This Level I RCT from 20 German trauma centers compared autologous iliac crest bone graft to a bioresorbable calcium sulfate/hydroxyapatite cement (CBVF) for filling metaphyseal defects after ORIF of tibial plateau fractures. The study asked whether synthetic bone substitute could match autograft on patient-reported function, pain, and radiographic healing at 26 weeks — without the morbidity of a donor-site harvest.
Iliac crest autograft has long been the reflex choice for tibial plateau metaphyseal defects, but its donor-site morbidity is substantial and often underappreciated — up to 39% of patients in some series experience harvest-site pain, hematoma, infection, or nerve injury.
This trial gives you permission to reach for synthetic bone substitute in OTA/AO 41-B2 and 41-B3 fractures without sacrificing outcomes. When you reduce a split-depression tibial plateau fracture and need to fill the metaphyseal void, a bioresorbable calcium sulfate/hydroxyapatite cement delivers equivalent function, equivalent bone healing, and less perioperative pain than autograft.
Apply this practically: in a healthy working-age patient with an isolated Schatzker II or III fracture, CBVF is a legitimate first-line choice. Reserve autograft for situations where synthetic substitutes are contraindicated or unavailable.
One important caveat: follow-up here is only 26 weeks. Whether synthetic remodeling holds up against autograft over years. Particularly in heavier patients or those with articular incongruity. Remains unanswered by this data.
This Level I RCT from 20 German trauma centers compared autologous iliac crest bone graft to a bioresorbable calcium sulfate/hydroxyapatite cement (CBVF) for filling metaphyseal defects after ORIF of tibial plateau fractures. The study asked whether synthetic bone substitute could match autograft on patient-reported function, pain, and radiographic healing at 26 weeks — without the morbidity of a donor-site harvest.
Iliac crest autograft has long been the reflex choice for tibial plateau metaphyseal defects, but its donor-site morbidity is substantial and often underappreciated — up to 39% of patients in some series experience harvest-site pain, hematoma, infection, or nerve injury.
This trial gives you permission to reach for synthetic bone substitute in OTA/AO 41-B2 and 41-B3 fractures without sacrificing outcomes. When you reduce a split-depression tibial plateau fracture and need to fill the metaphyseal void, a bioresorbable calcium sulfate/hydroxyapatite cement delivers equivalent function, equivalent bone healing, and less perioperative pain than autograft.
Apply this practically: in a healthy working-age patient with an isolated Schatzker II or III fracture, CBVF is a legitimate first-line choice. Reserve autograft for situations where synthetic substitutes are contraindicated or unavailable.
One important caveat: follow-up here is only 26 weeks. Whether synthetic remodeling holds up against autograft over years. Particularly in heavier patients or those with articular incongruity. Remains unanswered by this data.