Abstract
BackgroundInflation bone tamps are becoming increasingly popular as a reduction tool for depressed tibial plateau fractures. A number of recent publications have addressed the technical aspects of balloon inflation osteoplasty. However, no study has yet been published to describe the technical limitations, intraoperative complications, and surgical bailout strategies for this new technology.MethodsObservational retrospective study of all patients managed with inflatable bone tamps for depressed tibial plateau fractures between October 1, 2010 and December 1, 2012. The primary outcome parameter was the rate of complications, which were stratified into “minor” and “major” depending on the necessity for altering the surgical plan intraoperatively, and based on the risk for patient harm. This study was approved by the Institutional Review Board of the State of Colorado.ResultsA consecutive series of 20 patients were managed by balloon inflation osteoplasty for depressed tibial plateau fractures during the 15 months study period. The mean age was 42.8 years (range 20–79), with 9 females and 11 males. A total of 13 patients sustained an adverse intraoperative event (65%), with three patients sustaining multiple technical complications. Minor events (n = 8) included the burst of a balloon with extrusion of contrast dye, and the unintentional posterior wall displacement during balloon inflation. Major events (n = 5) included the intra-articular injection of calcium phosphate in the knee joint, and the inability to elevate the depressed articular fragment with the inflatable bone tamp.ConclusionThe observed intraoperative complication rate of 65% reflects a steep learning curve for the use of inflation bone tamps to reduce depressed tibial plateau fractures. Specific surgical bailout options are provided in this article, based on our early anecdotal experience in a pilot series of 20 consecutive cases. Patients should be advised on the benefits and risks of this new technology as part of the shared decision-making process during the informed consent.
Highlights
Inflation bone tamps are becoming increasingly popular as a reduction tool for depressed tibial plateau fractures
Between October 1, 2010, and December 1, 2012, a balloon-guided reduction of depressed tibial plateau fractures using an inflatable bone tamp was applied in a first pilot series of 20 consecutive patients (9 women, 11 men) with a mean age of 42.8 years
Two additional patients were treated by inflation osteoplasty during this time-period but were lost to follow-up and excluded from the study
Summary
Inflation bone tamps are becoming increasingly popular as a reduction tool for depressed tibial plateau fractures. Balloon-guided minimal-invasive fracture reduction, using an inflatable bone tamp, represents a “cutting edge” emerging technique which has been recently described in numerous publications [14,15,16,17,18,19]. The advantages of this new technique are intuitive, by (1) minimalinvasive percutaneous approaches which preserve the soft tissue envelope and avoid the necessity of a formal open arthrotomy, (2) by allowing a controlled gradual elevation of the depressed articular fracture fragment under fluoroscopic or arthroscopic guidance and (3) thanks to a large surface area, by allowing small fragments to be elevated simultaneously [15,16]. We have yet to demonstrate the supremacy of this new minimal-invasive technique, compared to the use of traditional bone tamps in “standard” open approaches, in prospective, controlled trials
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