Fixation of tibial plateau fractures with synthetic bone graft versus natural bone graft: a comparison study.

PURPOSE: The goal of this study was to determine differences in fracture stability and functional outcome between synthetic bone graft and natural bone graft with internal fixation of tibia plateau metaphyseal defects. METHODS: Hydroxyapatite calcium carbonate synthetic bone graft was utilised in 14 patients (six males and eight females). Allograft/autograft were utilised in the remaining 10 patients (six males and four females). All the 24 patients had clinical, radiological and subjective functional score assessments. RESULTS: There was no significant statistical difference between the groups for post-operative articular reduction, long-term subsidence, and WOMAC scores. The degree of subsidence was not related to age or fracture severity. Maintenance of knee flexion was found to be better in the allograft/autograft group (p = 0.048) when compared between the groups. Multivariate analysis compared graft type, fracture severity, post-operative reduction, subsidence rate, range of movement and WOMAC score. The only finding was a statistical significant association with the graft type related to the 6-month range of movement figures. CONCLUSIONS: Use of autologous or allogenic bone graft allows better recovery of long-term flexion, possibly due to reduced inflammatory response compared with synthetic bone composites. However, all other parameters, such as maintenance of joint reduction and subjective outcome measures were comparable with the use of hydroxyapatite calcium carbonate bone graft. This study shows that synthetic bone graft may be a suitable alternative in fixation of unstable tibia plateau fractures, avoiding risk of disease transmission with allograft and donor site morbidity associated with autograft.

Pressure ulcers of the popliteal fossae caused by thromboembolic deterrent stockings (TEDS).

INTRODUCTION: Thromboembolic deterrent (TED) stockings are commonly used in the prevention of deep venous thrombosis. We would like to highlight a potential complication associated with the use of TED stocking. A 42-year-old paraplegic gentleman suffering from a complicated Ischial ulcer was admitted for debridement and closure with a fasciocutaneous rotational flap. Two weeks later, new pressure sores of the popliteal fossae of both his legs had developed. Clinical assessment revealed linear pressure sores in the presence of poorly fitted, tight, thigh-length TED stockings, which had rolled up at the popliteal fossa creating a focal linear compression in the presence of bilateral spastic flexed knees in this paraplegic patient. The TED stockings were immediately discontinued and the pressure sores were managed with regular wound care and dressing change. CONCLUSION: We would like to highlight the complications that could arise amongst paraplegic patients with the widespread use of TED stockings.