graft with double locking plate: a symphony of mechanics and biology for atrophic distal femoral non-union with bone defect

“…Consequently, exposure of the non-union site, removal of the failed previous hardware, removal of fibrous scar tissue, correction of deformities, full bone grafting, and stable mechanical fixation are strategies for ADFNBD treatment. Jiang et al [39] proved that the application of double locking plates with a fibular autograft is a promising method for diaphyseal femur fracture non-union; however, due to the possible complications of obtaining a graft from the fibular, it is only recommended for severe non-union. Treatment with DP combined with bicortical iliac bone provides a mechanical and biological environment, and unlike fibular grafts, it is not associated with serious complications; therefore, it may be a suitable alternative treatment.…”

Is augmented LISS plating biomechanically advantageous over conventional LISS plating in unstable osteoporotic distal femoral fractures?

“…On the other hand, in comminuted fractures with lack of medial support, early weight‐bearing with callus formation would provide efficient medial reinforcement to avoid implant loosening or fatigue failure . However, early weight‐bearing has been identified as one of the etiological factors for plate failure and is therefore principally not advocated during the immediate postoperative phase . Typical complications with bridging locking plates, related to early weight‐bearing, are plate bending, screw cut‐out and fatigue implant failure .…”

“…Although intramedullary grafting is not a new phenomenon, it has not been established up to date as a standard procedure for implant augmentation. In two previous clinical studies, one of them with additional biomechanical testing, the authors emphasized that pressfit connection between the cortical graft and bone has the biomechanical benefit of providing better screw anchorage by simulating an enhanced cortical thickness. According to Jiang et al intramedullary placed fibular grafts can resemble intramedullary nails by offering medullary fixation and optimal alignment.…”

“…In two previous clinical studies, one of them with additional biomechanical testing, the authors emphasized that pressfit connection between the cortical graft and bone has the biomechanical benefit of providing better screw anchorage by simulating an enhanced cortical thickness. According to Jiang et al intramedullary placed fibular grafts can resemble intramedullary nails by offering medullary fixation and optimal alignment. Moreover, the grafts can provide immediate structural continuity at the fracture site, which remedies the disadvantage of the cancellous grafts.…”

“…One polylactide (PLA) based hollow cylindrical intramedullary graft of 200 mm length, 11 mm outer and 5 mm inner diameter was produced by means of three‐dimensional printing technology (Ultimaker B.V., Geldermalsen, Netherlands) for each femur in the group with LISS plus intramedullary graft fixation. Its tube‐like geometry was designed to mimic a simplified double cortical bone graft such as a fibula graft used for intramedullary reinforcement purposes in the clinical practice . PLA is a biodegradable material with a tensile modulus of 2852 MPa, yield tensile strength of 38 MPa and ultimate tensile strength of 50 MPa .…”