Abstract
Purpose
The goal of this study was to determine differences in fracture stability and functional outcome between synthetic bone graft and natural bone graft with internal fixation of tibia plateau metaphyseal defects.
Methods
Hydroxyapatite calcium carbonate synthetic bone graft was utilised in 14 patients (six males and eight females). Allograft/autograft were utilised in the remaining 10 patients (six males and four females). All the 24 patients had clinical, radiological and subjective functional score assessments.
Results
There was no significant statistical difference between the groups for post-operative articular reduction, long-term subsidence, and WOMAC scores. The degree of subsidence was not related to age or fracture severity. Maintenance of knee flexion was found to be better in the allograft/autograft group (p = 0.048) when compared between the groups. Multivariate analysis compared graft type, fracture severity, post-operative reduction, subsidence rate, range of movement and WOMAC score. The only finding was a statistical significant association with the graft type related to the 6-month range of movement figures.
Conclusions
Use of autologous or allogenic bone graft allows better recovery of long-term flexion, possibly due to reduced inflammatory response compared with synthetic bone composites. However, all other parameters, such as maintenance of joint reduction and subjective outcome measures were comparable with the use of hydroxyapatite calcium carbonate bone graft. This study shows that synthetic bone graft may be a suitable alternative in fixation of unstable tibia plateau fractures, avoiding risk of disease transmission with allograft and donor site morbidity associated with autograft.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Barei DP, Nork SE, Mills WJ et al (2004) Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma 18(10):649–657
Bellamy N, Buchanan WW (1986) A preliminary evaluation of the dimensionality and clinical importance of pain and disability in osteoarthrits of the hip and knee. Clin Rheumatol 5:231–241
Blokker CP, Rorabeck CH, Bourne RB (1984) Tibial plateau fractures. An analysis of the results of treatment in 60 patients. Clin Orthop Relat Res 182:193–199
Bucholz RW, Carlton A, Holmes R (1989) Interporous hydroxyapatite as bone graft substitute in tibial plateau fractures. Clin Orthop 240:53–62
Covall DJ, Fowble CD, Foster TE et al (1994) Bicondylar tibial plateau fractures: principles of treatment. Contemp Orthop 28(2):115–122
Delecrin J, Oka M, Takahashi S et al (1994) Changes in joint fluid after total arthroplasty. A quantitative study on the rabbit knee joint. Clin Orthop Relat Res 307:240–249
Fowler BL, Dall BE, Rowe DE (1995) Complications associated with harvesting autogenous iliac bone graft. Am J Orthop (Belle Mead NJ) 24(12):895–903
Goulet JA, Senunas LE, DeSilva GL et al (1997) Autogenous iliac crest bone graft. Complications and functional assessment. Clin Orthop 339:76–81
Keating JF, Hajducka CL, Harper J (2003) Minimal internal fixation and calcium-phosphate cement in the treatment of fractures of the tibial plateau. A pilot study. J Bone Joint Surg Br 85(1):68–73
Korovessis P, Repanti M, Koureas G (2002) Does coralline hydroxyapatite conduct fusion in instrumented posterior spine fusion? Stud Health Technol Inform 91:109–113
Lachiewicz PF, Funcik T (1990) Factors influencing the results of open reduction and internal fixation of tibial plateau fractures. Clin Orthop 259:210–215
Martin J, Marsh JL, Nepola JV et al (2000) Radiographic fracture assessments: which ones can we reliably make? J Orthop Trauma 14(6):379–385
Palmer SH, Gibbons CLMH, Athanasou NA (1999) The pathology of bone allograft. J Bone Joint Surg Br 81(2):333–335
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(10):2057–2061
Schaefer SL, Lu Y, Seeherman H et al (2009) Effect of rhBMP-2 on tibial plateau fractures in a canine model. J Orthop Res 27(4):466–471
Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res 138:94–104
Silber JS, Anderson DG, Daffner SD et al (2003) Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 28:134–139
Su EP, Westrich GH, Rana AJ et al (2004) Operative treatment of tibial plateau fractures in patients older than 55 years. Clin Orthop Relat Res 421:240–248
Tscherne H, Lobenhoffer P (1993) Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res 292:87–100
Younger EM, Chapman MW (1989) Morbidity at bone graft donor sites. J Orthop Trauma 3:192–195
Horstmann WG, Verheyen CC, Leemans R (2003) An injectable calcium phosphate cement as a bone-graft substitute in the treatment of displaced lateral tibial plateau fractures. Injury 34:141–144
Lim EV, Lavadia WT, Roberts JM (1996) Superior gluteal artery injury during iliac bone grafting for spinal fusion. A case report and literature review. Spine 21(20):2376–2378
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ong, J.C.Y., Kennedy, M.T., Mitra, A. et al. Fixation of tibial plateau fractures with synthetic bone graft versus natural bone graft: a comparison study. Ir J Med Sci 181, 247–252 (2012). https://doi.org/10.1007/s11845-011-0797-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-011-0797-y