Periprosthetic femoral fractures: When I use strut grafts and why?

Cortical onlay strut allografts, as the primary method of fixation or as a supplementary fixation when a plate is used, have been a common option to treat B1 and C type PFF in the past decades since the technique was described by Penenberg et al. in 1989. Strut grafts were described as a useful treatment option because they provide structural support to the internal fixation while increasing the host bone stock without the harvesting complications. However, the use of struts have some concerns such as if the soft tissue stripping required for its application may lead into a delayed bone healing or increase the infection rate. Other concerns are the role as disease carrier, immune reactions, incorporation to the host bone in the long term and, in some centres, the availability and costs. This article reviews the literature regarding the use of struts in PFF and provides an overview on the use of strut grafts with actual recommendations based on the authors experience and the data from literature.