Outcome of tibial plateau fractures managed with calcium phosphate cement

Abstract

Objectives: To compare the use of an injectable calcium phosphate cement (Skeletal Repair System (SRS), Norian corporation, Cupertino, CA) and minimal internal fixation with buttress plating and bone grafting for lateral tibial plateau fractures. Study design: Retrospective analysis with 13 age, sex and fracture matched pairs of tibial plateau fractures. Methods: Thirteen patients with lateral tibial plateau fractures treated with buttress plating and bone grafting were matched with 13 patients treated using minimal internal fixation and an injectable calcium phosphate cement (SRS). All patients were followed for a minimum of one year. The operative time, quality of reduction, maintenance of reduction and development of post-traumatic osteoarthritis was compared in both groups. Results: The mean duration of surgery was 101 min in patients treated with buttress plating and bone grafting and 55 min in patients treated with SRS ( P<0.0001). Nine patients in the internal fixation and bone graft group had excellent anatomical reductions as judged on post-operative radiographs but some loss of reduction was observed in 8 of the 13 (61%) cases. All 13 patients from the SRS group had an excellent reduction on post-operative radiographs but 3 (23%) demonstrated some loss of reduction of the plateau. The mean residual plateau depression at one year was 4 mm in the buttress plate group and 0.7 mm in the SRS group ( P<0.005). Two patients (15%) in the buttress plate group developed post-traumatic osteoarthritis and required knee arthroplasty. Conclusions: The use of SRS was associated with more favourable anatomical results than conventional treatment with buttress plating and bone grafting for lateral tibial plateau fractures.