High survival of modular tapered stems for proximal femoral bone defects at 5 to 10 years followup.

Background: Currently, the two most commonly used options for the revision of femoral components in North America are: cylindrical, nonmodular, cobalt-chromium stems and tapered, fluted, modular, titanium (TFMT) stems. Previous reports have cited high failure rates with cylindrical cobalt chrome stems in large femoral defects but the longer term survival of the fluted stems is unknown.

Questions/purposes: We examined the 5- to 10-year survival of TFMT stems implanted for severe femoral defects.

The pseudo A(LT) periprosthetic fracture: it's really a B2.

Periprosthetic fracture of the proximal femur involving the lesser trochanter (the Vancouver type A(LT)) is an uncommon occurrence. As it is basically an avulsion fracture of the attachment of the iliopsoas, it does not destabilize the stem and can be treated nonsurgically. In contrast, there is a so-called type "new B2" periprosthetic fracture of the lesser trochanter, which includes a segment of the proximal medial femoral cortex.

Treatment of osteopenic humeral shaft nonunion with compression plating, humeral cortical allograft struts, and bone grafting.

Surgical stabilization of humeral shaft nonunions can be difficult to achieve if severe osteopenia or loss of bone stock is present. We present a technique whereby a 4.5-mm standard dynamic compression plate is used in conjunction with a humeral cortical allograft strut and bone grafting to stabilize humeral shaft nonunions complicated by severe bone loss.