Fri., 10/15/10 Knee, Tibia & Pediatrics, Paper #55, 3:36 pm OTA-2010
A Prospective Functional Analysis of Proximal Tibia Fractures Using a Calcium Sulfate/Calcium Phosphate Composite Graft with an Early Weight Bearing Protocol
J. Tracy Watson, MD1; Joseph Borrelli, Jr., MD2; Timothy G. Weber, MD3;
Robert H. Choplin, MD, FACR4; Scott A. Persohn, RT4; Rena White, BS5;
Emily M. Haglund, MD5;
1St. Louis University, St. Louis, Missouri, USA;
2University of Texas Southwestern, Dallas, Texas, USA;
3OrthoIndy, Indianapolis, Indiana, USA;
4Indiana University, Indianapolis, Indiana, USA;
5Wright Medical Technology, Arlington, Tennessee, USA
Purpose: Bone grafting of subchondral voids during open reduction and internal fixation (ORIF) of tibial plateau fractures is commonly performed and recently a CaSO4-CaPO4 graft was shown to resist postoperative articular displacement. The most appropriate time to initiate weight bearing as tolerated (WBAT) and the actual time of full weight bearing (FWB) remains largely unstudied. This study was designed to determine whether a CaSO4-CaPO4 composite graft facilitates earlier weight bearing while maintaining postoperative reduction for patients with lateral tibial plateau fractures.
Methods: 49 patients with unilateral tibial plateau fractures (OTA 41A-B) were enrolled in a prospective multicenter single cohort study. The treatment protocol included ORIF and defect augmentation with a CaSO4-CaPO4 graft. The first 35 patients enrolled (group I) were instructed to initiate WBAT at 12 weeks. The next consecutive 14 patients (group II) were instructed to start WBAT at 6 weeks. Four patients had complications (infection, polytrauma, significant subchondral defect, and prior tibial injury) that did not allow the WBAT order and were excluded from group II based on attending physician recommendation. Actual weight-bearing status and Knee Society scores were collected.
Results: Group I (n = 35) had no patients FWB at 6 weeks, 32.3% of patients FWB at 12 weeks, and 90.0% of patients FWB at 24 weeks. Group II (n = 10) had 20% of patients FWB at 6 weeks and 100% of patients FWB at 12 weeks. When comparing the FWB status at the 12-week interval, group II patients achieved FWB status significantly earlier than group I patients (P < 0.001). CT evaluation demonstrated initial reduction was maintained within 2.1 mm on average for all patients. The average Knee Society score improved from 77.0 to 79.9 for group I and 76.6 to 83.7 for group II at 12 weeks (P = .9722) and 24 weeks (P = .5101), respectively.
Conclusion: The larger percentage of patients that were able to weight-bear at 12 weeks in group II suggests that some patients may benefit from an earlier WBAT order. Earlier weight bearing is a treatment option, although the potential benefits and risks of earlier weight bearing should be considered on a per-patient basis.
Alphabetical Disclosure Listing (292K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.