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Comparison of Autogenous Bone Graft and Endothermic Calcium Phosphate Cement for Defect Augmentation in Tibial Plateau Fractures

A Multicenter, Prospective, Randomized Study

¹ 240 LaGrange Creek Drive, Eads, TN 38028. E-mail address: tarmd{at}aol.com
² Division of Orthopaedics, Halifax Infirmary, Queen Elizabeth II Health Sciences Centre, Room 4867, 1796 Summer Street, Halifax, NS B3H 3A7, Canada

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from DePuy and less than $10,000 from ETEX Corp. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 from a commercial entity (ETEX) or a commitment or agreement to provide such benefits from this commercial entity. Also, a commercial entity (DePuy) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

^* Robert W. Bucholz, MD, University of Texas Southwestern Medical School, Dallas, Texas; Paul Tornetta III, MD, Boston Medical Center, Boston, Massachusetts; Charles N. Cornell, MD, Hospital for Special Surgery, New York, NY; Sam Agnew, MD, McLeod Regional Medical Center, Florence, South Carolina; Robert F. Ostrum, MD, Camden, New Jersey; B.H. Berrey, MD, University of Florida Health Science Center, Jacksonville, Florida; Brian Davison, MD, Grant/Riverside Methodist Hospital, Columbus, Ohio; Thomas A. Gruen, MS, Brandon, Florida; Mark S. Vrahas, MD, Massachusetts General Hospital, Boston, Massachusetts; Alan L. Jones, MD, Orthopaedic Trauma Associates of North Texas, Dallas, Texas; Andrew Pollak, MD, University of Maryland School of Medicine, Baltimore, Maryland; Peter O'Brien, MD, Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canada; Thomas F. Varecka, MD, Minneapolis, Minnesota; and James A. Goulet, MD, University of Michigan Hospitals, Ann Arbor, Michigan.

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Methods: One hundred and twenty acute, closed, unstable tibial plateau fractures (Schatzker types I through VI) in 119 adult patients were prospectively enrolled in twelve study sites in North America between 1999 and 2002. Randomization for the type of grafting of the subarticular defect was done at the time of surgery, with use of a 2:1 ratio, to treatment with calcium phosphate cement (eighty-two fractures) or autogenous iliac bone graft (thirty-eight fractures). After open reduction, standard plate-and-screw or screw-only fixation was used and then either the cement or the bone graft was placed in the defect cavity for subarticular support. Follow-up included standard radiographs, evaluated by multiple reviewers to avoid bias, and knee range-of-motion assessment at six months to one year or later.

Results: The age, weight, height, and sex of the patients and the fracture patterns were comparable in the two groups, as were union rates and time to union. There was a significantly (p = 0.009) higher rate of articular subsidence during the three to twelve-month follow-up period in the bone graft group.

Conclusions: The bioresorbable calcium phosphate cement used in this study appears to be a better choice, at least in terms of the prevention of subsidence, than autogenous iliac bone graft for the treatment of subarticular defects associated with unstable tibial plateau fractures.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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