Subjective and novel objective radiographic evaluation of inflatable bone tamp treatment of articular calcaneus, tibial plateau, tibial pilon and distal radius fractures

Department of Orthopaedics, 3000 Arlington Avenue, University of Toledo Medical Center, Toledo, OH, United States. Electronic address: .
Injury (Impact Factor: 2.14). 04/2013; 44(8). DOI: 10.1016/j.injury.2013.03.020
Source: PubMed


There is a growing need to develop tools that allow for better reductions of difficult to treat fractures in minimally disruptive ways. One such technique has been developed using the inflatable bone tamp and a fast setting calcium phosphate. KYPHON(®) XPANDER Inflatable Bone Tamp and the KYPHON(®) Osteo Introducer(®) System were used to reduce the articular fractures and a fast-setting calcium phosphate was introduced into those voids and metal hardware was applied as deemed necessary. Subjects were skeletally mature patients treated for articular fractures of the calcaneus, tibial plateau, tibial pilon, or distal radius. Post-operative day zero and week 12 radiographs were objectively and subjectively evaluated by three independent orthopaedic surgeons. Their objective scores were then translated into subjective categories based on the Heiney-Redfern scaled scoring (H-R score) system established herein. Overall, the thorough radiographic analysis by independent reviewers indicates that the technique is capable of obtaining and maintaining articular reductions in a good or adequate manner at 12-weeks post-operatively. Introduced is a potential novel evaluation scale scoring system for these articular fractures that evaluates the important anatomic considerations reproducibly in fracture reductions. There are many potential benefits that remain speculative to this type of tool within a procedure, and therefore this tool and technique warrants further research.

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Available from: Roberta Redfern, Sep 27, 2015
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    ABSTRACT: Purpose In vitro studies have shown promising results for balloon-guided inflation tibioplasty. It was our hypothesis that this technique may be safe and effective for use in depressed lateral tibial plateau fracture. Methods We performed a prospective study of all patients suffering from a depressed lateral tibial plateau fracture, managed in our institution with inflation tibioplasty and a resorbable calcium phosphate bone substitute injection, between January 2012 and December 2013. Twenty patients, mean age 54.3 ± 12. 8 years, suffering from a depressed lateral tibial plateau fracture (Schatzker type II and III) were included. We then aimed to evaluate at a minimum follow-up of one year: (1) the rate of complications, (2) the clinical outcome (Knee Injury and Osteoarthritis Outcome (KOO) and 12-Item Short Form Health Survey (SF-12) scores); and (3) the radiographic outcome (evaluated by CT-scan). Results No peri-operative complications occurred. In one patient, calcium phosphate substitute was found in the infrapatellar fat pad on post-operative radiography with no clinical or radiographic consequences at one year. At one year after surgery, the KOO subscores were: Pain 80 (range 64—93), other symptoms 81.3 (69–93), daily living activities 81.9 (46–99), sport 65.83 (20–100), and quality of life 67.04 (31–100). The SF-12 activity component was 40.4 (28.6—52.2) and SF-12 mental component 47.71 (28 – 67.1). The mean depressed step-off of the lateral joint decreased from 10.7 ± 4.8 mm pre-operatively to 2.7 ± 1.7 mm post-operatively (p < 0.0001). Conclusion Our observations suggest that the use of balloon-guided inflation tibioplasty with injection of a resorbable bone substitute is safe, and results in a high rate of anatomic reduction and good clinical outcomes in patients with depressed tibial plateau fractures. Level of Evidence: Therapeutic Level IV.
    No preview · Article · Nov 2015 · International Orthopaedics