Tibial Plateau Fractures Schatzker Type II–III Treated With Impacted Bone Allograft or Rafting Technique: Is Filling the Void Necessary? A Comparative Cohort Study of 80 Patients
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Published:
Dec 27, 2025
Keywords:
Tibial plateau fracture, tibial plateau depression, rafting technique, bone allograft
Main Article Content
Abstract
Introduction: Schatzker type II and III tibial plateau fractures require techniques that stabilize and maintain the articular surface. The objective of this study was to compare the use of impacted bone allograft and the rafting technique, evaluating secondary dis-placement and postoperative function.
Materials and Methods: We conducted a retrospective, comparative review of all patients with Schatzker type II and III tibial plateau fractures consecutively treated between January 2015 and December 2020 using either the rafting technique (RT) or impacted bone graft (IBG). Loss of articular reduction (defined as >2 mm of secondary depression) was assessed, along with clinical and radiographic outcomes using the Rasmussen score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
Results: Eighty patients were included: 39 treated with RT and 41 with IBG. Two pa-tients in each group experienced loss of articular reduction during follow-up. The Rasmussen clinical score was excellent or good in 93.75% of the series, with no significant differences between groups; likewise, no significant differences were found in the WOMAC score. The radiological Rasmussen score was excellent or very good in 96.25% of patients, again with no differences between groups.
Conclusion: The results suggest comparable performance between impacted bone allograft and the rafting technique in maintaining reduction and achieving functional outcomes in Schatzker type II -III tibial plateau fractures.
Materials and Methods: We conducted a retrospective, comparative review of all patients with Schatzker type II and III tibial plateau fractures consecutively treated between January 2015 and December 2020 using either the rafting technique (RT) or impacted bone graft (IBG). Loss of articular reduction (defined as >2 mm of secondary depression) was assessed, along with clinical and radiographic outcomes using the Rasmussen score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
Results: Eighty patients were included: 39 treated with RT and 41 with IBG. Two pa-tients in each group experienced loss of articular reduction during follow-up. The Rasmussen clinical score was excellent or good in 93.75% of the series, with no significant differences between groups; likewise, no significant differences were found in the WOMAC score. The radiological Rasmussen score was excellent or very good in 96.25% of patients, again with no differences between groups.
Conclusion: The results suggest comparable performance between impacted bone allograft and the rafting technique in maintaining reduction and achieving functional outcomes in Schatzker type II -III tibial plateau fractures.
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Pereira , S., Garabano , G., Juri, A., Pérez Alamino , L., Rodríguez, J., Pesciallo , C. A., & Bidolegui , F. (2025). Tibial Plateau Fractures Schatzker Type II–III Treated With Impacted Bone Allograft or Rafting Technique: Is Filling the Void Necessary? A Comparative Cohort Study of 80 Patients. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(6), 530-537. https://doi.org/10.15417/issn.1852-7434.2025.90.6.2213
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Clinical Research
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References
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13. Segur JM, Torner P, García S, Combalía A, Suso S, Ramón R. Use of bone allograft in tibial plateau fractures. Arch Orthop Trauma Surg 1998;117(6-7):357-9. https://doi.org/10.1007/s004020050265
14. Lasanianos N, Mouzopoulos G, Garnavos C. The use of freeze-dried cancellous allograft in the management of impacted tibial plateau fractures. Injury 2008;39(10):1106-12. https://doi.org/10.1016/j.injury.2008.04.005
15. Kulkarni SG, Tangirala R, Malve SP, Kulkarni MG, Kulkarni VS, Kulkarni RM, et al. Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: a biomechanical study. J Orthop Surg (Hong Kong) 2015;23(3):331-5. https://doi.org/10.1177/230949901502300315
16. Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am 1973;55(7):1331-50. PMID: 4586086
17. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988;15(12):1833-40. PMID: 3068365
18. Giannoudis PV, Tzioupis C, Papathanassopoulos A, Obakponovwe O, Roberts C. Articular step-off and risk of post-traumatic osteoarthritis. Evidence today. Injury 2010;41(10):986-95. https://doi.org/10.1016/j.injury.2010.08.003
19. Singleton N, Sahakian V, Muir D. Outcome after tibial plateau fracture: how important is restoration of articular congruity? J Orthop Trauma 2017;31(3):158-63. https://doi.org/10.1097/BOT.0000000000000762
20. Parkkinen M, Lindahl J, Mäkinen TJ, Koskinen SK, Mustonen A, Madanat R. Predictors of osteoarthritis following operative treatment of medial tibial plateau fractures. Injury 2018;49(2):370-5. https://doi.org/10.1016/j.injury.2017.11.014
21. Cross WW 3rd, Levy BA, Morgan JA, Armitage BM, Cole PA. Periarticular raft constructs and fracture stability in split-depression tibial plateau fractures. Injury 2013;44(6):796-801. https://doi.org/10. 1016/j.injury.2012.12.028
22. Ye X, Huang D, Perriman DM, Smith PN. Influence of screw to joint distance on articular subsidence in tibial-plateau fractures. ANZ J Surg 2019;89(4):320-4. https://doi.org/10.1111/ans.14978
23. Weimann A, Heinkele T, Herbort M, Schliemann B, Petersen W, Raschke MJ. Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: a biomechanical study. BMC Musculoskelet Disord 2013;14(1):120. https://doi.org/10.1186/1471- 2474-14-120
24. Sun H, Zhu Y, He QF, Shu LY, Zhang W, Chai YM. Reinforcement strategy for lateral rafting plate fixation in posterolateral column fractures of the tibial plateau: the magic screw technique. Injury 2017;48(12):2814-26. https://doi.org/10.1016/j.injury.2017.10.033
25. Giordano V, Pires RE, Kojima KE, Fischer ST, Giannoudis PV. Subchondral rafting plate for the treatment of fragmented articular central depression tibial plateau fracture patterns: Case series and technical illustration. Cureus 2021;3(1):e12740. https://doi.org/10.7759/cureus.12740
26. Vauclair F, Almasri M, Gallusser N, van Lanker H, Reindl R. Metaphyseal tibial level (MTL) screws: a modified percutaneous technique for lateral plateau depression fractures. Eur J Orthop Surg Traumatol 2015;25(5):963-7. https://doi.org/10.1007/s00590-015-1639-9
27. Kulkarni SG, Tangirala R, Malve SP, Kulkarni MG, KulkarniVS, Kulkarni RM, et al. Use of a raft construct through a locking plate without bone grafting for split-depression tibial plateau fractures. J Orthop Surg (Hong Kong) 2015;23(3):331-5. https://doi.org/10.1177/230949901502300315
2. Karunakar MA, Egol KA, Peindl R, Harrow ME, Bosse MJ, Kellam JF. Split depression tibial plateau fractures: a biomechanical study. J Orthop Trauma 2002;16:172-7. https://doi.org/10.1097/00005131-200203000-00006
3. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res 1979;(138):94-104. PMID: 445923
4. Pountos I, Giannoudis PV. Articular impaction injuries in the lower limb. EFORT Open Rev 2017;2(5):250-60. https://doi.org/10.1302/2058-5241.2.160072
5. Larsson S, Hannink G. Injectable bone-graft substitutes: current products, their characteristics and indications, and new developments. Injury 2011;42(Suppl 2):S30-4. https://doi.org/10.1016/j.injury.2011.06.013
6. Veitch SW, Stroud RM, Toms AD. Compaction bone grafting in tibial plateau fracture fixation. J Trauma 2010;68:980-3. https://doi.org/10.1097/TA.0b013e3181b16e3d
7. Kurz LT, Garfin SR, Booth RE Jr. Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine (Phila Pa 1976) 1989;14:1324-31. https://doi.org/10.1097/00007632-198912000-00009
8. Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA. Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res 1996;(329):300-9. https://doi.org/10.1097/00003086-199608000-00037
9. Springfield DS. Autogenous bone grafts: nonvascular and vascular. Orthopaedics 1992;15(10):1237-41. https://doi.org/10.3928/0147-7447-19921001-14
10. Fowler BL, Dall BE, Rowe DE. Complications associated with harvesting autogenous iliac bone graft. Am J Orthop (Belle Mead NJ) 1995;24(12):895-903. PMID: 8776079
11. Finkemeier CG. Bone-grafting and bone-graft substitutes. J Bone Joint Surg Am 2002;84(3):454-64. https://doi.org/10.2106/00004623-200203000-00020
12. Moore WR, Graves SE, Bain GI. Synthetic bone graft substitutes. ANZ J Surg 2001;71(6):354-61. PMID: 11409021
13. Segur JM, Torner P, García S, Combalía A, Suso S, Ramón R. Use of bone allograft in tibial plateau fractures. Arch Orthop Trauma Surg 1998;117(6-7):357-9. https://doi.org/10.1007/s004020050265
14. Lasanianos N, Mouzopoulos G, Garnavos C. The use of freeze-dried cancellous allograft in the management of impacted tibial plateau fractures. Injury 2008;39(10):1106-12. https://doi.org/10.1016/j.injury.2008.04.005
15. Kulkarni SG, Tangirala R, Malve SP, Kulkarni MG, Kulkarni VS, Kulkarni RM, et al. Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: a biomechanical study. J Orthop Surg (Hong Kong) 2015;23(3):331-5. https://doi.org/10.1177/230949901502300315
16. Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am 1973;55(7):1331-50. PMID: 4586086
17. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988;15(12):1833-40. PMID: 3068365
18. Giannoudis PV, Tzioupis C, Papathanassopoulos A, Obakponovwe O, Roberts C. Articular step-off and risk of post-traumatic osteoarthritis. Evidence today. Injury 2010;41(10):986-95. https://doi.org/10.1016/j.injury.2010.08.003
19. Singleton N, Sahakian V, Muir D. Outcome after tibial plateau fracture: how important is restoration of articular congruity? J Orthop Trauma 2017;31(3):158-63. https://doi.org/10.1097/BOT.0000000000000762
20. Parkkinen M, Lindahl J, Mäkinen TJ, Koskinen SK, Mustonen A, Madanat R. Predictors of osteoarthritis following operative treatment of medial tibial plateau fractures. Injury 2018;49(2):370-5. https://doi.org/10.1016/j.injury.2017.11.014
21. Cross WW 3rd, Levy BA, Morgan JA, Armitage BM, Cole PA. Periarticular raft constructs and fracture stability in split-depression tibial plateau fractures. Injury 2013;44(6):796-801. https://doi.org/10. 1016/j.injury.2012.12.028
22. Ye X, Huang D, Perriman DM, Smith PN. Influence of screw to joint distance on articular subsidence in tibial-plateau fractures. ANZ J Surg 2019;89(4):320-4. https://doi.org/10.1111/ans.14978
23. Weimann A, Heinkele T, Herbort M, Schliemann B, Petersen W, Raschke MJ. Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: a biomechanical study. BMC Musculoskelet Disord 2013;14(1):120. https://doi.org/10.1186/1471- 2474-14-120
24. Sun H, Zhu Y, He QF, Shu LY, Zhang W, Chai YM. Reinforcement strategy for lateral rafting plate fixation in posterolateral column fractures of the tibial plateau: the magic screw technique. Injury 2017;48(12):2814-26. https://doi.org/10.1016/j.injury.2017.10.033
25. Giordano V, Pires RE, Kojima KE, Fischer ST, Giannoudis PV. Subchondral rafting plate for the treatment of fragmented articular central depression tibial plateau fracture patterns: Case series and technical illustration. Cureus 2021;3(1):e12740. https://doi.org/10.7759/cureus.12740
26. Vauclair F, Almasri M, Gallusser N, van Lanker H, Reindl R. Metaphyseal tibial level (MTL) screws: a modified percutaneous technique for lateral plateau depression fractures. Eur J Orthop Surg Traumatol 2015;25(5):963-7. https://doi.org/10.1007/s00590-015-1639-9
27. Kulkarni SG, Tangirala R, Malve SP, Kulkarni MG, KulkarniVS, Kulkarni RM, et al. Use of a raft construct through a locking plate without bone grafting for split-depression tibial plateau fractures. J Orthop Surg (Hong Kong) 2015;23(3):331-5. https://doi.org/10.1177/230949901502300315