Impaction bone grafting has potential as an adjunct to the surgical stabilisation of osteoporotic tibial plateau fractures: Early results of a case series

Pol, G.J. van de; Iselin, Lukas Daniel; Callary, Stuart A.; Thewlis, Dominic; Jones, Claire F.; Atkins, Gerald J.; Solomon, Lucian B.

doi:10.1016/j.injury.2015.02.019

Cited by 15 publications

(7 citation statements)

References 49 publications

(67 reference statements)

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“…8 In contrast, results from another study on treatment of metaphyseal bone defects with impaction grafting using cancellous allograft bone as an adjunct to osteosynthesis of tibial plateau fractures in osteoporotic patients confirmed that the majority of the bone graft (mean: 55%) showed evidence of remodeling into trabecular bone with a normal radiological appearance on X-ray and CT after 1 year, while 37% remained unremodeled, and only 8% had resorbed. 19 These results are comparable to our radiological findings, which may indicate that unchanged X-ray appearance could be perceived as an indirect sign of at least partial graft integration. Furthermore, these results also support the rationale for the use of osteoconductive scaffolds, such as bone allografts or bone graft substitutes, which may contribute to a more complete bone cavity remodeling.…”

Section: Discussionsupporting

confidence: 90%

Treatment of benign and borderline bone tumors with combined curettage and bone defect reconstruction

Horstmann

Hettwer

Petersen

2018

J Orthop Surg (Hong Kong)

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The management of bone defects following simple curettage of bone tumors is controversial and in light of the numerous emerging substitutes for bone grafts, we wished to review and report our experience with the use of cancellous allograft bone in the treatment of benign and borderline bone tumors. Methods: We reviewed the medical records of 164 consecutive patients with benign or borderline bone tumors treated with simple curettage at our orthopedic oncology center between 2009 and 2013. Postoperative radiological changes were evaluated by a modified Neer's classification in defects that were subsequently reconstructed with allograft bone (n ¼ 133). Results: Simple curettage with subsequent defect filling using allograft bone was the surgical procedure performed in the majority of our patients (81%) and was associated with a low overall 2.5-year local recurrence (LR; 9.8%) and complication rate (7.5%). The radiological appearance of the grafted defects was deemed satisfactory in 85% of cases, with signs of either complete or partial healing present 6-12 months postoperatively. With respect to pathology, we found high rates of LR in giant cell tumors (GCTs) of bone, simple cysts (SCs) in children, and preexisting local recurrent disease. We did not observe any allograft-related complications. Conclusions: Simple curettage and bone defect reconstruction with bone allograft is a sufficient treatment for most benign bone lesions and is associated with a low complication rate. For high-risk entities, such as GCTs of bone, SCs in children, and recurrent disease, additional adjuvant treatment could be considered to avoid LR.

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Section: Discussionsupporting

confidence: 90%

Treatment of benign and borderline bone tumors with combined curettage and bone defect reconstruction

Horstmann

Hettwer

Petersen

2018

J Orthop Surg (Hong Kong)

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“…The intervention was based on existing techniques using a bone allograft to support the articular surface and a locking plate to fixate the fracture [ 5 , 8 , 9 ]. The last author, TB, further developed this technique as described below.…”

Section: Interventionmentioning

confidence: 99%

“…The AO foundation recommends no weight bearing for 10–12 weeks after surgery for an articular proximal tibial fracture ( surgeryreference.aofoundation.org ). However, small observational studies have reported early weight bearing after osteosynthesis of a proximal tibial fracture without an increased risk of subsequent articular collapse [ [3] , [4] , [5] , [6] ]. The surgical technique was not, though, formally described in these studies.…”

Section: Introductionmentioning

confidence: 99%

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

Hare

Brand

Bloch

2020

Trauma Case Reports

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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.

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“…Locking plates are widely used for treatment of periarticular fractures, as they provide angular stability and may allow earlier motion and weight bearing, particularly when compared with fracture fixation with nonlocking plates [4, 5]. There has been renewed interest recently in the morphology of tibial plateau fractures, using computed tomography (CT) imaging [6, 7].…”

Section: Introductionmentioning

confidence: 99%

Tibia plateau fracture mapping and its influence on fracture fixation

et al. 2019

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Background Tibial plateau fracture classifications are based on anteroposterior radiographs. Precontoured locking plates are commonly used to treat such fractures. The aims of this study are to: (1) describe tibial plateau fracture anatomy in the axial plane and (2) assess whether current plating systems allow screws to be placed suitably. Materials and methods A graphical tibial plateau template was developed. One hundred twenty-five tibial plateau fractures (four bilateral) were reviewed (80 men, 41 women; average age 45.5 years, range 21–77.7 years). The axial computed tomography (CT) slice 0.3–0.5 mm below the medial articular surface was reviewed in all cases. Fracture lines were drawn on the template. Four lateral locking plates were placed against a cadaveric adult tibia. Based on the projected screw directions, suitable fracture patterns were identified. Fractures were considered “suitable” if the screws passed 90 ± 22° to the fracture line. Results Two hundred sixty-one different fracture lines were identified. One hundred thirty-four fractures involved the lateral plateau; 96 were suitable for lateral plating. Ninety fractures involved the medial plateau, 82 were treatable using the various plate positions on medial-posterior aspect of the medial plateau. Thirty-seven fractures were bicondylar; 20 were treatable with a posteromedial plate. Conclusions Tibial plateau fractures follow consistent patterns, with most lateral and medial plateau fracture lines being in the sagittal plane, although there is greater variation medially. Positioning of modern locking plates will deal effectively with 72 % of all lateral plateau fractures and 91 % of medial plateau fractures. Level of evidence Level 3.

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Impaction bone grafting has potential as an adjunct to the surgical stabilisation of osteoporotic tibial plateau fractures: Early results of a case series

Cited by 15 publications

References 49 publications

Treatment of benign and borderline bone tumors with combined curettage and bone defect reconstruction

Treatment of benign and borderline bone tumors with combined curettage and bone defect reconstruction

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

Tibia plateau fracture mapping and its influence on fracture fixation

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