Comparison of Autogenous Bone Graft and Endothermic Calcium Phosphate Cement for Defect Augmentation in Tibial Plateau Fractures

Russell, Thomas A.; Leighton, Ross

doi:10.2106/jbjs.g.01191

Cited by 202 publications

(151 citation statements)

References 9 publications

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“…The amount of activity patients perform in the first few postoperative weeks can be extremely variable along with the amount of weight bearing. Interestingly in the cases investigated, the non-compliant weight bearing applied by Patient 1 did not lead to excessive displacement of the fracture according to current definitions of anatomical reduction (less than 2 mm of articular step) [5,6] . The results of Patient 1 also suggested that his fracture stabilization was adequate and in these cases weight bearing as tolerated after a TPF may lead to a quicker rehabilitation.…”

Section: Discussionmentioning

confidence: 78%

“…In the laboratory, articular steps of greater than 1.5 mm of the tibial condyles were shown to cause significantly increased pressure on the surrounding cartilage [4] . In clinical practice, reduction of the articular surface of the tibia with articular steps of less than 2 mm have been labeled as "anatomical" [5,6] , while articular steps of more than 3 mm have been associated with worse outcomes and identified as a risk factor for post-traumatic knee osteoarthritis [2,3] . The problem with correlating outcomes of TPF, and for that matter of any articular fracture, with small articular steps measured on standard radiographs, is that the method is known to have a poor accuracy of ± 5 mm [7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

“…To date, there is no consensus on how TPF patients should be rehabilitated after open reduction and internal fixation (ORIF), with current recommendations varying from non-weight bearing for up to 12 wk [13] to partial weight bearing in all cases [5,6] . It is reasonable to assume that most surgeons would recommend various postoperative weight bearing prescriptions for their patients, depending on the type of fracture and the "quality" of fixation achieved.…”

Section: Introductionmentioning

confidence: 99%

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Collecting a comprehensive evidence base to monitor fracture rehabilitation: A case study

Callary

Thewlis²,

Rowlands³

et al. 2013

WJO

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Author contributions: Solomon LB designed the study and performed the surgery on both patients included in this study; Callary SA performed the radiostereometric analysis radiographic examinations and subsequent measurements; Rowlands AV performed the activity monitoring; Thewlis D performed the gait analysis and subsequent analysis; all authors contributed to detailed analysis, interpretation of results, and the preparation of the manuscript. Abstract AIM: To determine the feasibility and potential role of combining radiostereometric analysis (RSA), gait analysis and activity monitoring in the follow-up of fracture patients. METHODS:Two patients with similar 41B3 tibial plateau fractures were treated by open reduction internal fixation augmented with impaction bone grafting and were instructed to partial weight bear to 10 kg for the first six postoperative weeks. Fracture reduction and fixation were assessed by postoperative computer tomographic (CT) scanning. Both patients had tantalum markers inserted intra-operatively to monitor their fracture stability during healing using RSA and differentially loaded RSA (DLRSA) at 6 and 12 wk postoperatively. Gait analyses were performed at 1, 2, 6, and 12 wk postoperatively. Activity monitors were worn for 4 wk between the 2 and 6 wk appointments. In addition to gait analysis, knee function was assessed using the patient reported Lysholm scores, and doctor reported knee range of motion and stability, at 6 and 12 wk postoperatively. RESULTS:There were no complications. CT demonstrated that both fractures were reduced anatomically. Gait analysis indicated that Patient 1 bore weight to 60% of body weight at 2 wk postoperative and 100% at 6 wk. Patient 2 bore weight at 10% of body weight to 6 wk and had very low joint contact forces to that time. At 12 wk however, there was no difference between the gait patterns in the two patients. Patient 1 increased activities of moderate-vigorous intensity from 20 to 60 min/d between 2 and 6 postoperative weeks, whereas Patient 2 remained more stable at 20-30 min/d. The Lysholm scores were similar for both patients and did not improve between 6 and 12 wk postoperatively. DLRSA examination at 12 wk showed that both patients were comfortable to weight bear to 80 kg and under this weight the fractures displaced less than 0.4 mm. RSA measurements demonstrated over time fracture migrations of less than 2 mm in both cases. However, Patient 2, who followed the postoperative weight bearing instructions most closely, displaced less (0.3 mm vs 1.6 mm). CONCLUSION:This study demonstrates the potential of using a combination of RSA, gait analysis and activity monitoring to obtain a comprehensive evidence base for postoperative weight bearing schedules during fracture healing.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Collecting a comprehensive evidence base to monitor fracture rehabilitation: A case study

Callary

Thewlis²,

Rowlands³

et al. 2013

WJO

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“…그러나 완벽한 정복을 이루었다 하더라도 함몰 골편을 관절선까지 들어올리고, 이렇게 함으로써 생기는 사강 때문에 정복의 소실의 가능성이 있다. 이런 사강을 채우는 방법으로는 자가골 이식, 동종골 이식, 골 대치물, 골 시멘트 등이 소개되고 있다 3,11,15) . 이들 중 보편적으로 쓰이는 자가골 이식 방법은 높은 골 전도 및 골유도 효과 때문에 가장 보편화가 된 방법이지만 수술 시간의 지연과 공여부에서 출혈의 가능성, 통증, 감염, 신경 손상, 혈종 형성, 근육 탈출, 이소성 골화, 수술 창상 에 따른 미용적 문제 등 여러 가지 문제가 발생될 수 있다 1) .…”

Section: Resultsunclassified

The Use of Fresh Frozen Allogenic Bone Graft in the Impacted Tibial Plateau Fractures

et al. 2010

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Results: According to last follow-up weight bearing A-P X-ray, the fresh frozen cancellous allograft incorporated soundly in all cases and no complications such as joint depression, fracture reduction loss, angular deformity, and malunion were found. The mean time to complete bone union was postoperative 10±0.7 weeks. The mean range of motion was 135 (115∼145) degrees. The mean Rasmussen's radiological score at last follow up was 15.3 (10 cases: excellent, 3 cases: good). The mean Lysholm's knee score at last follow up was 88.2±4.3.

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“…Bone autograft is the preferred method for filling up the resulting void in metaphyseal bone, although it does not allow full weight bearing until the fracture heals. Recent studies have demonstrated that injectable calcium phosphate cement is able to fill up the voids allowing full weight bearing within 6 weeks after surgery, without the hazards associated with bone autograft harvesting [69,70]. Bone cements are, nevertheless, only fillers that are not replaced by bone tissue.…”

Section: Proximal Tibiamentioning

confidence: 99%

Updates in biological therapies for knee injuries: bone

Kfuri

Freitas

Batista

et al. 2014

Curr Rev Musculoskelet Med

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Bone is a unique tissue because of its mechanical properties, ability for self-repair, and enrollment in different metabolic processes such as calcium homeostasis and hematopoietic cell production. Bone barely tolerates deformation and tends to fail when overloaded. Fracture healing is a complex process that in particular cases is impaired. Osteoprogenitor cells proliferation, growth factors, and a sound tridimensional scaffold at fracture site are key elements for new bone formation and deposition. Mechanical stability and ample vascularity are also of great importance on providing a proper environment for bone healing. From mesenchymal stem cells delivery to custom-made synthetic scaffolds, many are the biological attempts to enhance bone healing. Impaired fracture healing represents a real burden to contemporary society. Sound basic science knowledge has contributed to newer approaches aimed to accelerate and improve the quality of bone healing.

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Comparison of Autogenous Bone Graft and Endothermic Calcium Phosphate Cement for Defect Augmentation in Tibial Plateau Fractures

Abstract: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Cited by 202 publications

References 9 publications

Collecting a comprehensive evidence base to monitor fracture rehabilitation: A case study

Collecting a comprehensive evidence base to monitor fracture rehabilitation: A case study

The Use of Fresh Frozen Allogenic Bone Graft in the Impacted Tibial Plateau Fractures

Updates in biological therapies for knee injuries: bone

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