Grafting for periprosthetic femoral fractures: Strut, impaction or femoral replacement § Eleftherios Tsiridis a, * , Gavin Spence b , Zakareya Gamie a , Mohamed A. El Masry a , Peter V. Giannoudis a a Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, United Kingdom b Orthopaedic Research Unit, Department of Surgery, University of Cambridge, United Kingdom Accepted 28 February 2007 Injury, Int. J. Care Injured (2007) 38, 688—697 www.elsevier.com/locate/injury KEYWORDS Periprosthetic; Femoral; Fractures; Hip revision; Strut grafts; Impaction grafting Summary Peri-prosthetic fractures are technically demanding to treat, as they require the skills of revision arthroplasty as well as those of trauma surgery. [Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 2005;20:857—65.] reporting on 1049 peripros- thetic femoral fractures found that the annual incidence varied between 0.045% and 0.13% for all THAs performed in Sweden and that the accumulated incidence for the primary hip arthroplasties was 0.4% while for the revision arthroplasties was 2.1% [Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 2005;20:857—65.]. The elderly population is particularly vulnerable to low energy periprosthetic fractures attributed to osteopenia or osteoporosis leaving limited reconstruction options to the hip revision surgeon. Bone grafting in the form of autograft has well recognized limitations and allograft represents the gold standard of bone augmentation in the majority of the cases. Allograft can be used as morselised in the form of impaction grafting, reconstructing the bone from within out, or in the form of structural allograft. In the latter case, strut onlay plates or whole proximal femoral allografts can be used to augment the deficient bone or to totally replace it respectively. Immune reaction and disease transmission along with delayed revascularization of the cortical allograft can cause failure of the construct in the long term; however, the results to date from their use are promising. We here present an overview of the literature on the use of available bone grafts in the treatment of periprosthetic femoral fractures. # 2007 Elsevier Ltd. All rights reserved. § No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study. * Corresponding author at: Academic Department of Trauma & Orthopaedics, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom. Tel.: +44 113 20 66460; fax: +44 113 20 65156. E-mail address: etsiridis@doctors.org.uk (E. Tsiridis). 0020–1383/$ — see front matter # 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2007.02.046