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Abstract
Introduction : The rationale for operative treatment of depressed tibial plateau fractures is anatomic reduction, stable fixation and grafting. Grafting options include autogenous bone graft or bone substitutes.Methods : The autograft group included 18 patients with depressed tibial plateau fractures treated with autogenous bone grafting from the ipsilateral femoral condyle following open reduction and internal fixation. According to Schatzker classification, there were 9 type II, 4 type III, 2 type IV and 3 type V lesions. The average time to union and the hospital charges were compared with the bone substitute group. The latter included 17 patients who had an excellent outcome following treatment of split and/or depressed lateral plateau fractures, using a similar surgical technique but grafting with bone substitutes (allografts).Results : Excellent clinical and radiological results were detected in the autograft group after an average follow-up of 28 months (range 12-37). The average time to union in the autograft group was 14 weeks (range 12-16), while in the bone substitute group it was 18 weeks (range 16-20). The mean total cost was 1276 Euros for the autograft group and 2978 Euros for the bone substitute group.Discussion : The use of autogenous graft from the ipsilateral femoral condyle following open reduction and internal fixation of depressed tibial plateau fractures provided enough bone to maintain the height of the tibial plateau and was not associated with any donor site morbidity. Using this method, the surgical time was not significantly elongated and the rehabilitation was not affected. It also exhibited faster fracture healing without postoperative loss of reduction and it was less expensive than the use of bone substitutes.
Highlights
The rationale for operative treatment of depressed tibial plateau fractures is anatomic reduction, stable fixation and grafting
The principles of treatment include arthroscopically assisted or open anatomic reduction followed by stable internal fixation [1,2,3,4,5]
The medical records of 18 patients (18 fractures) that had autogenous bone grafting taken from the ipsilateral femoral condyle in depressed tibial plateau fractures, following open reduction and internal fixation, were retrospectively reviewed
Summary
The rationale for operative treatment of depressed tibial plateau fractures is anatomic reduction, stable fixation and grafting. Grafting options include autogenous bone graft or bone substitutes. The early restoration of normal joint function is the goal of treatment of depressed fractures of the tibial plateau. The principles of treatment include arthroscopically assisted or open anatomic reduction followed by stable internal fixation [1,2,3,4,5]. Indirect reduction associated with external or hybrid fixation may be used in high-energy fracture types with a severe concomitant injury to the soft tissue envelope [10, 11]. Bone grafting using autografts or bone substitutes is concomitantly used to support the reduction and promote fracture healing. Recommendations of bone grafting materials are based on their mechanical and handling characteristics, safety, and cost [12]
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