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Treatment of tibial plateau fractures with a novel fenestrated screw system for delivery of bone graft substitute

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript



The purpose of this study was to describe the incidence of subsidence in patients with AO/OTA 41 (tibial plateau) fractures which were repaired with a novel fenestrated screw system to used to deliver CaPO4 bone substitute material to fill the subchondral void and support the articular reduction.


Patients with unicondylar and bicondylar tibial plateau fractures were treated according to the usual technique of two surgeons. After fixation, the Zimmer Biomet N-Force Fixation System®, a fenestrated screw that allows for the injection of bone substitute was placed and used for injection of the proprietary calcium phosphate bone graft substitute into the subchondral void. For all included patients, demographic information, operative data, radiographs, and clinic notes were reviewed. Patients were considered to have articular subsidence if one or more of two observations were made when comparing post-operative to their most recent clinic radiographs: > 2 mm change in the distance between the screw and the lowest point of the tibial plateau, > 2 mm change in the distance between the screw and the most superior aspect of the plate. Data were analyzed to determine if there were any identifiable risk factors for complication, reoperation, or subsidence using logistic regression. Statistical significance was set at p < 0.05.


34 patients were included with an average follow-up of 32.03 ± 22.52 weeks. There were no overall differences between height relative to the medial plateau or the plate. Two patients (5.9%) had articular subsidence. Six patients (15.2%) underwent reoperation, two (6%) for manipulations under anaesthesia due to arthrofibrosis, and four (12%) due to infections. There were 6 (19%) total infections as 2 were superficial and required solely antibiotics. One patient had early failure.


Use of a novel fenestrated screw system for the delivery of CaPO4 BSM results in articular subsidence and complication rates similar to previously published values and appears to be a viable option for addressing subchondral defects in tibial plateau fractures.

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Correspondence to Adam K. Lee.

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Conflict of interest

G. S. Marecek has received research support funding from BoneSupport AB and is a paid consultant for DePuy Synthes Globus Medical, Nuvasive, Stryker, Smith & Nephew, and Zimmer Biomet. G.S. Marecek is a committee member for the Orthopaedic Trauma Association and Western Orthopaedic Association. Donald Desanto has stock or stock options in AbbVie, Amgen Co, Becton Dickinson, and Company, Cardinal Health, Inc., Celgene, Hill-Rom Holdings, Inc., Johnson & Johnson, Masimo, Norvartis, Procter & Gamble, Sangam Therapeutics, Shockwave Medical, and Stryker. John Scolaro is a paid consultant for Globus Medical, Nuvasive, Smith & Nephew, Stryker, and Zimmer Biomet. John Scolaro receives IP royalties from Globus Medical. Alexander Telis, Edward Compton, Douglass Tucker, John Carney, and Adam K. Lee have no competing interests.

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This study received no outside funding and was initiated following after Institutional Review Board (IRB) approval.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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As this study included human subjects informed consent was obtained from all individual participants included in the study.

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Telis, A.L., Tucker, D.W., Compton, E. et al. Treatment of tibial plateau fractures with a novel fenestrated screw system for delivery of bone graft substitute. Eur J Orthop Surg Traumatol 31, 1321–1327 (2021).

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