Maintenance of joint reduction and allograft incorporation in treating tibial plateau fractures. Retrospective case series using cortico-cancellous, non-irradiated, bone allograft.

Abstract

BackgroundRestoring joint congruence and maintaining reduction until healing is imperative in treating tibial plateau fractures (TPF). The main objective of this study was to evaluate the feasibility of augmentation with impacted bone allograft (IBA) to prevent loss of reduction in tibial plateau fractures during healing and to evaluate its incorporation. MethodsWe retrospectively analyzed all patients with an acute, closed tibial plateau fracture (Schatzker II, III, IV) treated between 2010 and 2019 with open reduction and internal fixation (ORIF) and impacted bone allograft (IBA), with a minimum follow-up of 24 months. We evaluated the postoperative radiographs by drawing a line along the tibial axis and another perpendicular to the healthy plateau to measure the reduction and subsequent behavior. The incorporation of the allograft was evaluated by radiological analysis assessing its integration, non-union, resorption, or sclerosis. We used the clinical-radiological Rasmussen system and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to objectify the outcomes. Results78 TPFs were included, with a median age of 51.5 (40.7 – 62.2) years and a median follow-up of 66 (24-89) months. Two (2.5%) patients presented loss of joint reduction (subsidence) during the follow-up regarding the achieved in the surgery. Seventy-six (94.7%) patients presented integration, two (2.5%) resorption, and one (1.3%) sclerosis. Seventy-two (92.3%) patients presented excellent and good results in the Rasmussen radiological score, and 72 (92.3%) patients presented excellent or good clinical scores. The mean WOMAC at two years postoperatively was 15 ± 6.5. ConclusionOur results demonstrate that allograft is an adjuvant in maintaining a reduction in type II, III, and IV Schatzker´s tibial plateau fractures. Low rates of loss of reduction during follow-up can be expected with its use.