Long-term radiographic appearance of calcium-phosphate synthetic bone grafts after surgical treatment of tibial plateau fractures.

OBJECTIVES

Synthetic bone grafts (SBGs) are widely used to fill bone defects after fracture reduction. This study assessed the long-term resorption of two different calcium phosphate products (A=ChronOS™ inject and B=Norian SRS; both DePuy Synthes, Oberdorf, Switzerland) used in the surgical treatment of tibial plateau fractures.

DESIGN

Long-term clinical and radiologic follow-up of 52 patients after surgical treatment of intraarticular tibial plateau fractures augmented with SBGs.

SETTING

The study was performed at a level 3 trauma center.

PATIENTS

Between January 2000 and December 2006 a total of 52 patients with intraarticular tibial plateau fractures were operatively treated and augmented with SBGs consisting of a Brushite matix with β-TCP granules (SBG A) or hydroxylapatite with 4-6% carbonate content (SBG B). 46 patients could be contacted and 38 were included in the study. Half of the patients received SBG A and the other half SBG B.

MAIN OUTCOME MEASUREMENTS

Loss of reduction and SBG resorption was investigated by comparison of follow-up X-ray images to pre- and postoperative X-ray images. Furthermore, pain, activity level and knee function were evaluated by means of questionnaires and clinical examination.

RESULTS

The mean age of patients was 59.7±12.5years. The follow-up was 8.6±0.9years for SBG A and 11.6±1.4years for SBG B (p<0.001). In most cases SBG A was completely resorbed in a homogenous pattern, while SBG B was still visible on the X-ray images revealing a peripheral resorption pattern. A loss of reduction (>2mm) could be observed in two patients with SBG A and two patients with SBG B, although only one of them had an impaired knee function.

CONCLUSIONS

The composite SBG A reveals a comprehensive long-term resorption in comparison to SBG B. Nevertheless, both provided suitable mechanical support as part of the surgical treatment of tibial plateau fractures.

LEVEL OF EVIDENCE

Case series, Level IV.