Highly impacted bone allograft may allow immediate weight bearing in tibial plateau fractures: A case report

Abstract

Introduction Proximal tibial fractures are common with an incidence of 10.2/100.000. Those displaced and involving the articular surface will often require surgical treatment. However, no consensus exists on whether to allow the patient early weight bearing or not. We developed a technique using structural bone chips, highly impacted under the articular surface, to permit immediate weight bearing after surgery. Patient The patient was a 44-year old male who suffered a lateral tibial plateau fracture (AO type 41B2). Intervention We used an anterolateral approach with an S-shaped incision. A small window in the tibia was made using an awl, and the articular surface was reduced under radiographic imaging. The bone allograft was prepared by splitting the frozen femoral head in quarters and then taking large pieces of bone with a bone rongeur forceps avoiding the cartilage. The large pieces of bone were gathered in a small tray and thereafter compressed into the drill guide insert. The drill guide filled with bone graft was then inserted into the tibia window and directed in the appropriate position guided by radiography. Hereafter, the bone graft was impacted under the articular surface with force using the appropriate trocar and a hammer, and the fracture was finally reduced. Finally, the fracture was fixated utilizing an angular stable plate. Outcome The patient was followed up one year postoperatively and allowed immediate weight bearing after surgery. No subsequent articular collapse occurred. Discussion In this case, we present a proximal tibial fracture with articular depression, which was surgically treated with a highly impacted bone allograft of large pieces and a locking plate. The patient was allowed immediate weight bearing and no subsequent articular collapse occurred.

Early weight bearing in tibial plateau fractures treated with ORIF: a systematic review of literature

“…The patient was allowed immediate weight bearing on the affected limb and follow up was performed at 2 and 6 weeks and 3 and 12 months after surgery. There was no widening of the tibial plateau, no collapse of the articular surface, the patient at 6 weeks had 0–125 degrees of range of motion (ROM) and returned to work three months after surgery [ 23 ].…”