Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Outcomes of autologous bone grafts vs bone substitutes in tibial plateau fractures: A meta-analysis
Ali Saad Alshahrani, Yazan Jumah Alalwani, Nihal Mushabb Alqahtani, Abdullah Shafi D Alanazi, Ahmed Khaled Almarri, Shatha Saud Alqurashi, Deemah Khalid Ghazi, Abdullah Musaaed Alsalamah, Rahaf Hamdan Alruwaili, Ahmed Y Azzam, Fawaz Alanii
Ali Saad Alshahrani, Fawaz Alanii, Department of Orthopedic Surgery, King Fahad University Hospital, Khobar 34445, Saudi Arabia
Yazan Jumah Alalwani, Ahmed Khaled Almarri, College of Medicine, Imam Abdulrahman Bin Faisal University, Khobar 31441, Saudi Arabia
Nihal Mushabb Alqahtani, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11421, Saudi Arabia
Abdullah Shafi D Alanazi, College of Medicine, Northern Border University, Arar 91431, Saudi Arabia
Shatha Saud Alqurashi, College of Medicine, Fakeeh College for Medical Sciences, Jeddah 23323, Saudi Arabia
Deemah Khalid Ghazi, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
Abdullah Musaaed Alsalamah, Qassim Health Cluster, Ministry of Health, Qassim 51921, Saudi Arabia
Rahaf Hamdan Alruwaili, College of Medicine, Aljouf University, Sakaka 42421, Al Jawf, Saudi Arabia
Ahmed Y Azzam, Director of Clinical Research and Clinical Artificial Intelligence, ASIDE Healthcare, Lewes, DE 19958, United States
Co-first authors: Ali Saad Alshahrani and Yazan Jumah Alalwani.
Author contributions: Alshahrani AS designed research, performed research, analyzed data, wrote the paper; Alalwani YJ designed research, performed research, analyzed data, wrote the paper; Alqahtani NM performed research, analyzed data, wrote the paper; Alanazi ASD designed research, performed research, analyzed data, wrote the paper; Almarri AK performed research, analyzed data, wrote the paper; Alqurashi SS performed research, analyzed data, wrote the paper; Ghazi DK designed research, performed research, analyzed data, wrote the paper; Alsalamah AM performed research, analyzed data, wrote the paper; Alruwaili RH performed research, analyzed data, wrote the paper; Azzam AY designed research, performed research, analyzed data, wrote the paper; Alanii F designed research, performed research, analyzed data, wrote the paper.
Conflict-of-interest statement: All authors declare no conflict-of-interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ahmed Y Azzam, Director of Clinical Research and Clinical Artificial Intelligence, ASIDE Healthcare, 16192 Coastal Highway, Lewes, DE 19958, United States.
ahmedyazzam@gmail.com
Received: June 23, 2025
Revised: August 3, 2025
Accepted: August 27, 2025
Published online: September 18, 2025
Processing time: 80 Days and 11.2 Hours
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.
Core Tip: This meta-analysis of seven randomized controlled trials involving 424 patients demonstrates that bone substitutes provide equivalent structural outcomes to autologous bone grafts in tibial plateau fractures while offering significant procedural advantages. The study introduces a novel combined outcome scoring system integrating structural, procedural, and complication domains, revealing bone substitutes reduce blood loss by 70-90 mL and operative time, particularly in Asian populations. Geographic variations showed Western studies had 45% higher secondary collapse risk with autografts. These findings support bone substitutes as viable alternatives across all fracture complexities, challenging the traditional gold standard approach and offering particular benefits in resource-limited settings.
