Fixation augmentation using calcium-phosphate bone substitute improves outcomes of complex tibial plateau fractures. A matched, cohort study
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Injectable cements have been developed to improve fixation’s stability and thus obtain early return to adequate joint function. We aimed to compare post-operative radiographic and clinical outcomes of patients suffering from a complex tibial plateau fracture (TPF) fixed with calcium-phosphate bone substitutes (CPBS) augmentation to a matched group of patients with identical fracture pattern, treated with the same fixation’s type, but augmented with bone grafting.
After local ethic committee approval, we retrospectively identified in a prospectively collected database, patients with complex comminuted metaphyseal and epiphysial bicondylar TPF (Schatzker type VI) admitted in our emergency department between January 2011 and December 2013. From those, 23 patients (14 males, 9 females) were treated with CPBS (Quickset-CP®, Graftys, Aix-en-Provence, France) fixation augmentation. Patients’ mean age were 44.4 years. We then created a control group using a 1:1 matching process on gender, age, fracture pattern, and method of fixation. Patients were evaluated prospectively at 3, 6, and then every six months using radiographic (AP/ML views) and clinical criteria (knee osteoarthritis outcomes score (KOOS) and EuroQOL-5D).
Articular step-off and variation of articular step-off were significantly lower in the CPBS groups (mean step-off 1.4 ± 1.9 (0.5–6.5 mm) and mean step-off Δ = 0.3 ± 0.4 (0.5–2.2 mm)) than in the control group (mean step-off 3.6 ± 2.1 (1–7.5 mm) and mean step-off Δ = 2.2 ± 2 (0.5–7 mm) p < 0.01). At last follow-up, patients of the control group presented a higher rate of step-off > 2 mm and step-off Δ > 2 mm (respectively, 56 and 35%) than patients of the CPBS group (26 and 9%). Odd ratio of, respectively, 3.6 (95% CI (1.08–12.7) and p = 0.03) and 5.6 (95% CI (1.04–30.1) and p = 0.03).At mean follow-up of 29 months, KOOS pain subscore was significantly better in patients of the CPBS group (85.3 ± 12.1) than in control patients (74.2 ± 10.4 and p = 0.03).
The present study demonstrates that calcium-phosphate bone substitute used as synthesis augmentation improves mid-term radiological outcomes of patients suffering from complex tibial plateau fracture. Series reporting outcomes from a larger number of patients and longer follow-up must confirm clinical benefits and safety of this method.
KeywordsTibial Plateau Fractures Augmentation Osteosynthesis Phosphocalcic cement Clinical outcomes CT-Scan
Compliance with ethical standards
This article does not contain any studies with human participants performed by any of the authors. Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors declare that they have no competing interests.
- 16.Lachiewicz PF, Funcik T (1990) Factors influencing the results of open reduction and internal fixation of tibial plateau fractures. Clin Orthop:210–215Google Scholar
- 17.Lefkoe TP, Walsh WR, Anastasatos J et al (1995) Remodeling of articular step-offs. Is osteoarthrosis dependent on defect size? Clin Orthop:253–265Google Scholar
- 19.Russell TA, Leighton RK, Alpha-BSM Tibial Plateau Fracture Study Group (2008) Comparison of autogenous bone graft and endothermic calcium phosphate cement for defect augmentation in tibial plateau fractures. A multicenter, prospective, randomized study. J Bone Joint Surg Am 90:2057–2061. https://doi.org/10.2106/JBJS.G.01191 CrossRefPubMedGoogle Scholar
- 24.Heiney JP, Redfern RE, Wanjiku S (2013) Subjective and novel objective radiographic evaluation of inflatable bone tamp treatment of articular calcaneus, tibial plateau, tibial pilon and distal radius fractures. Injury 44:1127–1134. https://doi.org/10.1016/j.injury.2013.03.020 CrossRefPubMedGoogle Scholar
- 25.Ornetti P, Parratte S, Gossec L et al (2008) Cross-cultural adaptation and validation of the French version of the knee injury and osteoarthritis outcome score (KOOS) in knee osteoarthritis patients. Osteoarthr Cartil 16:423–428. https://doi.org/10.1016/j.joca.2007.08.007 CrossRefPubMedGoogle Scholar
- 26.Giannoudis PV, Harwood PJ, Kontakis G et al (2009) Long-term quality of life in trauma patients following the full spectrum of tibial injury (fasciotomy, closed fracture, grade IIIB/IIIC open fracture and amputation). Injury 40:213–219. https://doi.org/10.1016/j.injury.2008.05.024 CrossRefPubMedGoogle Scholar