Fractures of the proximal humerus account for 4%-8% of injuries to the appendicular skeleton. Most are stable, minimally displaced osteoporotic fractures in the elderly, and are the result of low-energy falls. A large majority of these patients regain adequate shoulder function without operative intervention. Surgery is considered in approximately 20% of patients because they require improved shoulder function for their activities of daily living or because of the significant deformity of their fracture and the need to restore functional alignment, length, and rotation in active, higher demand individuals. However, fixation of these fractures can pose a challenge due to poor bone quality and displacing forces of the rotator cuff. This is especially true in 3-part and 4-part fractures. These factors lead to the high failure rates seen with early attempts at osteosynthesis. In the last 2 decades, locking plate technology has been an innovation in treating these complex fractures. Despite the improvements in torsional strength and rigidity, outcome studies on locking plate technology demonstrate equivocal results with complication rates as high as 20%-30% and a revision rate of 10%. Specifically, these complications include avascular necrosis, varus collapse, intra-articular screw penetration, and postoperative stiffness. Varus collapse occurs when the weak osteoporotic bone fails around the implant. In turn, fibular strut endosteal augmentation was introduced to provide additional support and decrease implant failure rates in displaced fractures with varus coronal malalignment and significant metaphyseal bone loss. Although clinically successful and biomechanically superior to plate-only constructs, a few concerns remain. In turn, we introduce a novel technique of creating individual cancellous femoral head allograft struts or \"French fries\" that provides structural support for the humeral head but does not have the potential problems of a cortical fibular strut.

UNASSIGNED: Selecting an appropriate graft for anterior cruciate ligament (ACL) reconstruction requires consideration of a patient\'s preferences, goals, age, and physical demands alongside the risks and benefits of each graft choice.
UNASSIGNED: To determine the most popular ACL reconstruction grafts among patients and the most important factors influencing their decisions.
UNASSIGNED: Cross-sectional study; Level of evidence, 3.
UNASSIGNED: Patients undergoing ACL reconstruction between October 2022 and April 2023 completed a survey either before (nonconsult group) or after (consult group) speaking with their surgeon, who provided an evidence-based description of the pros and cons of an allograft and the following autografts: bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT). Patient characteristics, graft choice, information influencing their graft choice, and surgeon recommendation were collected and compared between the groups.
UNASSIGNED: Among the 100 included patients, 59.0% were male, and the mean age was 28.3 ± 10.4 years. The most popular grafts were the BPTB (56.0%), followed by the QT (29.0%), HT (8.0%), and allograft (7.0%). No significant difference was observed in the graft selection between the consult group (n = 60; BPTB, 46.7%; QT, 38.3%; HT, 8.3%; allograft, 6.7%) and nonconsult group (n = 40; BPTB, 70.0%; QT, 15.0%; HT, 7.5%; allograft, 7.5%) (P = .0757). In the consult group, 81.7% of patients selected the graft recommended to them by their surgeon. The top 2 graft selection reasons were usage in professional athletes and failure rates, while the top 2 ACL surgery concerns were returning to their desired level of athletics and graft failure risk. Among the 93 patients who researched their ACL graft options before their visit, the most popular information source was some form of media (72.0% [67/93]).
UNASSIGNED: The study findings underscore the importance of patient preference and surgeon recommendation in a patient\'s graft selection and highlight the need to be cognizant of the information sources available to patients when researching their graft options.

UNASSIGNED: Variation in stiffness, fixation methods, and donor-site morbidity after anterior cruciate ligament reconstruction (ACLR) with different graft types and with anterior cruciate ligament suture repair (ACLSR) can lead to differences in dynamic knee laxity and consequent differences in posttraumatic osteoarthritis (PTOA) development.
UNASSIGNED: To compare the incidence of PTOA between different graft types used for primary ACLR and between primary ACLR and ACLSR. It was hypothesized that the incidence of PTOA would vary between ACLR with different autografts and allografts and between ACLR and ACLSR.
UNASSIGNED: Systematic review; Level of evidence, 1.
UNASSIGNED: A search of the literature was performed to identify all randomized controlled trials (RCTs) comparing radiographic evidence of PTOA after ACLR between different graft types-hamstring tendon (HT) autograft, bone-patellar tendon-bone (BPTB) autograft, quadriceps tendon autograft, and allograft-and between ACLR and ACLSR. The minimum follow-up was 2 years. Study quality was assessed using the modified Coleman Methodology Score. A meta-analysis was performed to determine whether there was a difference in the incidence of PTOA between the different graft types and between ACLR and ACLSR.
UNASSIGNED: Eleven randomized controlled trials were included in the meta-analysis-HT: 440 patients (mean follow-up, 9.7 years); BPTB: 307 patients (mean follow-up, 11.8 years); allograft: 246 patients (mean follow-up, 5 years); ACLSR, 22 patients (5 years). No study reporting the incidence after ACLR with quadriceps tendon was included. The study quality ranged from 70 to 88. The meta-analysis indicated no significant difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR (risk ratios: HT vs BPTB, 1.05; HT vs allograft, 0.81; BPTB vs allograft, 0.82; HT vs ACLSR, not estimable [P > .05 for all]). The combined number of patients with PTOA in all studies per graft type showed that patients who underwent ACLR with a BPTB autograft had the highest percentage of PTOA (HT, 23.4%; BPTB, 29.6%; allograft, 8.1%; ACLSR, 0%). However, excluding studies with a follow-up <5 years resulted in similar outcomes for patients with an HT autograft and a BPTB autograft.
UNASSIGNED: This meta-analysis reported no difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR. More research is necessary to make a reliable conclusion about which technique is associated with the lowest incidence of PTOA after ACL surgery.

Percutaneous Nephrolithotomy is a minimally-invasive procedure used in the setting of complex stone burden. Among its uses, PCNL can be employed to treated renal allograft calculi. This case presented a unique challenge and a rare usage of PCNL that involved removal of a 2.6 cm stone that presented in a 43-year-old male with dual renal allografts. The unique location of the allograft presented challenges that were navigated successfully with an uneventful postoperative course and no residual stone burden. The utilization of PCNL to treat calculi in dual renal allografts has been minimally reported in the literature.

UNASSIGNED: Allograft tendons are perceived to have a high ACL graft failure rate in primary anterior cruciate ligament (ACL) reconstruction (ACLR). Historical series may be biased by graft processing methods that degrade the biomechanical properties of donor tendons such as irradiation. Supercritical carbon dioxide (SCCO2) is a validated method of terminally sterilizing biomaterials at physiological temperatures without irradiation, but in vivo use of SCCO2-processed tendon allografts for primary ACLR has not been reported to date.
UNASSIGNED: ACLR with SCCO2 allografts would result in acceptable failure rates, subjective knee scores, and clinical evaluation at 2 years postoperatively.
UNASSIGNED: Case series; Level of evidence, 4.
UNASSIGNED: Patients underwent primary ACLR with terminally sterilized SCCO2-processed human gracilis, peroneus longus, semitendinosus, tibialis anterior, and tibialis posterior tendon allografts. Patient demographics were collected, along with tendon donor age and sex. At 1 year postoperatively, subjective International Knee Documentation Committee (IKDC) and ACL-Return to Sport After Injury (ACL-RSI) scores were collected, as well as clinical evaluation. At 2 years postoperatively, the IKDC and ACL-RSI scores were repeated, and return to sports and further knee injuries were recorded.
UNASSIGNED: A total of 144 patients with a medianage of 26 (IQR 14) years formed the study group. Patients were predominately male (58%). The loss to follow-up rate was 8% (n = 12). The mean age of allograft tendon donors was 37 (range 17-58) years, and the majority were male (83%). The mean allograft diameter was 8.9 ± 1.0 mm. At 2 years, ACL graft failureoccurred in 5% (n = 7). All graft failureswere in patients aged ≤25 years (P = .007). Neither donor age (≤40 or >40 years) nor donor sex was associated with graft failure (P > .05). The median IKDC subjective score was 95 and ACL-RSI score was 75. There were no revisions for sepsis within the first 2 years postoperatively.
UNASSIGNED: SCCO2 processing of allograft tendons demonstrated satisfactory clinical and patient-reported outcomes at 24 months postoperatively in a consecutive series of patients with primary ACLR, with similar ACL graft failure rates and subjective knee scores compared with those reported in published series of hamstring tendon autograft and fresh frozen nonirradiated allograft.

OBJECTIVE: Cleft lip and palate are the most common craniofacial malformations worldwide. The alveolar cleft is treated with a bone graft, between 4 and 7 years of age in mixed dentition. This is an important step because it provides good quality jawbone and a better support of the lip and the alar cartilage on the side of the cleft. Bone autografting with iliac harvesting remains the most commonly used technique, but it is not without risks. Allograft techniques have therefore been described to reduce this morbidity (pain, infectious risk, hemorrhagic risk, fracture risk). The aim of this study was to evaluate, one year after allografting, the efficiency and consolidation of the bone allograft in the alveolar cleft.
METHODS: A retrospective study was conducted in the department of pediatric craniomaxillofacial surgery in the Woman-Mother-Child Hospital in Lyon, France.
METHODS: This series includes 22 patients or 25 alveolar cleft bone grafts, including 16 boys and 6 girls, with an average age of 6.1 years.
METHODS: Quantify the residual bone allograft by evaluating the ratio between the volume of the bone graft and the volume of the initial space on pre- and post-operative cone beam computed tomography.
RESULTS: The residual bone allograft percentage at 1 year was 58.5% (± 22.3).
CONCLUSIONS: Alveolar cleft bone graft with bone allograft is an alternative to iliac autografting to reduce donor site morbidity.

BACKGROUND: Bone defects around the teeth affect a large portion of the population. Bone regeneration in the area of existing teeth is completely different from that in an edentulous area. To date, no method has been developed for three-dimensional (3D) bone reconstruction in regions with preserved teeth.
OBJECTIVE: This study aimed to radiologically evaluate the results of the new method of 3D mandibular bone reconstruction in preserved dentition using a custom-made allogeneic bone block with a 6-month follow-up.
METHODS: Alveolar ridge dimensions were radiographically assessed before and 6 months after reconstruction using cone beam computed tomography (CBCT) scans in 32 patients (192 teeth). Reconstruction used a bone block that had been previously planned and prepared using CAD/CAM technology.
RESULTS: The observed changes in alveolar bone dimensions were highly significant in most cases (p < 0.001). The closer to the tooth root apex, the lower the bone growth in the sagittal dimension (average of the mean values for each tooth examined in the measured heights): CEJ2: 2.9 mm, ½ CEJ2: 2.7 mm, ¼ CEJ2: 1.9 mm, and API: 1.4 mm. The maximum bone growth in the vertical dimension was observed on tooth 43 (9.9 mm), followed by 32 (9.8 mm), 33 (8.5 mm), 31 (8.4 mm), 42 (8 mm), and 41 (7 mm). The degree of decrease in vestibular dehiscence of the bone was greater the closer the tooth was to the midline (average of -3.8 mm and -3.4 mm for the central incisors; average of -2.8 mm and -2.6 mm for the lateral incisors; average of -2.6 mm and -2.5 mm for the canines).
CONCLUSIONS: The results prove that it is possible to prevent bone dehiscence in patients undergoing orthodontic treatment, increasing the ability and effectiveness of covering recessions and improving the morphology of the lower part of the face.

BACKGROUND: The posterior maxilla presents challenges for implant insertion because of the poor bone quality as well as the loss of vertical bone height. Indirect transcrestal sinus lift techniques are advised when a few millimeters of additional height are needed. This study aimed to evaluate the clinical and radiographic outcomes of antral membrane balloon technique versus Densah burs for transcrestal maxillary sinus lifting with simultaneous implant placement.
METHODS: This randomized clinical trial was conducted on 22 patients received 32 dental implants for replacement of missed maxillary posterior teeth after crestal maxillary sinus lifting. The patients were randomly divided into two groups. Group 1, patients underwent crestal sinus floor elevation with simultaneous implant placement using antral membrane balloon technique. Group 2, patients underwent crestal sinus floor elevation with simultaneous implant placement using Densah burs. Patients were evaluated clinically and radiographically using cone beam computed tomography (CBCT) at regular time intervals immediately, 6 months and 12 months after surgery. All clinical and radiographic parameters were statistically analyzed.
RESULTS: All dental implants were successful for 12 months of follow up. Regarding implant primary stability, there was a statistical significant difference between the study groups in favor of Densah group (P = 0.004), while there was no significant difference after 6 months (P = 0.07). Radiographically, balloon group showed a statistically significant immediate postoperative vertical bone height (P < 0.0001), and significant reduction in vertical bone height after 6 months (P < 0.0001). Densah group showed significant increase in bone density (P ≤ 0.05).
CONCLUSIONS: Both techniques demonstrated successful clinical and radiographic outcomes for crestal sinus lift. The antral membrane balloon group demonstrated better immediate postoperative vertical bone gain, while Densah burs had higher implant primary stability and bone density.
BACKGROUND: This study was registered in Clinical-Trials.gov PRS ( https://register.
RESULTS: gov ) under identification number NCT05922592 on 28/06/2023.

This study presents the case of a 40-year-old male patient after renal transplantation. The CT scan revealed a large mass in the lower abdomen and pelvis, with a branch of the right external iliac artery intersecting the growth. After a comprehensive examination, it was shown that the mass originated from the transplanted kidney, and a radical nephrectomy (including the mass) was performed. We document a case of atypical angiomyolipoma (AAM) occurring in a transplanted kidney. This article reports the case study and a brief literature review of the clinical presentation, diagnosis and treatment of AAM.

BACKGROUND: Augmentation rhinoplasty is one of five aesthetic surgeries in the world. Expanded polytetrafluoroethylene (ePTFE) has been reported as a rational choice to augment the nasal dorsum and tip. However, its application for nasal tip augmentation has some debates. This study presented a technique using ePTFE grafts combined with human acellular dermis matrix (HADM) to reconstruct a deformed nose caused by previous rhinoplasties.
METHODS: 50 female patients who came to the hospital from 08/2022 to 09/2022 for surgical revision of their nasal deformity. ePTFE was applied to reconstruct the nasal dorsum, tip, and columella strut. HADM grafts were utilized to reinforce the reconstructed framework. Patients were evaluated for at least 12 months for both aesthetic and functional results.
RESULTS: Postoperatively, the nasal dorsal length increased from 38.9 ± 1.32 to 43.4 ± 1.22 mm; while, the projection of the nasal tip also raised from 19.8 ± 1.16 to 23.9 ± 1.05 mm. 38 patients (76%) reported that their breathing and smelling were improved compared to preoperatively. No cases had implant reactions, extrusion, or warping columella strut. Most of the patients (84%) were satisfied with the surgical outcomes. Three patients (6%) had redness at the nasal tip. The nasal tip of ten patients (20%) was hardened for 3 months postoperatively. There were 6% of patients who developed an infection and 2% of patients had asymmetric soft tissues of the tip 3 postoperative months.
CONCLUSIONS: This technique brought satisfactory aesthetic and functional results to patients, with no extrusion or rejection observed 12 months postoperatively. Infection was a prominent complication that should be considered and strictly monitored.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .