title: Effect of additional fixation in tibial plateau impression fractures treated with balloon reduction and cement augmentation.
abstract: BACKGROUND
  Isolated tibial plateau impression fractures can be reduced through minimally invasive techniques using balloon inflation and cement augmentation. No evidence exists yet if an additional fixation at all and which method of fixation is necessary in the treatment of these fractures. The purpose of this study was to compare a locking plate and a screw raft for additional fixation after balloon reduction and cement augmentation in isolated tibial plateau impression fractures. Loss of reduction was subsequently analysed without additional fixation.
  
  
  METHODS
  Lateral tibial plateau impression fractures were created in eight matched pairs of human cadaveric tibiae. Reduction was performed using a balloon inflation system, followed by cement augmentation. Additional fixation was performed with a lateral locking plate or a screw raft (four 3.5-mm screws). Specimens were cyclically loaded at 20-240N, 20-360N and 20-480N. Subsequently, additional fixation was removed and the last cyclic interval (20-480N) repeated. Loss of reduction was assessed by measuring subsidence of the subchondral bone.
  
  
  RESULTS
  Fractures treated with plate fixation exhibited less subsidence at higher loads compared with those treated with screw raft fixation (P<0.05). Loss of reduction significantly increased after removal of the additional fixation.
  
  
  CONCLUSIONS
  This experimental study suggests that loss of reduction can be minimised by using locking plate fixation after balloon reduction and cement augmentation in the treatment of isolated tibial plateau impression fractures.
authors.affiliation: Department of Trauma Surgery, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Electronic address: raul.mayr@uki.at.
authors.forename: Raul
authors.initials: R
authors.lastname: Mayr
authors.affiliation: Department of Trauma Surgery, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Electronic address: rene.attal@uki.at.
authors.forename: Rene
authors.initials: R
authors.lastname: Attal
authors.affiliation: Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University Innsbruck, Müllerstrasse 59, 6020 Innsbruck, Austria. Electronic address: marit.zwierzina@i-med.ac.at.
authors.forename: Marit
authors.initials: M
authors.lastname: Zwierzina
authors.affiliation: Department of Trauma Surgery, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Electronic address: michael.blauth@i-med.ac.at.
authors.forename: Michael
authors.initials: M
authors.lastname: Blauth
authors.affiliation: Department of Trauma Surgery, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Electronic address: werner.schmoelz@i-med.ac.at.
authors.forename: Werner
authors.initials: W
authors.lastname: Schmoelz
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D001843:Bone Cements / Q000627:therapeutic use*; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000379:methods; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery*
chemical_list: D001843:Bone Cements
keywords: Balloon; Fixation; Impression; Tibial plateau fracture; Tibioplasty