Visualized Precise Minimally Invasive Local Bone Cement Injection and Traditional Conservative Treatment for Tibial Plateau Bone Contusion

Author(s): Shuai Zheng, Liu Jiaqi

This retrospective study compared the efficacy of image-guided local bone cement injection and traditional conservative treatment for tibial plateau bone contusion. A total of 72 patients from the Sixth Affiliated Hospital of Jinan University from May 2020 to May 2024 were selected. The intervention group included 38 patients who underwent C-arm fluoroscopy-guided bone cement injection (assessed by DR and MRI before the operation), while the control group consisted of 34 patients who received conservative treatment with physical therapy and anti-inflammatory drugs. All patients were followed up for 11 to 13 months. The results showed that the bone cement distribution in the intervention group was precise and uniform. The HSS knee score significantly increased from 55.93 ± 3.63 to 90.31 ± 2.69, and the VAS pain score decreased from 7.48 ± 1.06 to 1.07 ± 0.53. In the control group, the improvement was milder, with the HSS score rising from 58.92 ± 2.29 to 77.36 ± 4.56 and the VAS score dropping from 7.63 ± 1.32 to 4.94 ± 0.95. The differences between the two groups were statistically significant (P < 0.05). Imaging studies indicated that the bone marrow edema in the intervention group subsided more rapidly. This minimally invasive therapy can quickly relieve symptoms, promote functional recovery, and has stable long-term efficacy and good safety. It is conducive to early rehabilitation and reduces the risk of long-term joint dysfunction, thus having high clinical promotion value.

Tibial Plateau Bone Contusion, Local Injection of Bone Cement, Visual Positioning, Traditional Conservative Treatment

1. Seong H K, Hyun J S, Dong W S, Kang-Il K, Sang H L, et al. Analysis of Risk Factors for Ramp Lesions Associated with Anterior Cruciate Ligament Injury.[J], The American journal of sports medicine, 2020, 48(7): 1673-1681.
2. Jay M, Lee D K, Christopher A S, Don T L, Joseph B K, Annie W, Jack P, Andin F, Ryan C, Peter J, Timothy E H, Michael J M, et al. A Novel MRI Mapping Technique for Evaluating Bone Bruising Patterns Associated with Noncontact ACL Ruptures.[J], Orthopaedic Journal of Sports Medicine, 2022, 10(4).
3. Yu Z, Rui W, Jun H, Xiaodong Q, Aiping C, Xiang L, et al. Magnetic Resonance Imaging (MRI) and Computed Topography (CT) Analysis of Schatzker Type IV Tibial Plateau Fracture Revealed Possible Mechanisms of Injury Beyond Varus Deforming Force.[J], Injury, 2021, 53(2): 683-690.
4. Lanyu Q, Bo S, Jia L, Zhibo X, Mao Y, Haitao Y, Fajin L, Furong L, et al. Mechanisms of Non-Contact Anterior Cruciate Ligament Injury As Determined by Bone Contusion Location and Severity.[J], Quantitative imaging in medicine and surgery, 2021, 11(7): 3263-3273.
5. Nailah Coleman. Sports Injuries[J], Pediatrics in Review, 2019, 40(6): 278-290.
6. Moon H, Choi C, Kim S, Yoo J, Jung M, Hong Y, Kim S, et al. Outpatient-based Diagnostic Criteria for Partial ACL Injury: Clinical Outcomes of Non-Operative Treatment and Radiographic Predictor[J], Archives of Orthopaedic and Trauma Surgery, 2022, 143(4): 2027-2036.
7. Lanny L. Johnson. What I Have Seen and Learned Since Looking Through an Arthroscope: 43 Years and Counting[J], Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2015, 31 8: 1571-5.
8. Elena Galvez-Sirvent, Aitor Ibarzabal-Gil, E. Carlos Rodriguez-Merchan. Complications of the Surgical Treatment of Fractures of the Tibial Plateau: Prevalence, Causes, and Management[J], EFORT open reviews, 2022, 7: 554-568.
9. Andrew B Harris, Julius K Oni. Cementless, Cruciate-Retaining Primary Total Knee Arthroplasty Using Conventional Instrumentation[J], JBJS Essential Surgical Techniques, 2024, 14(3).
10. R. O'Donnell, J. Dolan. Anaesthesia and Analgesia for Knee Joint Arthroplasty[J], BJA Education, 2017
11. Silvio G, Nicola B, Andrea S, Attilio S, et al. Minimally invasive fixation in tibial plateau fractures using an pre-operative and intra-operative real size 3D printing[J], Injury, 2017, 48(3): 784-788.
12. Wei-Qiang Z, Xu-Song L, Jiang H, Jie-Feng H, et al. Reverse Traction with Kirschner Wires and Bilateral External Fixation Device Combined with Minimally Invasive Plate Oseoynthesis Technique for Tibial Plateau Fractures of Type Schatzker V and VI.[J], International Orthopaedics, 2023, 47(9): 2327-2336.
13. Fengkun W, Chunxu F, Shuai Y, Wei H, Haiyue Z, Peng W, Yiran Z, Lei W, Yanbin Z, Yingze Z, et al. Factors Influencing the Effectiveness of Minimally Invasive Reduction for Tibial Plateau Depression Fractures[J], International Orthopaedics, 2025, 49(9): 2263-2270.
14. Jellina M H, Nynke V D G, Lars B, Ruurd L J, Job N D, Michael J R E, Erik H, et al. Are 3D-Printed Models of Tibial Plateau Fractures a Useful Addition to Understanding Fractures for Junior Surgeons?[J], Clinical Orthopaedics and Related Research, 2022, 480(6): 1170-1177.
15. Mauricio K J, Fabrício F, Rogério C B, Rafael L F, Rodrigo S, Cleber A J P, et al. Tibial Plateau Fractures[J], Revista Brasileira de Ortopedia, 2024: 519-532.
16. Elena Galvez-Sirvent, Aitor Ibarzabal-Gil, E. Carlos Rodriguez-Merchan. Complications of the Surgical Treatment of Fractures of the Tibial Plateau: Prevalence, Causes, and Management[J], EFORT open reviews, 2022, 7: 554-568.
17. Brandon N, Justin B, Anita A B, Natalie G, Joseph M S, Jeffrey G, et al. The Role of Immediate Arthroplasty in Elderly Tibial Plateau Fractures.[J], Orthopedic Reviews, 2025, 17: 143563.
18. S. G, D. S, F. I R, W. M O, E. D, T. O W, J. F K, C. E H S, et al. Pre-existing Knee Osteoarthritis and Severe Joint Depression Are Associated with the Need for Total Knee Arthroplasty after Tibial Plateau Fracture in Patients Aged over 60 Years[J], The bone & joint journal, 2024, 106B(1): 28-37.
19. Zachary M W, Danielle P, Michelle L, Kelsey O, Ryan C, Matthew T P, Darin M F, Brian J, Theodore M, Chelsea S B, et al. Collagen X Longitudinal Fracture Biomarker Suggests Staged Fixation in Tibial Plateau Fractures Delays Rate of Endochondral Repair[J], Journal of orthopaedic trauma, 2022, 36: S32-S39.
20. Muhammad Zaim Chilmi, Firas Febrian. The Application of Posterior Plate in Tibial Plateau Fracture: A Case Report[J], Journal Orthopaedi and Traumatology Surabaya, 2024, 13(1): 47-51.
21. Zhongzheng W, Zhanle Z, Pengyu Y, Siyu T, Yanbin Z, Wei C, Zhiyong H, Qi Z, Yingze Z, et al. Treatment of Tibial Plateau Fractures: A Comparison of Two Different Operation Strategies with Medium-Term Follow Up[J], Journal of orthopaedic translation, 2022, 36: 1-7.
22. Vincenzo G, Robinson E P, Frederico S P, Túlio V D O C, Marco A P D A, Peter V G, et al. Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm[J], The journal of knee surgery, 2022, 35(09): 959-970.
23. Huazhang Z, Xiaochun M, Cheng T, Chuang L, Jianwei C, Jiandong Y, et al. [Biomechanical Study on a Novel Injectable Calcium Phosphate Cement Containing Poly (Latic-Co-glycolic Acid) in Repairing Tibial Plateau Fractures].[J], Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(7): 855-9.
24. Avraam C, Piero G, Carlo R M, Micaela P, Marco M, et al. Treatment of Schatzker Type III Tibial Plateau Fractures: Report of an Alternative, Percutaneous Technique and Brief Review of the Literature[J], Journal of Long-term Effects of Medical Implants, 2024, 34(3): 23-26.
25. Chowdam Jagan Babu, Tandlam Manish Reddy, Arun Murugesan Sathya. A Study of Tibial Plateau Fracture Management by Surgical Methods and Their Functional and Radiological Evaluation in Tertiary Care Hospital[J], Perspectives In Medical Research, 2025, 13(2): 85-91.
26. Aabid A R, Aamir N B, Mohammad A G, Jawed A B, et al. The Clinicoradiological Outcome of Arthroscopic-assisted Reduction and Internal Fixation of Tibial Plateau Fractures[J], Journal of Arthroscopy and Joint Surgery, 2024, 11(2): 62-68.
27. A. Fontalis, F. S. Haddad. Roentgen Stereophotogrammetric Analysis: Still a Very Valuable Tool in the Orthopaedic Research Armamentarium[J], Bone & joint research, 2022, 11(4): 210-213.
28. Kafeel K, Muzaffar M, Mudasir R, Aabid A R, Owais A Q, et al. Management of Tibial Plateau Fractures: a Fresh Review[J], Acta orthopaedica Belgica, 2023, 89(2): 265-273.