Effectiveness of the management of bony articular collapse with bony defects in tibial plateau fractures with the use of genex: An absorbable calcium composite synthetic bone graft

Abstract

Background: Synthetic grafts containing calcium sulfate and calcium phosphate are used to manage defects and support the articular surface in the management of periarticular fractures. GeneX is a synthetic graft that contains beta-tricalcium phosphate and calcium sulfate. Objectives: This study's aim was to assess the maintenance of elevated articular segments in tibial plateau fractures grafted with a synthetic calcium composite graft. Methods: Patients who received a single synthetic calcium composite graft intraoperatively at a single Level 1 Major Trauma Centre were identified. Case notes and radiographic images were reviewed to assess articular collapse, mode of fixation, maintenance of the articular surface, and reoperation rates. All intra-articular segments were elevated, graft applied, and combination of implant (circular frame/plate) were used for definitive fixation along with raft screws. There were forty tibial plateau with average preoperative collapse of 13.12 mm (2.2−50). Modes of definitive fixation: frame and raft screw technique 19, plate 18, and screws alone 3. Results: Two (5%) had postoperative collapse after anatomical reduction intraoperatively (one plate and one circular frame). Five demonstrated inadequate reduction intraoperatively, three circular frames, and 2 plates as definitive mode of stabilization. Four maintained inadequate reduction at final X-ray but one collapsed postoperatively. Of those with collapse, final average was 4.2 mm (3−5.3). Five patients required secondary surgery and none directly attributable to the synthetic graft. Conclusions: The use of the synthetic graft GeneX with subchondral raft screws along with circular frame or plate appears to be safe and effective in providing support to elevated intra-articular fractures and provides satisfactory outcomes in tibial plateau fractures.