Comparison of formalin preserved bone allograft in the form of a paste and as bone chips in fresh femoral shaft fractures with comminution.

Femoral shaft fractures with comminution are indicators for primary bone grafting. Problems related to autograft use have led us to evolve methods using allografts preserved in formalin. This method is cheap, easy, reliable and is readily available in the poorer countries. Comparison of 20 cases using allograft paste with 20 cases using allograft chips slivers in similar femoral shaft fractures was done. In both cases, the fusion time was slightly delayed as compared to cases using autograft. The infection rates were comparable, but it was noticed that bone paste got resorbed in 2 cases, leading to plate bending and malunion. The theoretical advantage of the bone paste in filling up the defects and crevices in the comminuted fractures was offset by the practical disadvantage of having no osteoconductive scaffolding, which was provided by the bone chips. It is thus recommended that formalin preserved bone allograft paste may be better suited for use in bony cavities and joint replacements, while formalin preserved bone chips are a good alternative to bone autografts, especially in polytrauma cases. Formalin preserved allografts are a viable alternative method for use in third world countries.