***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Bone graft augmentation is often selected to treat defects associated with unstable tibial plateau fractures . This prospect i ve , r and omized , multicenter study was undertaken to determine the efficacy of bioresorbable calcium phosphate cement compared with st and ard autogenous iliac bone graft in the treatment of these osseous defects . METHODS One hundred and twenty acute , closed , unstable tibial plateau fractures ( Schatzker types I through VI ) in 119 adult patients were prospect ively enrolled in twelve study sites in North America between 1999 and 2002 . R and omization for the type of grafting of the subarticular defect was done at the time of surgery , with use of a 2:1 ratio , to treatment with calcium phosphate cement ( eighty-two fractures ) or autogenous iliac bone graft ( thirty-eight fractures ) . After open reduction , st and ard plate- and -screw or screw-only fixation was used and then either the cement or the bone graft was placed in the defect cavity for subarticular support . Follow-up included st and ard radiographs , evaluated by multiple review ers to avoid bias , and knee range-of-motion assessment at six months to one year or later . RESULTS The age , weight , height , and sex of the patients and the fracture patterns were comparable in the two groups , as were union rates and time to union . There was a significantly ( p = 0.009 ) higher rate of articular subsidence during the three to twelve-month follow-up period in the bone graft group . CONCLUSIONS The bioresorbable calcium phosphate cement used in this study appears to be a better choice , at least in terms of the prevention of subsidence , than autogenous iliac bone graft for the treatment of subarticular defects associated with unstable tibial plateau fractures . LEVEL OF EVIDENCE Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence Purpose of this study was to compare bioactive glass and autogenous bone as a bone substitute material in tibial plateau fractures . We design ed a prospect i ve , r and omized study consisting of 25 consecutive operatively treated patients with depressed unilateral tibial comminuted plateau fracture ( AO classification 41 B2 and B3).14 patients ( 7 females , 7 males , mean age 57 years , range 25–82 ) were r and omized in the  bioglass group ( BG ) and 11 patients ( 6 females , 5 males , mean age 50 years , range 31–82 ) served as autogenous bone control group ( AB ) . Clinical examination of the patients was performed at 3 and 12 months , patients ’ subjective and functional results were evaluated at 12 months . Radiological analysis was performed preoperatively , immediately postoperatively and at 3 and 12 months . The postoperative redepression for both studied groups was 1 mm until 3 months and remained unchanged at 12 months . No differences were identified in the subjective evaluation , functional tests and clinical examination between the two groups during 1 year follow-up . We conclude that bioactive glass granules can be clinical ly used as filler material instead of autogenous bone in the lateral tibial plateau compression fractures Objectives : External fixation devices are sold in the United States as single-use devices and can be costly . Approved processes for refurbishment of nonimplantable components are available . We evaluated one such program for safety , efficacy , and fiscal ramifications . Design : R and omized clinical trial Setting : Single center , Level I trauma center Patients / Participants : During the 30-month enrollment period ( November 16 , 2001 to May 16 , 2004 ) , 41 patients ( 13 % ) of 315 patients were not able to consent and were excluded . A total of 178 ( 65 % ) of the 274 eligible patients who were offered entry into a r and omized trial of new versus refurbished external fixation components for their injury refused to participate , leaving 96 ( 35 % ) of the 274 eligible patients entered into the study . Intervention : Consented patients were entered into a trial of new versus refurbished nonimplantable external fixation components for their injury ( all pins were new ) . Main Outcome Measurements : The frames were evaluated at the time of removal for efficacy and the complications of pin tract infections , loss of fixation , or loosening of components . Results : A total of 48 distal radius fractures , 29 pilon fractures , and 19 tibial plateau fractures were entered into the study . With the 96 fractures treated in our study ( 50 new frames , 46 reused frames ) , we found no statistical differences in the incidence of pin tract infections ( 46 % versus 52 % , P = 0.32 ) , loss of fixation ( 4 % versus 4 % , P = 0.70 ) , or loosening of the components ( 1 % versus 1 % , P = 1.0 ) . Conclusions : Sixty-five percent of consentable patients did not wish to have an external fixation frame with refurbished clamps . Our study demonstrated that this type of program is safe and effective with an actual cost savings of $ 65,452 . The potential savings of such a program is 25 % of the cost of all new frames Fixation of tibial plateau fractures with plate has been widely used . This prospect i ve study was planned to compare locking plate fixation of tibial plateau fracture with nonlocking methods in terms of their functional outcomes . The subjects of the study were selected from consecutive patients suffering from tibial plateau fractures referred to Kashani Hospital in Isfahan , Iran , between 2012 and 2013 and were c and i date for surgery . The final included patients were assigned to two groups , those who were treated with locking plate ( n = 20 ) and those who were treated with nonlocking plates ( N = 21 ) . The mean duration of follow-up was 13.4 months ( ranging between 10 and 17 months ) . The mean of knee scores was significantly higher in locking plate group than in nonlocking plate group at the follow-up time ( 80.20 ± 10.21 versus 72.52 ± 14.75 , P = 0.039 ) . Also , the mean VAS pain severity score was significantly lower in locking plate group compared with nonlocking plate group ( 4.45 ± 2.50 versus 6.00 ± 2.59 , P = 0.046 ) . This study confirmed superiority of the locking plate method over nonlocking plate method with regard to knee score as well as VAS pain score Background Bone graft substitutes are widely used for reconstruction of posttraumatic bone defects . However , their clinical significance in comparison to autologous bone grafting , the gold-st and ard in reconstruction of larger bone defects , still remains under debate . This prospect i ve , r and omized , controlled clinical study investigates the differences in pain , quality of life , and cost of care in the treatment of tibia plateau fractures-associated bone defects using either autologous bone grafting or bioresorbable hydroxyapatite/calcium sulphate cement ( CERAMENT ™ |BONE VOID FILLER ( CBVF ) ) . Methods / Design CERTiFy ( CERament ™ Treatment of Fracture defects ) is a prospect i ve , multicenter , controlled , r and omized trial . We plan to enroll 136 patients with fresh traumatic depression fractures of the proximal tibia ( types AO 41-B2 and AO 41-B3 ) in 13 participating centers in Germany . Patients will be r and omized to receive either autologous iliac crest bone graft or CBVF after reduction and osteo synthesis of the fracture to reconstruct the subchondral bone defect and prevent the subsidence of the articular surface . The primary outcome is the SF-12 Physical Component Summary at week 26 . The co- primary endpoint is the pain level 26 weeks after surgery measured by a visual analog scale . The SF-12 Mental Component Summary after 26 weeks and costs of care will serve as key secondary endpoints . The study is design ed to show non-inferiority of the CBVF treatment to the autologous iliac crest bone graft with respect to the physical component of quality of life . The pain level at 26 weeks after surgery is expected to be lower in the CERAMENT bone void filler treatment group . Discussion CERTiFy is the first r and omized multicenter clinical trial design ed to compare quality of life , pain , and cost of care in the use of the CBVF and the autologous iliac crest bone graft in the treatment of tibia plateau fractures . The results are expected to influence future treatment recommendations .Trial registration number Clinical Trials.gov : Tibial plateau fractures can occur concomitant with injuries to the collateral and cruciate ligaments , menisci , and surrounding nerves and arteries . The purpose of this article is to record the frequency of these soft tissue injuries with tibial plateau fractures . Patients with plateau fractures were entered into a prospect i ve protocol consisting of radiographic evaluation , Schatzker classification , pre- and postfixation stress testing , and diagnostic arthroscopy .  Thirty tibial plateau fractures were evaluated in this study . There was a 56 % ( 17 of 30 ) frequency of associated soft tissue injuries in this series of tibial plateau fractures . The medial collateral ligaments were injured in 20 % ( six of 30 ) , the lateral collateral ligaments in 3 % ( one in 30 ) , the menisci in 20 % ( six in 30 ) , the peroneal nerve in 3 % ( one in 30 ) , and the anterior cruciate ligaments in 10 % ( three in 30 ) . Schatzker type IV and type II fracture patterns were associated with the highest frequency of soft tissue injuries . Medial collateral ligament injuries were most commonly associated with Schatzker type II fracture patterns . Menisci were most commonly injured with Schatzker type IV fracture patterns . Based on the findings , routine arthroscopy should be indicated in nondisplaced Schatzker type I fractures . Pre- and postfixation stress testing should be performed to diagnose collateral and cruciate ligament injuries Introduction Restoration of articular congruency is a key factor in preventing post-traumatic osteoarthritis following tibial plateau fractures . Current surgical techniques using a bone tamp carry the risk of joint perforation and comminution of the depressed fragments which affect patient outcome . Successful use of inflation osteoplasty has been reported in both in vitro studies ( Broome et al. in J Orthopaed Traumatol 13(2):89–95 , 2012 ; Mauffrey et al. in Patient Saf Surg 6:6 , 2012 ) and case reports in the management of fractures of the calcaneus , cuboid , distal radius , tibial plateau and acetabulum ( Gupta et al. in Foot Ankle Int 32(2):205–210 , 2011 ; Heim et al. in Foot Ankle Int 29(11):1154–1157 , 2008 ; Konig et al. in Case Rep Unfallchirurg 109(4):328–331 , 2006 ; Reiley in J Orthop Trauma 17:141–163 , 2006 ) . The aim of our study is to assess whether the use of the balloon osteoplasty improves the quality of reduction of a depressed tibial plateau fracture when compared to traditional methods of fracture reduction . Method This is a single-centred r and omised trial . We will recruit 24 adult patients admitted with either a depressed or split depressed tibial plateau fracture ( medial or lateral ) requiring surgical intervention . Consenting patients will be r and omly allocated to the two treatment groups . Patients with concomitant injuries influencing the management of the tibial plateau fracture will be excluded from our study . The primary outcome measure is the quality of reduction based on the post-operative CT scan . Secondary outcome measures will be any surgical complication and patient satisfaction , measured using the Oxford Knee score and SF12 question naire at 3 , 6 and 12 months . Principal analysis will be for the success of fracture reduction from the two techniques and the effect the operative technique had on patient satisfaction and the prevalence of surgical complications We have developed a 12-item question naire for patients having a total knee replacement ( TKR ) . We made a prospect i ve study of 117 patients before operation and at follow-up six months later , asking them to complete the new question naire and the form SF36 . Some also filled in the Stanford Health Assessment Question naire ( HAQ ) . An orthopaedic surgeon completed the American Knee Society ( AKS ) clinical score . The single score derived from the new question naire had high internal consistency , and its reproducibility , examined by test-retest reliability , was found to be satisfactory . Its validity was established by obtaining significant correlations in the expected direction with the AKS scores and the relevant parts of the SF36 and HAQ . Sensitivity to change was assessed by analysing the differences between the preoperative scores and those at follow-up . We also compared change in scores with the patients ' retrospective judgement of change in their condition . The effect size for the new question naire compared favourably with those for the relevant parts of the SF36 . The change scores for the new knee question naire were significantly greater ( p < 0.0001 ) for patients who reported the most improvement in their condition . The new question naire provides a measure of outcome for TKR that is short , practical , reliable , valid 
    Output:
    
Currently , there is insufficient evidence to ascertain the best method of fixation or the best method of addressing bone defects during surgery .
However , the evidence does not contradict approaches aim ing to limit soft-tissue dissection and damage or to avoid autograft donor site complications through using bone substitutes .