Outcomes of autologous bone grafts <i>vs</i> bone substitutes in tibial plateau fractures: A meta-analysis
Bibliographic record
Abstract
BACKGROUND Tibial plateau fractures often require structural support for metaphyseal defects created during articular reduction. While autologous bone grafting has been utilized as the gold standard, bone substitutes offer advantages including reduced donor site morbidity. Our meta-analysis evaluated the comparative efficacy of these approaches across clinical and operative outcomes. AIM To conduct a systematic review and meta-analysis of randomized controlled trials comparing autologous bone grafts with bone substitutes for tibial plateau fractures. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials comparing autologous bone grafts with bone substitutes for tibial plateau fractures. Primary outcomes included joint depression, secondary collapse rate, operative time, blood loss, and infection rate. Subgroup analyses were performed by fracture complexity, geographic region, and methodological factors. In addition to that, we also developed a combined outcome score integrating structural, procedural, and complication domains. RESULTS Seven randomized controlled trials with 424 patients (296 bone substitute, 128 autograft) were included. No significant differences in joint depression or secondary collapse were observed across fracture complexity categories. Geographic variations were evident, with Western studies showing significantly higher risk of secondary collapse with autografts (risk ratio = 1.45, P value = 0.02). Both Western and Asian studies have demonstrated significantly reduced blood loss with bone substitutes (70-90 mL less), while operative time reduction was more significant in the Asian studies (23.65 vs 8.00 minutes, P value = 0.04 for subgroup difference). The combined outcome score (standardized effect size -0.2481) favored bone substitutes, primarily due to procedural advantages. CONCLUSION Bone substitutes provide similar structural outcomes to autologous bone grafts while having better procedural advantages in tibial plateau fracture management. These findings support bone substitutes as a viable option across fracture patterns. Future studies should focus on specific bone substitute formulations and cost-effectiveness analyses.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".