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Cancellous allograft bone chips
7%
74/1016
Autograft iliac crest
16%
167/1016
Femoral intramedullary reamings
2%
25/1016
Calcium phosphate cement
68%
688/1016
Calcium sulfate cement
6%
58/1016
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Figures A and B show a plateau fracture with a lateral split and depression of the articular surface. In treating tibial plateau fractures, calcium phosphate has been shown to have the least amount of articular subsidence on follow-up examinations due to its high compressive strength. The study by Lobenhoffer et al noted improved radiographic outcomes and earlier weightbearing with usage of calcium phosphate cement. Welch and Zhang reproduced tibial plateau fractures in goats and compared cancellous autograft to calcium phosphate cement augmentation. At 24 hours, four of five specimens treated with autograft had subsidence of the fragment. Only two specimens from limbs treated with cement showed minimal subsidence; the remaining were congruent. Yetkinler’s study compared cement to no cement treatment in a model of depressed plateau fractures. Calcium phosphate cement of high compressive strength provided equivalent or better stability than conventional open reduction and internal fixation with either auto/allograft bone which had both a lower compressive strength and reduced mechanical stability.
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