Managing subchondral bone defects during surgical treatment of depressed tibial plateau fractures

The optimal strategy for managing subchondral cancellous bone defects after elevation of the articular surface during treatment of depressed tibial plateau fractures remains controversial.

Current literature suggests that certain synthetic bone void fillers are superior to autologous bone grafting in preventing articular subsidence due to a higher compressive strength. Allograft bone has been advocated as an alternative to autologous bone grafting and synthetic bone void fillers for these defects, but a direct comparison of these various methods has not been performed. The choice of bone void filler has both clinical and economic ramifications that merit further study.

 The primary purpose of this survey is to analyze contemporary trends in management of subchondral bone defects in depressed tibial plateau fractures amongst orthopaedic traumatologists. Additionally, this survey is designed to identify patient, fracture, and surgeon related factors that may influence the choice of bone void filler used. We believe the results of this survey will be useful in identifying important variables that influence the choice of bone void filler which in turn will be used to guide the development of prospective trials designed to identify the optimal bone void filler based on patient and fracture characteristics.  

 

* 1. Do you use any form of bone void filler to support the articular surface during treatment of a depressed tibial plateau fracture?

* 2. If you answered "it depends" on question 1, what factor(s) influence your decision to use a bone void filler?

* 3. My default bone void filler is:

* 4. Patient related social factors that influence your decision to change from your default type of bone void filler to a different one include:

* 5. How do these patient social factors influence what you use?

* 6. Patient medical comorbidities that influence your decision to change from your default type of bone void filler to another type include:

* 7. How do these patient comorbidities influence what you use?

* 8. Does the maximum amount of depression measured on CT scan influence your decision to change from your default bone void filler to a different type?

* 9. How does maximum articular depression influence what you use?

* 10. Does the % of depressed articular surface of the involved condyle influence your decision to change from your default bone void filler to a different type?

* 11. How does percentage of articular surface depression influence what you use?

* 12. Does the number of depressed articular fragments influence your decision to change from your default bone void filler to a different type?

* 13. How does the number of articular fragments influence what you use?

* 14. Does your perception of the patient's bone quality influence your decision to change your default bone void filler to a different type?

* 15. How does perceived bone quality influence what you use?

* 16. Does patient age influence your decision to change from your default bone void filler to a different type?

* 17. How does patient age influence what you use?

* 18. Did you do an orthopaedic trauma fellowship?

* 19. What is your practice setting?

* 20. What is the trauma designation of your hospital?

* 21. How many years into practice are you?

* 22. What is your gender?

* 23. What is your geographic location?

* 24. If within the US, what is your region?

* 25. Is your primary choice of bone void filler based primarily on:

* 26. Do you think increased wound drainage is a true risk when using synthetic bone fillers as compared to none or bone graft?

* 27. What is your perceived cost of synthetic bone void filler compared to allograft bone chips?

* 28. What are the top 3 factors influencing your decision to either use a bone void filler vs not OR to change from your default bone void filler?

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