- FDA committee recommends approval of OraSure's in-home HIV test
- FDA to review Achillion's HCV drug on fast track basis
- FDA unclear on link between Novartis' MS drug Gilenya, patient deaths
- Stiefel's Fabior foam approved for treating acne
- Ohr Pharmaceutical wins fast track designation for wet AMD product candidate
- Private FFS MA plans may be linked with higher costs for beneficiaries, GAO report shows
- Pediatric subspecialty telephone consultations may be cost-saving for Medicaid, research reveals
- Use of mental health services greater in health plans with parity in cost sharing, data find
- Public opinions appear split on health care affordability, satisfaction, survey finds
- In Brief: California Supreme Court
Alpha-BSM may better prevent articular subsidence than autogenous iliac bone graft following treatment of subarticular defects associated with unstable tibial plateau fracture
Thursday, October 16 2008 | Comments
What's This?
Alpha-BSM, a bioresorbable calcium phosphate cement, shows comparable outcomes with autogenous iliac bone graft for the treatment of subarticular defects associated with unstable tibial plateau fractures; alpha-BSM also appears to better prevent articular subsidence than the bone graft, new research suggests. In the prospective trial, researchers evaluated 119 adult patients with 120 acute, closed, unstable tibial plateau fractures. Patients were randomly assigned at the time of surgery to treatment with either alpha-BSM (n=82 fractures) or to autogenous iliac bone graft (n=38 fractures).
Plate-and-screw fixation (n=109) or screws only (n=9) were applied to the fracture. Following open reduction of the articular fracture, the residual defect was measured and packed with either the alpha-BSM or the bone graft. Follow-up assessment included evaluation of union, subsidence, loss or premature resorption of the graft, infection, and functional recovery.
Data were available at the 12-month follow-up for 63 fractures in the alpha-BSM group and for 26 fractures in the autogenous bone graft group. Radiographs made from 12 to 48 months provided data on 102 fractures in 101 patients (alpha-BSM, n=69; bone graft, n=33). Final radiographic material was evaluated by a blinded, 3-person panel.
Fractures united at the same rate (an average of 3-months) in both groups. Dissolution did not occur in either the bone graft or the alpha-BSM groups prior to the fracture union. One varus malunion occurred in each group (both in the 5 degrees to 10 degrees range), and no patient in either group experienced a loss of internal fixation constructs.
Although the researchers expected equivalent subsidence in both groups, they found a significantly higher rate of articular subsidence in the autogenous bone-graft group than in the alpha-BSM group at the 12-month or longer follow-up (P=.009). Subsidence of at least 2 mm was noted on anteroposterior radiographs in 10 of the 33 fractures in the autogenous group (30%) and in 6 of the 69 fractures in the alpha-BSM group (9%). The subsidence occurred between 3 and 6 months following the surgery.
"The results of this study indicate that alpha-BSM can provide similar and possibly better mechanical support than autogenous iliac bone graft in the treatment of defects in unstable fractures of the tibial plateau," the researchers concluded. (Russell TA, et al. J Bone Joint Surg Am 2008;90:2057-2061.)
Comments
Be the first to write a comment for this article!
You must be logged in to post a comment.
- White blood cell count in presence of elevated ESR, CRP level predicts infection status in patients undergoing total hip arthroplasty, researchers report
- Laminar airflow ventilation during orthopedic, abdominal procedures does not prevent surgical site infections, study suggests
- Interposition elbow arthroplasty with Achilles tendon allograft may be effective salvage treatment for elbow arthritis, data indicate
- Arthroscopic acromioplasty may provide better long-term outcomes than open acromioplasty for chronic shoulder impingement syndrome
- Instrument breakage during orthopedic surgeries infrequent, poses low risk to patient
- Interposition elbow arthroplasty with Achilles tendon allograft may be effective salvage treatment for elbow arthritis, data indicate
- White blood cell count in presence of elevated ESR, CRP level predicts infection status in patients undergoing total hip arthroplasty, researchers report
- Health-related quality of life may be reduced in veterans who have undergone total knee arthroplasty, total hip arthroplasty, researchers suggest
- Laminar airflow ventilation during orthopedic, abdominal procedures does not prevent surgical site infections, study suggests
- Active management role by orthopaedic surgeons improves osteoporosis treatment following hip fracture, study shows
