I’m scheduled for surgery in two days to repair a fractured tibial plateau. There’s a pretty big hole in the bone they won’t be able to fix without a graft. I may have a choice between taking bone from my hip and using a special powder substitute. I’m doing a quick Internet search to see which is better. What can you tell me?

The tibial plateau is the flat top of the upper portion of the tibia (lower leg bone). This type of fracture was once called a bumper or fender fracture. During a car accident (fender bender), force directed from the femur (thigh bone) down onto the tibial plateau, results in fracture of the plateau. Car accidents aren’t the only way this type of injury occurs. Falls, industrial accidents, and getting hit by a car as a pedestrian are also possible ways to sustain a tibial plateau fracture.

Surgery to repair unstable fractures is usually done by open reduction and internal fixation (ORIF) using a plate and screws. Bone graft material is used whenever there’s a need for extra bone to support a fracture site or defect in the bone. It’s easily available (taken from the patient’s pelvic bone) and inexpensive. And it is bone inductive (fosters bone growth) to provide structural support to the damaged area.

The downside is that the graft site can be painful for a very long time. In some cases, infection can delay recovery. Patients often report difficulty walking due to the pain. And the combination of pain and impaired walking result in loss of function.

To avoid the major and minor complications of bone graft, scientists are exploring the use of bone substitutes. At the present time, bone graft is considered more risky with a greater chance of complications compared with bone substitutes. But bone substitutes are still considered somewhat experimental.

Studies so far have shown that there is a higher rate of subsidence in the bone graft group. Subsidence refers to the sinking or collapse of bone into itself. Bone substitute is an acceptable replacement for bone graft material. It may be a better choice. It is stiffer, offers more support, and holds up better under load compared with autogenous bone graft. There is also less sideways shifting or subsidence of the healing bone with this type of bone substitute.

Talk to your surgeon about this decision. He or she may have some additional thoughts or comments. It’s always wise to go with whatever the surgeon is most comfortable or more experienced with. The main goal is to use a graft material that will prevent collapse of the joint surface and underlying bone.