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Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

The metaphyseal defects in 40 patients with displaced tibial plateau fractures necessitating surgical repair were filled with either cancellous autograft or interporous hydroxyapatite. Roentgenographic and clinical assessments at follow-up periods averaging 15.4 months (autograft) and 34.5 months (hydroxyapatite) demonstrated no significant differences in the two groups. Interporous hydroxyapatite is a safe, effective alternative to autogenous cancellous bone for the filling of metaphyseal defects associated with tibial plateau fractures.The indications for operative reduction and fixation of tibial plateau fractures include posttraumatic knee instability and significant displacement of intraarticular fragments. Precise numerical guidelines for what constitutes significant displacement in any given patient have yet to be established. During open reduction of most plateau fractures, especially those with a central compression component, impaction of the metaphyseal bone beneath the articular surface is a common finding. Following elevation of all articular fracture fragments, filling of the re-

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