Current Advancements in Bone Grafting Substitutes for Osteoporotic Distal Tibia Fractures: A Narrative Review of...

The surgical management of distal tibia fractures in the elderly is increasingly complex due to the rising prevalence of osteoporosis and the unique anatomical constraints of the region. While autologous bone graft remains the gold standard, its limitations have led to the widespread adoption of synthetic and biological substitutes. This narrative review explores the current trends in bone grafting for osteoporotic distal tibia fractures, focusing on pure β-tricalcium phosphate (β-TCP) and demineralized bone matrix (DBM). We specifically examine the biological mechanisms, resorption kinetics, and clinical outcomes of these materials. Furthermore, we highlight the emerging clinical preference for powder-type pure β-TCP (Neobone™) due to its superior surface area and packing efficiency in irregular metaphyseal voids. Powder-type pure β-TCP demonstrates superior packing efficiency and predictable resorption kinetics for metaphyseal void filling, while DBM remains a context-dependent biological supplement. Ion-substituted TCP formulations, pharmacological augmentation, and hybrid scaffolds are highlighted as future directions.