scholarly journals Composite Xenohybrid Bovine Bone-Derived Scaffold as Bone Substitute for the Treatment of Tibial Plateau Fractures

2019 ◽  
Vol 9 (13) ◽  
pp. 2675 ◽  
Author(s):  
Riccardo Ferracini ◽  
Alessandro Bistolfi ◽  
Riccardo Garibaldi ◽  
Vanessa Furfaro ◽  
Agnese Battista ◽  
...  
Keyword(s):  
Bone Graft ◽  
Tibial Plateau ◽  
Short Form ◽  
Bone Substitutes ◽  
Tibial Plateau Fractures ◽  
Bovine Bone ◽  
Lateral Projection ◽  
Autologous Iliac Bone Graft ◽  
Ikdc 2000

Introduction: Tibial plateau fractures represent a common challenge for orthopaedic surgeons, sometimes representing complex cases to manage, where augmentation using bone grafts is required for stabilisation. Autologous iliac bone graft (AIBG) is the current gold standard for bone grafting. In order to overcome limitations related to the procedure, alternative strategies, like allogenic and xenogeneic bone substitutes have been investigated. Here, within the framework of an observational clinical study, we report clinical and radiological outcomes of patients treated for tibial plateau fractures with a composite xenohybrid bone graft, aiming at assessing clinical and radiological outcomes. Materials and Methods: We performed a cohort retrospective study of patients treated for tibial plateau fractures from May 2017 to January 2018. Thirty-four patients, i.e. 100% of those having received the bone graft under investigation for tibial plateaux fracture treatment, met the inclusion criteria and were enrolled in the study. Patients were assessed at 2 weeks, and then at a 1-, 3-, and 6-months, and 1-year follow-up. At each evaluation patients filled a visual analogue scale (VAS) for the level of pain during the day life activities and underwent physical exam and anteroposterior and lateral projection radiographs of the knee. At 1 year the Tegner Lysholm Scoring Scale, International Knee Document Committee 2000 (IKDC 2000), and Short Form (36) Health Survey (SF-36) were administered. Results: At 1-year, mean VAS decreased from 6.33 ± 1.40 to 1 ± 0.79 (P < 0.0001); Tegner Lysholm Scoring Scale was 89 ± 4.10 and mean IKDC 2000 was 78.67 ± 3.31. No infections, neurovascular complications or adverse effects related to implants were reported during the clinical exams at follow-up. Mean ROM was 124 ± 6°. Radiographs did not show defects of consolidation or progressive post-surgical subsidence and demonstrated a good grade of integration of the implant. Conclusions: Clinical and radiological outcomes, and scores of questionnaires, were good. The xenograft has demonstrated to be a safe biomaterial, with satisfactory mechanical and biological performances in the mid-term period. It also showed a high grade of osteointegration and remodelling.

scholarly journals Structural Bicortical Autologous Iliac Crest Bone Graft Combined with the Tunnel Bone Tamping Method for the Depressed Tibial Plateau Fractures

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Zhongzheng Wang ◽  
Yanbin Zhu ◽  
Xiangtian Deng ◽  
Xin Xing ◽  
Siyu Tian ◽  
...  
Keyword(s):  
Bone Graft ◽  
Tibial Plateau ◽  
Iliac Crest ◽  
Short Form ◽  
Tibial Plateau Fractures ◽  
Absolute Difference ◽  
Iliac Crest Bone Graft ◽  
Special Surgery ◽  
The Mean

Background. Clinically, autologous iliac crest bone grafts (ICBG) and bone tamping methods are often applied to manage depressed tibial plateau fractures (DTPFs). The purpose of this study was to describe and evaluate the technique of using structural bicortical autologous ICBG combined with the tunnel bone tamping method (TBTM) for treating DTPFs. Methods. All patients with DTPFs who underwent structural bicortical autologous ICBG combined with TBTM from January 2016 to February 2018 were prospectively analysed. Demographics, injury, surgery, postoperative complications, and clinical outcomes were recorded. All patients were followed up for more than 30 months. Postoperative radiography and CT were employed to assess fracture healing and the reduction quality. Results. Forty-three of the included patients completed the follow-up. No malreduction was observed. Based on the immediate postoperative imaging, the intra-articular step-off was significantly reduced (8.19 mm preoperatively vs. 1.30 mm immediate postoperatively, P < 0.001 ). From the immediate operation to the latest follow-up, the reduction was maintained significantly well, with a nonnegligible absolute difference (0.18 mm, P = 0.108 ). A remarkable secondary loss of reduction (intra-articular step   off > 3   mm ) was found in two elderly patients (2/43, 4.65%). The incidence of complications related to the bone-graft donor and bone-graft site was 2.33% and 4.65%, respectively. At the final follow-up, the mean Hospital for Special Surgery (HSS) score of the knee was 98.19 ± 2.89 , and the mean 36-Item Short-Form Health Survey (SF-36) score was 95.65 ± 4.59 . Conclusion. Structural bicortical autologous ICBG combined with TBTM is radiologically effective and stable in terms of complications for the DTPFs.

scholarly journals Clinical Analysis of Classification for Tibial Plateau Fractures and Popliteal Artery Injury

2020 ◽  
Author(s):  
Yilun Yao ◽  
Xiaoshu Wu ◽  
Lei Wu ◽  
Lei Yang ◽  
Chunzhi Jiang ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Clinical Analysis ◽  
Tibial Plateau Fractures ◽  
Artery Injury ◽  
Type Iv ◽  
Schatzker Type ◽  
Schatzker Classification ◽  
Tibial Head ◽  
Type V

Abstract Background To explore the association between the classification for tibial plateau fractures (TPF) and the popliteal artery injury (PAI).Methods 22 TPF patients accompanied by PAI who were treated from May 2012 to July 2019 were retrospectively analyzed. There were 19 males and 3 females with an average age of 49.43 years. The Schatzker classification and three-column classification were performed for TPF. The severity of extremity injury was evaluated using the mangled extremity severity score (MESS). Except 3 patients treated with amputation, the remaining patients underwent surgical repair of popliteal artery and fracture external fixation. The outcome was evaluated using the Rasmussen score for tibial head fractures.Results There were 10 cases of Schatzker type IV fractures, 1 case of type V fractures and 11 cases of type VI fractures. Based on the three-column classification, the posterior column was involved in 22 cases, 2 columns in 15 cases and 3 columns in 6 cases. The MESS was 6-10 points, with an average of 7.59 points. Except 1 case directly receiving amputation, 3 cases of segment P1 injury was observed via preoperative DSA + intraoperative exploration, while segment P2 in 6 cases and segment P3 in 12 cases. Popliteal artery was found completely ruptured in 11 cases, partially ruptured in 1 case, and severely contused with thrombosis in 10 cases. The Rasmussen score was given to 19 patients at the last follow-up, except for the cases undergoing amputation. The outcome was satisfied in 14 cases, unsatisfied in 5 cases.Conclusion: In patients with complex TPF, the risk of PAI becomes higher with the increase of Schatzker classification level. Knee CT scan is helpful in determining the severity of fractures and evaluating PAI. Based on the three-column classification, PAI should be suspected when the fractures involve the medial and posterior column.PAI is mainly in the segment P3, and artery rupture or severe contusion with extensive thrombosis may occur.

Mapping recovery in simple and complex tibial plateau fracture fixation

2019 ◽  
Vol 101-B (8) ◽  
pp. 1009-1014 ◽  
Author(s):  
D. N. Ramoutar ◽  
K. Lefaivre ◽  
H. Broekhuyse ◽  
P. Guy ◽  
P. O’Brien
Keyword(s):  
Functional Outcome ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Short Form ◽  
Tibial Plateau Fractures ◽  
Functional Score ◽  
Complex Group ◽  
Sf 36 ◽  
Functional Scores ◽  
Plateau Fracture

Aims The aim of this study was to determine the trajectory of recovery following fixation of tibial plateau fractures up to five-year follow-up, including simple (Schatzker I-IV) versus complex (Schatzker V-VI) fractures. Patients and Methods Patients undergoing open reduction and internal fixation (ORIF) for tibial plateau fractures were enrolled into a prospective database. Functional outcome, using the 36-Item Short Form Health Survey Physical Component Summary (SF-36 PCS), was collected at baseline, six months, one year, and five years. The trajectory of recovery for complex fractures (Schatzker V and VI) was compared with simple fractures (Schatzker I to IV). Minimal clinically important difference (MCID) was calculated between timepoints. In all, 182 patients were enrolled: 136 (74.7%) in simple and 46 (25.3%) in complex. There were 103 female patients and 79 male patients with a mean age of 45.8 years (15 to 86). Results Mean SF-36 PCS improved significantly in both groups from six to 12 months (p < 0.001) and one to five years (simple, p = 0.008; complex, p = 0.007). In both groups, the baseline scores were not reached at five years. The SF-36 PCS was significantly higher in the simple group compared with the complex group at both six months (p = 0.007) and 12 months (p = 0.01), but not at five years (p = 0.17). Between each timepoint, approximately 50% or more of the patients in each group achieved an MCID in their score change, indicating a significant clinical change in condition. The complex group had a much larger drop off in the first six months, with comparable proportions achieving MCID at the subsequent time intervals. Conclusion Tibial plateau fracture recovery was characterized overall by an initial decline in functional outcome from baseline, followed by a steep improvement from six to 12 months, and ongoing recovery up to five years. In simple patterns, patients tended to achieve a higher functional score by six months compared with the complex patterns. However, comparable functional scores between the groups achieved only at the five-year point suggest later recovery in the complex group. Function does not improve to baseline by five years in either group. This information is useful in counselling patients about the course of prospective recovery. Cite this article: Bone Joint J 2019;101-B:1009–1014.

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