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

Abstract

ObjectivesSynthetic 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. DesignLong-term clinical and radiologic follow-up of 52 patients after surgical treatment of intraarticular tibial plateau fractures augmented with SBGs. SettingThe study was performed at a level 3 trauma center. PatientsBetween 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 measurementsLoss 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. ResultsThe 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. ConclusionsThe 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 evidenceCase series, Level IV.