Osseous vitality in single photon emission computed tomography/computed tomography (SPECT/CT) after balloon tibioplasty of the tibial plateau: a case series

Abstract

BackgroundThe minimally invasive, balloon-assisted reduction and cement-augmented internal fixation of the tibial plateau is an innovative surgical procedure for tibial plateau fractures. The close proximity of balloons and cement to the knee joint poses a potential risk for osteonecrosis; especially in the case of thin bone lamellae. However, there are no studies about the vitality of the cement-surrounding tissue after these tibioplasties. Therefore, our goal was to assess the osseous vitality after cement-augmented balloon tibioplasty using single photon emission computed tomography/computed tomography (SPECT/CT) in a series of patients.MethodsThis case series evaluated available consecutive patients, whose tibial plateau fractures were treated with balloon-assisted, cement-augmented tibioplasty and received a SPECT/CT. Primary outcome variables were osseous vitality on SPECT/CTs according to the semiquantitative tracer activity analysis. The mean uptake of eight tibial regions of interest was referenced to the mean uptake count on the same region of the contralateral leg to obtain a count ratio. Osteonecrosis was defined as a photopenic area or cold defect. Secondary variables included clinical and radiological follow-up data. Statistics were carried out in a descriptive pattern.ResultsTen patients with a mean age of 59 years and a mean follow up of 18 months were included. Calcium phosphate (CaP) substitute bone cement was used in 60 % and polymethyl methacrylate mixed with hydroxyapatite (PMMA/HA) bone cement in 40 %. Normal to high SPECT/CT activity without photopenic areas were observed in all patients and the mean tracer activity ratio was four, indicating vital bone in all patients. There were no postoperative infections and only one 57 year old patient with hemineglect and CaP cement showed failed osseous consolidation. The mean Tegner and Lysholm as well as the Lysholm scores were three and 80, respectively.ConclusionsThis novel study about cement-augmented balloon tibioplasties showed that osseous vitality remains intact according to SPECT/CT analysis; irrespective of the type of cement and even in the presence of thin bone lamellae. This procedure was safe and well-suited for lateral tibial plateau fractures in particular. Surgeons may consider using PMMA/HA bone cement for void filling in elderly fracture patients without concern about bone viability.

Contribution of Minimally Invasive Bone Augmentation With PMMA Cement in Primary Fixation of Schatzker Type II Tibial Plateau Fractures

“…Polymerization at 90°C can induce a risk of cartilage, skin, nerve, and vascular burns ( Verlaan et al, 2003 ). However, bone vitality appears to remain intact according to SPECT/CT analysis after cement-augmented balloon tibioplasty ( Jentzsch et al, 2015 ) when technical principles and indications are strictly respected ( Mauffrey et al, 2014 ; Vendeuvre and Gayet, 2021 ).…”

Arthroscopic-assisted balloon tibioplasty versus open reduction internal fixation (ORIF) for treatment of Schatzker II–IV tibial plateau fractures: study protocol of a randomised controlled trial

“…Arthroscopic-assisted balloon tibioplasty is an emerging technology that aims to visualise the articular surface, and uses balloon distension tibial plasty assisted by arthroscopy to recover depression of the articular surface and fix the fracture according to its specific type. 16 This technology has shown advantages in recovering depression of the articular surface, 17 treating additional intra-articular lesions during the operation and minimising surgical trauma. Furthermore, under fluoroscopy, optimal centring of the expanding tibioplasty balloon allows a widespread and continuously increasing reduction force to be applied to the fracture area.…”