OTA 1999 Posters

Poster #115

·*The Use of Norian SRS and Minimal Internal Fixation in the Management of Tibial Plateau Fractures

John Keating (a-Norian); Carol Hajsucka, RGN (a-Norian), Royal Infirmary, Edinburgh, SCOTLAND

Purpose: To evaluate the use of Norian SRS in the management of tibial plateau fractures

Methods: Norian SRS is a carbonated apatite cement. It has a high compressive strength, which makes it a suitable material to fill cancellous bone defects present following reduction of metaphyseal fractures. We have treated 41 tibial plateau fractures (21 male; 21 female; mean age 49 years) using this material. All patients had isolated tibial plateau fractures

There were 15 B2.2, 23 B3.1 and 3 B2.3 fractures. Fractures were fixed with limited internal fixation using a short anterior parapatellar incision. Reduction and fixation were initially achieved. Once this was carried out the void under the elevated plateau was filled using Norian SRS. A buttress plate was used in one case, screws or K-wires in 33 cases and Norian SRS alone in 7 cases. Patients were mobilised partially weight bearing in a hinged knee brace and allowed full weight bearing at 6 weeks. All patients have been followed up for at least a year.

Results: Reductions were anatomic (<2mm displacement) in 32 (78%) cases, satisfactory (3 ­ 5mm displacement) in 7 (17%) cases and imperfect (>5mm) in 2 (5%) patients. Extrusion of some Norian SRS into surrounding soft tissue occurred in one case. This material resorbed within 6 weeks of surgery with no adverse effects. There was one DVT and one pulmonary embolus. Loss of reduction was observed in 6 (15%) cases. In 5 of these the loss of reduction was slight (<3mm) and no action was required. Gross loss of reduction and deep infection occurred in one (2%) elderly male. There were no other significant complications. Thirty-seven patients (90%) had more than 120 degrees of knee flexion at 6 months. There were no flexion contractures. The median visual analogue pain scale (range 0 to 10) was 2 at 6 months. No posttraumatic arthritis has yet been noted on radiographs.

Discussion: Norian SRS is an alternative to the use of bone grafting in any area of cancellous bone subject to compressive load. It is ideal for use in tibial plateau fractures with compressed subchondral bone after elevation. It obviates the need for buttress plating and bone grafting and there is no bone graft donor site morbidity. Patients are able to mobilize more rapidly and early discharge is facilitated.

Conclusion: Use of Norian SRS is a promising development in the management of tibial plateau fractures, and initial results suggest it may be more effective in maintaining reduction that standard methods of fixation and grafting.