Osseous vitality in single photon emission computed tomography/computed tomography (SPECT/CT) after balloon tibioplasty of the tibial plateau: a case series

BackgroundThe minimally invasive, balloon-assisted reduction and cement-augmented internal fixation of the tibial plateau is an innovative surgical procedure for tibial plateau fractures. The close proximity of balloons and cement to the knee joint poses a potential risk for osteonecrosis; especially in the case of thin bone lamellae. However, there are no studies about the vitality of the cement-surrounding tissue after these tibioplasties. Therefore, our goal was to assess the osseous vitality after cement-augmented balloon tibioplasty using single photon emission computed tomography/computed tomography (SPECT/CT) in a series of patients.MethodsThis case series evaluated available consecutive patients, whose tibial plateau fractures were treated with balloon-assisted, cement-augmented tibioplasty and received a SPECT/CT. Primary outcome variables were osseous vitality on SPECT/CTs according to the semiquantitative tracer activity analysis. The mean uptake of eight tibial regions of interest was referenced to the mean uptake count on the same region of the contralateral leg to obtain a count ratio. Osteonecrosis was defined as a photopenic area or cold defect. Secondary variables included clinical and radiological follow-up data. Statistics were carried out in a descriptive pattern.ResultsTen patients with a mean age of 59 years and a mean follow up of 18 months were included. Calcium phosphate (CaP) substitute bone cement was used in 60 % and polymethyl methacrylate mixed with hydroxyapatite (PMMA/HA) bone cement in 40 %. Normal to high SPECT/CT activity without photopenic areas were observed in all patients and the mean tracer activity ratio was four, indicating vital bone in all patients. There were no postoperative infections and only one 57 year old patient with hemineglect and CaP cement showed failed osseous consolidation. The mean Tegner and Lysholm as well as the Lysholm scores were three and 80, respectively.ConclusionsThis novel study about cement-augmented balloon tibioplasties showed that osseous vitality remains intact according to SPECT/CT analysis; irrespective of the type of cement and even in the presence of thin bone lamellae. This procedure was safe and well-suited for lateral tibial plateau fractures in particular. Surgeons may consider using PMMA/HA bone cement for void filling in elderly fracture patients without concern about bone viability.

[1]  T. Higgins,et al.  Incidence and Morphology of the Posteromedial Fragment in Bicondylar Tibial Plateau Fractures , 2009, Journal of orthopaedic trauma.

[2]  Vincenzo Giordano,et al.  Epidemiological study on tibial plateau fractures at a level I trauma center , 2013, Acta ortopedica brasileira.

[3]  C. Krettek,et al.  Versorgung von bikondylären Tibiakopf-Frakturen mit einem unilateral platzierten winkelstabilen Plattensystem , 2007, Der Unfallchirurg.

[4]  Gamal Baroud,et al.  Setting properties of four acrylic and two calcium-phosphate cements used in vertebroplasty. , 2006, Journal of long-term effects of medical implants.

[5]  Michael T. Hirschmann,et al.  A novel standardized algorithm for evaluating patients with painful total knee arthroplasty using combined single photon emission tomography and conventional computerized tomography , 2010, Knee Surgery, Sports Traumatology, Arthroscopy.

[6]  S Ted Treves,et al.  The value of SPECT in the detection of stress injury to the pars interarticularis in patients with low back pain , 2010, Journal of orthopaedic surgery and research.

[7]  E. Rutherford,et al.  Lumbar spine fusion and stabilization: hardware, techniques, and imaging appearances. , 2007, Radiographics : a review publication of the Radiological Society of North America, Inc.

[8]  N S Eftekhar.  Osteolysis caused by polymethylmethacrylate (PMMA). , 1994, Instructional course lectures.

[9]  John A Jansen,et al.  Bone cements and their potential use in a mandibular endoprosthesis. , 2009, Tissue engineering. Part B, Reviews.

[10]  F Biggi,et al.  Tibial plateau fractures: internal fixation with locking plates and the MIPO technique. , 2010, Injury.

[11]  Martin Law,et al.  Characteristic Uptake Pattern of Bone Scintigraphy in Patients with Hepatocellular Carcinoma Following Treatment with High-Intensity Focused Ultrasound , 2013, Nuclear Medicine and Molecular Imaging.

[12]  Douglas Wardlaw,et al.  Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial , 2009, The Lancet.

[13]  Satoshi Hamai,et al.  Scintigraphic assessments of the reparative process in osteonecrosis of the femoral head using SPECT/CT with 99mTc hydroxymethylene diphosphonate , 2014, Nuclear medicine communications.

[14]  J. Lysholm,et al.  Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale , 1982, The American journal of sports medicine.

[15]  R. McBroom,et al.  The tibial plateau fracture. The Toronto experience 1968--1975. , 1979, Clinical orthopaedics and related research.

[16]  Patrick Veit-Haibach,et al.  The clinical rehabilitation of spine and spinal cord disorders: detection and evaluation using SPECT/CT , 2014, Neural regeneration research.

[17]  C.M.L. Werner,et al.  Minimal-invasive, ballonassistierte Aufrichtung und innere Fixation von Tibiaplateaufrakturen , 2012, Der Unfallchirurg.

[18]  R. Wiesmann,et al.  SPECT/CT arthrography of the knee , 2012, European Journal of Nuclear Medicine and Molecular Imaging.

[19]  C Krettek,et al.  Single Lateral Locked Screw Plating of Bicondylar Tibial Plateau Fractures , 2005, Clinical orthopaedics and related research.

[20]  D. S. Evangelopoulos,et al.  Percutaneous cement augmentation for the treatment of depression fractures of the tibial plateau , 2009, Knee Surgery, Sports Traumatology, Arthroscopy.

[21]  S. Scharf,et al.  Bone SPECT/CT in skeletal trauma. , 2015, Seminars in nuclear medicine.

[22]  F. Signorelli,et al.  Explicative Cases of Controversial Issues in Neurosurgery , 2012 .

[23]  J. Lysholm,et al.  Rating systems in the evaluation of knee ligament injuries. , 1985, Clinical orthopaedics and related research.

[24]  Paul Thorpe,et al.  In Vivo Temperature Profile of Intervertebral Discs and Vertebral Endplates During Vertebroplasty: An Experimental Study in Sheep , 2006, Spine.

[25]  M. Scheyerer,et al.  [Minimally invasive balloon-assisted reduction and internal fixation of tibial plateau fractures]. , 2012, Der Unfallchirurg.

[26]  Patrick Veit-Haibach,et al.  SPECT, CT and MR: Integration in Degenerative Musculoskeletal Diseases , 2013 .

[27]  Jose Morey,et al.  The bone scan. , 2012, Seminars in nuclear medicine.

[28]  Yi-Sheng Chan,et al.  Arthroscopic evaluation of soft tissue injuries in tibial plateau fractures: retrospective analysis of 98 cases. , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[29]  C Krettek,et al.  [Management of bicondylar fractures of the tibial plateau with unilateral fixed-angle plate fixation]. , 2007, Der Unfallchirurg.

[30]  K. Kuehn,et al.  Acrylic bone cements: composition and properties. , 2005, The Orthopedic clinics of North America.

[31]  Radek Hart,et al.  SPECT scan is a reliable tool for selection of patients undergoing unicompartmental knee arthroplasty , 2008, Archives of Orthopaedic and Trauma Surgery.

[32]  S. Belkoff,et al.  Temperature elevation caused by bone cement polymerization during vertebroplasty. , 1999, Bone.

[33]  Florian Gebhard,et al.  Minimally invasive and open surgical treatment of proximal tibia fractures using a polyaxial locking plate system: a prospective multi-centre study , 2013, International Orthopaedics.

[34]  Changsheng Liu,et al.  The exothermal behavior in the hydration process of calcium phosphate cement. , 2003, Biomaterials.

[35]  Tim Pohlemann,et al.  Balloon Tibioplasty: A Useful Tool for Reduction of Tibial Plateau Depression Fractures , 2012, Journal of orthopaedic trauma.

[36]  H.-P. Meinzer,et al.  Osseous integration of calcium phosphate in osteoporotic vertebral fractures after kyphoplasty: initial results from a clinical and experimental pilot study , 2006, Osteoporosis International.

[37]  Tae-Hong Lim,et al.  Vertebroplasty comparing injectable calcium phosphate cement compared with polymethylmethacrylate in a unique canine vertebral body large defect model. , 2008, The spine journal : official journal of the North American Spine Society.

[38]  M. A. Glasby,et al.  AN EXPERIMENTAL STUDY IN SHEEP , 1994 .

[39]  Sean Molloy,et al.  Temperature Measurement During Polymerization of Polymethylmethacrylate Cement Used for Vertebroplasty , 2003, Spine.

[40]  Cx Fang,et al.  Tibia Plateau Fractures , 2017 .

[41]  Patrick Veit-Haibach,et al.  Evaluation of pelvic ring injuries using SPECT/CT , 2015, Skeletal Radiology.

[42]  Esko Vanninen,et al.  Bone mineral density and single photon emission computed tomography changes after total knee arthroplasty: a 2‐year follow‐up study , 2008, Clinical physiology and functional imaging.

[43]  Thomas W Bauer,et al.  Histologic Evaluation of Human Vertebral Bodies After Vertebral Augmentation With Polymethyl Methacrylate , 2003, Spine.

[44]  Thomas Mendel,et al.  Temperature evaluation during PMMA screw augmentation in osteoporotic bone--an in vitro study about the risk of thermal necrosis in human femoral heads. , 2009, Journal of biomedical materials research. Part B, Applied biomaterials.

[45]  J CHARNLEY,et al.  Anchorage of the femoral head prosthesis to the shaft of the femur. , 1960, The Journal of bone and joint surgery. British volume.

[46]  Cyril Mauffrey,et al.  Inflation osteoplasty: in vitro evaluation of a new technique for reducing depressed intra-articular fractures of the tibial plateau and distal radius , 2012, Journal of Orthopaedics and Traumatology.