Examining Various Graft Substrates and Their Clinical Evidence in the Treatment of Tibial Plateau Fractures
DOI:
https://doi.org/10.12974/2313-0954.2019.06.4Keywords:
Allograft, Autograft, Biologics, Calcium Hydroxyapatite, DBM, Synthetics, Xenograft.Abstract
Tibial plateau fractures (TPF) are complex injuries of the tibia that involve the articular surface and commonly have depression of subchondral and metaphyseal bone. Common sequelae of this injury include arthritis and gait disturbances. A popular surgical strategy for this fracture calls for elevation of subchondral bone to restore the joint line, in turn leaving a metaphyseal bone void; this is then commonly secured with plates and screws. Autologous bone has been the gold-standard graft option to fill these voids, but other filling agents such as allografts, biologic grafts, and xenografts are gaining popularity TPF surgery. This is because bone graft substitutes provide predictable outcomes in the treatment of TPF and avoid complications such as donor site pain, infection, increased blood loss, and increased operative time that is seen with autografts. This review explores the benefits, complications, and outcomes of clinically researched graft substrates used for TPF reconstruction. Secondarily, we aim to find potential graft candidates for future clinical research that will progress the treatment of TPF. Internet searches with specific keywords were conducted on different journal databases to find clinically researched graft options in the treatment of TPF within the last 10 years. Multiple studies of various bone graft substitutes achieved similar, if not better results than autologous bone grafts in the treatment of TPF. A summary of each clinically researched graft in this review can be found in Table 1. Establishing a graft selection protocol remains a challenge for fracture surgeons, as well as choosing the best graft material. Future studies should aim to establish a superior graft substrate based clinical outcomes, while minimizing the cost and morbidity to the patient.
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