title: Impaction bone grafting has potential as an adjunct to the surgical stabilisation of osteoporotic tibial plateau fractures: Early results of a case series.
abstract: BACKGROUND
  Osteoporotic tibial plateau fractures (TPFs) are difficult to treat with either open reduction internal fixation (ORIF) or acute total knee arthroplasty (TKA). They have high complication rates, poor outcomes and often fail in the short- to mid-term. We investigated the use of impaction bone grafting (IBG) as an adjunct to stabilise the fracture in a cohort of osteoporotic TPFs.
  
  
  METHODS
  Nine consecutive osteoporotic TPFs were surgically stabilised with ORIF augmented with IBG or with IBG alone (one pure depression fracture) using on average allograft from 2 femoral heads/case (range 1-4 heads or 25-100 cm(3)). The median bone mineral density T-score of the patients was -2.9 (-2.5 to -4.5). All patients were mobilised weight-bearing as tolerated immediately after surgery and had regular follow-up to a minimum of 2 years where functional scores were taken and gait was assessed. Fracture reduction was assessed on plain radiographs and computed tomography (CT) scans; maintenance of fracture reduction was monitored using plain radiographs, CT and radiostereometric analysis (RSA). Bone graft remodelling was assessed by comparison of immediate post-operative CT scans with scans at a minimum of 1 year.
  
  
  RESULTS
  All surgeries were uneventful. All patients progressed to full weight bearing within 6 weeks of surgery and regained a normal gait by 3 months. Seven fractures healed with a cranio-caudal migration of less than 3mm (range 0-2.6mm using RSA and 0-2mm using CT). Two fractures had an isolated posterolateral fragment depression of 13.5mm and 9 mm, respectively, which did not affect the overall joint alignment or clinical outcomes at short-term follow-up. At latest CT follow-up, on average 51% of the graft area (range 36-70%) had remodelled into new host bone.
  
  
  CONCLUSIONS
  Impaction bone grafting shows promising results as an adjunct to the surgical stabilisation of osteoporotic TPFs. In this case series the technique provided enough fracture stability for patients to mobilise weight-bearing as tolerated immediately after surgery and achieve full weight-bearing by the sixth postoperative week. There was no failure of fixation and 7 of the 9 cases healed with minimal fracture displacement.
authors.affiliation: Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
authors.forename: Gerrit J
authors.initials: GJ
authors.lastname: van de Pol
authors.affiliation: Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
authors.forename: Lukas D
authors.initials: LD
authors.lastname: Iselin
authors.affiliation: Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Callary
authors.affiliation: Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5000, Australia.
authors.forename: Dominic
authors.initials: D
authors.lastname: Thewlis
authors.affiliation: Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia.
authors.forename: Claire F
authors.initials: CF
authors.lastname: Jones
authors.affiliation: Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia.
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Atkins
authors.affiliation: Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia. Electronic address: bogdansolomon@mac.com.
authors.forename: Lucian B
authors.initials: LB
authors.lastname: Solomon
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D016025:Bone Transplantation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D013978:Tibial Fractures / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016474:Weight-Bearing
keywords: Impaction bone grafting; Internal fixation; RSA; Tibial plateau fracture