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

Russell, Thomas A.; Leighton, Ross K.
October 2008
Journal of Bone & Joint Surgery, American Volume;Oct2008, Vol. 90-A Issue 10, p2057
Academic Journal
Background: Bone graft augmentation is often selected to treat defects associated with unstable tibial plateau fractures. This prospective, randomized, multicenter study was undertaken to determine the efficacy of bioresorbable calcium phosphate cement compared with standard autogenous iliac bone graft in the treatment of these osseous defects. Methods: One hundred and twenty acute, closed, unstable tibial plateau fractures (Schatzker types I through VI) in 119 adult patients were prospectively enrolled in twelve study sites in North America between 1999 and 2002. Randomization for the type of grafting of the subarticular defect was done at the time of surgery, with use of a 2:1 ratio, to treatment with calcium phosphate cement (eighty-two fractures) or autogenous iliac bone graft (thirty-eight fractures). After open reduction, standard plate-and-screw or screw-only fixation was used and then either the cement or the bone graft was placed in the defect cavity for subarticular support. Follow-up included standard radiographs, evaluated by multiple reviewers to avoid bias, and knee range-of-motion assessment at six months to one year or later. Results: The age, weight, height, and sex of the patients and the fracture patterns were comparable in the two groups, as were union rates and time to union. There was a significantly (p = 0.009) higher rate of articular subsidence during the three to twelve-month follow-up period in the bone graft group. Conclusions: The bioresorbable calcium phosphate cement used in this study appears to be a better choice, at least in terms of the prevention of subsidence, than autogenous iliac bone graft for the treatment of subarticular defects associated with unstable tibial plateau fractures. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Open Reduction and Plate Fixation Versus Nonoperative Treatment for Displaced Midshaft Clavicular Fractures A Multicenter, Randomized, Controlled Trial. Robinson, C. M.; Goudie, E. B.; Murray, I. R.; Jenkins, R. J.; Ahktar, M. A.; Read, E. O.; Foster, C. J.; Clark, K.; Brooksbank, A. J.; Arthur, A.; Crowther, M. A.; Packham, I.; Chesser, T. J. // Journal of Bone & Joint Surgery, American Volume;9/4/2013, Vol. 95-A Issue 17, p1576 

    Background: There is a growing trend to treat displaced midshaft clavicular fractures with primary open reduction and plate fixation; whether such treatment results in improved patient outcomes is debatable. The aim of this multicenter, single-blinded, randomized controlled trial was to compare...

  • Upper and Lower Limb Reconstruction Following Trauma. Jordan, Daniel J.; Hindocha, Sandip // Open Orthopaedics Journal;2014 Supplement, Vol. 8, p397 

    An introduction to the journal is presented in which the editor discusses various reports within the issue on topics including common techniques in open fracture management, pilon fracture treatment, and deficiency of soft tissue.

  • The Emperor's new vertebroplasty?  // Clinical Cardiology Alert;Oct2009 Clinical Briefs, p20 

    The article discusses research on vertebroplasty. It references a study by R. Buchbinder and colleagues, published in the 2009 issue of the "New England Journal of Medicine." The study examined the use of vertebroplasty in 78 patients with painful osteoporotic fracture. It found that...

  • AOA initiative guides physicians, hospitals in bone health education and treatment. Rapp, Susan M. // Orthopedics Today;Mar2010, Vol. 30 Issue 3, p22 

    The article focuses on the Own the Bone quality improvement initiative launched by the American Orthopaedic Association to guide hospitals and practitioners in managing bone health and fragility fractures.

  • Outcome Assessment in Clinical Trials of Fracture-Healing. Morshed, Saam; Corrales, Luis; Genant, Harry; Miclau, III, Theodore // Journal of Bone & Joint Surgery, American Volume;Feb2008 Supplement 1, Vol. 90-A, p62 

    Although there are numerous methods for defining fracture-healing in clinical studies, no consensus exists regarding the most valid and reliable manner for assessing union or for determining which outcomes are most important. This article summarizes and describes methods for the clinical...

  • Selection and Development of Preclinical Models in Fracture-Healing Research. O'Loughlin, Padhraig F.; Morr, Simon; Bogunovic, Ljiljana; Kim, Abraham D.; Park, Brian; Lane, Joseph M. // Journal of Bone & Joint Surgery, American Volume;Feb2008 Supplement 1, Vol. 90-A, p79 

    Animal fracture models have been extensively applied to preclinical research as a platform to identify and characterize normal and abnormal physiological processes and to develop specific maneuvers that alter the biology and biomechanics being examined. The choice of animal model employed in a...

  • Stimulation of Fracture-Healing with Systemic Intermittent Parathyroid Hormone Treatment. Barnes, George L.; Kakar, Sanjeev; Vora, Siddarth; Morgan, Elise F.; Gerstenfeld, Louis C.; Einhorn, Thomas A. // Journal of Bone & Joint Surgery, American Volume;Feb2008 Supplement 1, Vol. 90-A, p120 

    Over the past several years, there has been an increasing interest in the biology of bone repair and potential technologies for enhancing fracture-healing. Part of this interest is derived from the growing age of the population and the recognition that increased age carries an increased risk of...

  • Nanofibers and Nanoparticles for Orthopaedic Surgery Applications. Nair, Lakshmi S.; Laurencin, Cato T. // Journal of Bone & Joint Surgery, American Volume;Feb2008 Supplement 1, Vol. 90-A, p128 

    The ability of nanostructures to elicit altered cell behaviors, including cell adhesion, proliferation, orientation, motility, integrin expression, cytoskeletal organization, and modulation of intracellular signaling, has raised heightened interest in these materials for various biomedical...

  • Osteoporotic fracture management: closing the gap of knowledge. Goldhahn, J.; Blauth, M. // Archives of Orthopaedic & Trauma Surgery;Feb2007, Vol. 127 Issue 1, p1 

    The author reflects on the increased risk of complications during osteoporosis fracture healing. The reasons for complications during the fracture treatment are largely unknown. The author comments that the journal Archives of Orthopaedic and Trauma Surgery offers informative articles on...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics