Cortical onlay allograft struts in the treatment of periprosthetic femoral fractures.

Cortical onlay strut allografting is emerging as a very attractive option for periprosthetic femoral fractures around stable implants. The cortical struts essentially represent biologic bone plates. In addition to conferring mechanical stability they may enhance fracture healing and can potentially increase bone stock. If appropriately selected and prepared, cortical struts can be customized to fit any femur. Because the modulus of elasticity of allograft struts is similar to that of the host bone there is less stress shielding of the host bone than with other more rigid forms of internal fixation. Cortical struts can also be used in combination with other modalities of periprosthetic fracture treatment. They can be useful when combined with plate fixation or with revision to a long-stem prosthesis, and as adjunctive stabilizers at the junction between the host and a proximal femoral structural allograft.