Compaction Bone Grafting in Tibial Plateau Fracture Fixation

Background: Displaced tibial plateau fractures are traditionally treated with internal fixation using autologous bone grafting to provide structural support. In comminuted and osteoporotic fractures, there can be insufficient autograft available for this. Fresh-frozen bone allograft is readily available in sufficient quantity to fill all voids, is relatively inexpensive, and avoids donor site morbidity. Methods: We describe our technique and the early clinical and radiologic results of compaction morselized bone grafting (CMBG) for displaced tibial plateau fractures using fresh-frozen allograft. Results: This technique has been performed since July 2006 on eight patients. One patient died of an unrelated cause 3 months after surgery and one patient failed to attend follow-up clinic. Clinical and radiologic follow-up was performed on the remaining six patients at an average 15 months (range, 12-19) after surgery. One patient underwent a manipulation under anesthesia at 3 months for knee stiffness. One patient developed a painless valgus deformity and underwent a corrective osteotomy at 15 months. The height of the tibial plateau on radiographs has been maintained to an excellent grade (less than 2 mm depression) in all but one patient. Conclusion: CMBG using fresh-frozen allograft in depressed tibial plateau fractures provides structural support sufficient to maintain the height of the tibial plateau, is associated with few complications in complex patients with large bone loss, and has theoretical advantages of graft incorporation and remodeling.