Augmentation of distal tibial defects with synthetic b-tricalcium phasphate and Osteomatrix xenoplastic material in surgical treatment of intra-articular impression fractures

Abstract

Purpose. To analyze the results of surgical treatment of distal tibial intra-articular fractures using b-tricalcium phosphate synthetic material (b-tricalcium phosphate, bTCP) and Osteomatrix xenoplastic material. Materials and Methods. The authors made a retrospective analysis of the results of surgical treatment of 51 patients with intra-articular impression fractures of the distal tibia (DT) over the period of 2009-2013. The inclusion criteria were the following: the use of open reposition and internal fixation technique, the augmentation of bone impression defects with bTCP or Osteomatrix xenoplastic material, the period of postoperative follow-up to 36 months inclusively. Two groups presented for evaluation of comparative efficiency of impression DT defect augmentation: Group А (n=32), the procedure of augmentation performed using b-tricalcium phosphate synthetic material (bTCP); Group B (n=19) – that using Osteomatrix xenoplastic material. X-ray, clinical and statistical methods used in the study. Statistical methods included the evaluation of the significance of differences by parametric and non-parametric criteria, the evaluation of the relationship of signs by the value of the Pearson coefficient of linear correlation. The difference in the distal epiphysis-diaphysis angle (ΔdEDA) determined in order to evaluate reposition maintenance; the Mazur point scale (2006) – to evaluate functional status. Results. 36 months after surgery ΔdEDA value within 1°-5° encountered in 90.7% among Group A patients and in 89.4% among those of Group B (p=0.127). Unsatisfactory roentgenometric results equally observed in both groups (p=0.0412). In Group A the percentage of excellent and good results by the Mazur scale (2006) was 53.0 %; that of satisfactory ones – 37.5 %, unsatisfactory – 9.5 %. As for Group B, the percentage of excellent and good results was 57.9%; satisfactory results encountered in 36.8%, unsatisfactory – in 5.3%. The direct correlation of average degree revealed between roentgenometric and functional parameters (r=0.670±0.143 for Group A, r=0.549±0.103 – for Group B). The total number of complications for both groups was 8 (15.7%) cases. Conclusion. No significant roentgenometric and functional differences observed in the follow-up period of 3, 6, 12, 24 and 36 months when bTCP and Osteomatrix used. The use of bTCP and Osteomatrix for bone defect filling is a little-invasive and effective technique of augmentation, and it can be recommended for surgical treatment of patients with intra-articular impression fractures of the distal tibia.