1. Tibial plateau fracture and calcium phosphate
Case for small group discussion
Michael Verhofstad, NL
Learning objectives
Rationale for osteosynthesis of tibia plateau fracture
When and how biomaterials might support osteosynthesis
What calcium phosphate can do and what not
AO Trauma Advanced Principles Course

2. Case description 52-year-old, healthy woman
Valgus knee injury during bowling
Further imaging?

3. Discuss and classify injury
Classification?

4. AO-type 41-B2, Schatzker III
Discuss treatment options and planning of operation:
Positioning
Tourniquet
Surgical exposure
Reduction and maintaining reduction
Type of fixation and implant
Addition of structural support: Option of calcium phosphate
reduce → fix → fill (e.g. Norian)
reduce → fill → fix (e.g. Norian drillable) 4

5. Surgical technique Discussion points: Patient positioning
Approach (lateral curved, open joint)
Reduction technique (direct reduction, clamp, K-wires)
Implant (small fragment buttress plate, locking head screws)
Angular stability
Graft indication, material

6. Follow-up Discussion points: CPM (continuous passive motion)
Weight bearing
Physical therapy
Postop imaging

7. Follow-up at 6 weeks
Discuss additional diagnostics

8. Follow-up at 3 months Discussion points: Further treatment
Clinical testing ROM and stability
Activity
Arthroscopy?

9. Follow-up at 6 months Clinical result:
No significant functional impairment
ROM extension flexion 5/0/140°
Stable knee joint
Discussion points:
Oblique x-rays
Residual pain
Cartilage status

10. Take-home message Depressed joint surfaces need support.
Beside bone graft, calcium phosphate is an option and might enhance primary construct stability.
Stability of joint is improved with angular stable devices.
Postoperative management includes continuous passive motion (CPM) and active motion.
Moderator should ask participants to summarize what else they have learned from this case. 10