The Use of Fibular Allograft in Complex Periarticular Fractures Around the Knee

Abstract

Although the use of fibular strut allografts in proximal humerus fractures has gained popularity, their use in other types of fractures is less well described. Fibular allografts have recently been used in the repair of complex periarticular fractures of the proximal tibia and distal femur. Fibular allografts can be inserted in a variety of manners to achieve goals specific to each individual fracture pattern. In the proximal tibia, insertion through a fracture line or cortical window facilitates joint surface elevation, prevents subsidence and enhances overall construct stability. In distal femoral fractures, including complex periarticular fractures, insertion through the fracture or cortical window permits indirect reduction of the medial cortex and provides necessary medial column support. An additional option in distal femur fractures includes fibula insertion as an intramedullary nail, allowing enhanced fixation in short distal fracture segments. In all cases, the use of a fibular allograft augments poor bone stock and provides improved screw purchase and construct stability when combined with conventional plating methods. Here we present a series of cases at our institution illustrating an array of novel techniques utilizing endosteal fibular allografts in the fixation of complex periarticular fractures about the knee.

Are Fibular Allograft Struts Useful for Unicameral Bone Cysts of the Proximal Humerus in Skeletally Mature Patients?

“…Fibular strut allografting has been reported to provide immediate and long-term stability in the treatment of comminuted fractures of different long bones such as the humerus [7,15]. We have been using fibular strut grafts to treat UBCs in patients with a closed physis for several years.…”

Use of an Intramedullary Allogenic Fibular Strut Bone and Lateral Locking Plate for Distal Femoral Fracture with Supracondylar Comminution in Patients over 50 Years of Age

“…Further medialization of the bone strut by the K-wire “joystick” manipulation technique can reduce the medial comminuted cortex to its original position and augment the medial column in the case of massive medial cortical bone defect ( Figure 1 ). A bone strut can sometimes be inserted through the intercondylar notch [ 12 ]. If the comminuted condyle is too fragile to be reduced in size, the bone strut can be advanced distally for the indirect reduction of the distal femoral articular block and facilitation of distal screw purchase.…”

Use of Osteobiologics for Fracture Management: The When, What, and How

“…fibula strut) that provides mechanical support [37] . The use of cortical strut allografts has been described in periprosthetic fractures of the femur, proximal humerus [38] as well as in the setting of nonunions of the distal femur and humeral shaft [39] . Freeze-dried allografts can be combined with osteoinductive factors such as Bone Morphogenic Proteins (BMP) or iliac crest graft to treat atrophic nonunions [40] .…”