Slovenská chirurgia 4/2020

Tricalcium phosphate spongioplasty and secondary decrease in joint area after fractures of the lateral condyle of the tibia

Aim of the study: There are various types of fracture treatment options for split-depressed lateral tibial plateau fracture (AO/OTA B3.1; Schatzker type 2). Raft construct screws, buttress plate and locked plates are amongst the most used. After fracture reduction the cancellous bone defect often need to be filled with autograft, allograft or synthetic bone graft substitutes. Despite treatment, one of the complications following surgery is secondary collapse of tibial plateau. The aim of the study was determination of the rate and size of the secondary depression of tibial plateau after surgical treatment of split-depressed lateral tibial plateau fracture in combination with tricalcium phospate bone graft substitute. Methodology: The retrospective study included all adult patients who were surgically treated at the Department of Trauma Surgery UNLP in Košice from 1.1.2008 to 31.12.2011 for non-pathological split-depressed lateral tibial plateau fracture (AO/OTA B3.1) Patient‘s radiograph was used to assess presence and extent of secondary depression of tibial plateau at least 12 months after surgery. Additional relevant clinical and treatment information were retrieved from the patient medical records. Results: During the study secondary depression of tibial plateau (≥ 2 mm) occurred in 16 (52%) out of the 31 patients with the mean of 1,8 mm (SD 2,4). The greatest depression of tibial plateau was noticed in the group treated with screws/buttress plate without bone grafting which reached 3,1 mm (SD 2,3). The patients in this group developed 4,4 times (95% CI 1,3-15,7; p=0.02) more likely secondary plateau depression than patients in treated with locked plate and tricalcium phosphate bone grafting (TCP). Conclusion: Secondary depression of tibial plateau in for split-depressed lateral tibial plateau fracture can be expected in patients treated without locked plates and without bone grafting. Locked plate with or without TCP bone grafting seems to be viable option for the treatment this type of fractures.

Keywords: tibial plateau fractures, bone substitutes, complications