Osteosynthesis with allograft screws in pediatric orthopedics

Purpose: A significant percentage of patients develop complications related to the use of implants made of stainless steel or titanium. The purpose of our study is to retrospectively analyze the clinical and radiological outcomes of allograft screws implanted in the Pediatric Orthopedic unit of our center. Methods: A retrospective analysis was conducted, including 30 patients (16 females and 14 males) with lower limb pathologies who received 50 human cortical bone allograft screws. The study period covered 48 months, from 1 January 2020, to 1 January 2023. The average age was 12 years 7 months (range 3, 15 years). The mean follow-up was 44 months (range 24-66). Results: After an average follow-up of 44 months, no patients developed minor or major complications, delayed union, or infections. Three patients reported discomfort due to implant prominence, and two of them (7%) required reoperation for screw head remodeling. The average resorption time was 9 months (range 5, 15 months). The postoperative American Orthopaedic Foot & Ankle Society score increased by 38.28 points compared to the preoperative score. Conclusions: This is the first reported series assessing cortical bone allograft screws in the pediatric population. Our findings suggest that these implants may reduce the need for hardware removal and associated morbidity. It is important to avoid implant prominences that may cause discomfort to the patient and potentially require reoperation. Level of evidence: IV, Therapeutic.