Thomas A. Russell, MD
Autogenous iliac bone graft has been the most frequently recommended treatment for defects associated with unstable tibial plateau fractures. Despite the wide acceptance of autogenous iliac bone graft as the so-called gold standard, complications of graft harvest, ranging from temporary pain and numbness to long-term functional impairment, are well documented. Because the primary objective of the use of grafting in a subarticular defect associated with a tibial plateau fracture is to prevent the collapse of the articular surface, it seems reasonable that an artificial material might be suitable for use with internal fixation if it were biocompatible, readily available, and offered some structural support for the articular fracture. T.A. Russell, MD, et.al. conducted a prospective, randomized, multicenter study to determine the efficacy of bioresorbable calcium phosphate cement compared with standard autogenous iliac bone graft in the treatment of these osseous defects. The conclusion was “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.” In this JBJS/VJO video supplement to the published study, Dr. Russell demonstrates on a cadaveric specimen his surgical technique for open reduction and internal fixation using a plating system that features scalloped contouring to allow for independent lag screws for easier articular reduction. The plate also features the option of compression and locking in every hole. Following reduction of the articular fracture, the residual subarticular defect is packed with the calcium phosphate cement. Dr. Russell demonstrates three methods to apply the cements: Alpha-bsm® is a bioresorbable, calcium-deficient, apatitic calcium phosphate cement; Beta-bsm™ is injected through a 16 gauge needle; Gamma-bsm™ meets the need for faster setting, high compressive-strength materials.
- Surgical Pearls to achieve articular fixation with a plate
- Cement techniques for subarticular fixation
- Avoiding Complications
See the Corresponding JBJS Article:
- Thomas A. Russell, Ross K. Leighton on behalf of the Alpha-BSM Tibial Plateau Fracture Study Group.
- Comparison of Autogenous Bone Graft and Endothermic Calcium Phosphate Cement for Defect Augmentation in Tibial Plateau Fractures. A Multicenter, Prospective, Randomized Study
J. Bone Joint Surg. Am., Oct 2008; 90: 2057 – 2061 [Article]
- Total Run Time: 23:24 minutes
- Catalog Number: 5108
- VJO Publication Date: December, 2009