Optimal graft choices for tibial plateau fractures with joint depression

Abstract

Objectives: This study aims to provide insight into the advantages and disadvantages of autograft and synthetic graft use in the surgical treatment of tibial plateau fractures with joint depression by comparing the clinical and radiological outcomes of both graft types.

Patients and methods: Between February 2019 and September 2022, a total of 51 patients (23 males, 28 females; mean age: 45.3±13.5 years; range, 20 to 69 years) who underwent surgical treatment for Schatzker type 2 and type 3 tibial plateau fractures in our clinic were retrospectively analyzed. The patients were divided into two groups; 30 patients received autografts and 21 received tricalcium phosphate synthetic grafts. Demographic data, graft type, fracture classification, preoperative joint depression, body mass index (BMI), and smoking status were recorded. Postoperative evaluations included Lysholm and Visual Analog Scale (VAS) scores at two years.

Results: Similar clinical and radiological outcomes were observed in both graft groups in the short term (p>0.05). Smoking had a negative effect on graft stability, with a significantly higher postoperative depression rate in smokers (p=0.026). Patients with a BMI above 30 kg/m2 also showed higher rates of postoperative depression (p=0.004). Clinical outcomes were worse in patients with joint depression compared to those without depression (p=0.003).

Conclusion: Autografts and synthetic grafts show similar efficacy in the mid-term treatment of tibial plateau fractures. High BMI and smoking may be associated with potential joint depression and worse clinical outcomes in the postoperative period.