Medial versus lateral locking plate for fixation of distal tibial fractures

doi:10.3969/j.issn.2095-4344.2013.43.021

Abstract

Abstract:

BACKGROUND: With the increasing incidence of distal tibial fractures, locking plate fixation has become the preferred internal fixation method.
OBJECTIVE: To analyze the biomechanical performance of distal tibial fractures, and to study the difference between medial and lateral locking plate methods for internal fixation of distal tibial fractures.
METHODS: Articles concerning the biomechanics of the internal fixation of distal tibial fractures were collected by literature search. The articles that met the criteria were analyzed in depth. In this paper, a biomechanical comparison between locking plate fixation and intramedullary nail fixation was done as well as the stress distribution and mechanism of the ankle joint. Meanwhile, 60 patients with distal tibial fractures who had received medial or lateral locking plate fixation at the Department of Orthopedics, Chongming Branch, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China from January 2009 to January 2012 were enrolled for efficiency comparison.
RESULTS AND CONCLUSION: For patients with distal tibial fractures, it is easy to cause posterior malleolus fractures, Y-shaped fractures and anterior tibial compression, respectively, in the plantar flexion position, neutral position, and dorsiflexion position. Locking plate is better than the intramedullary nail in the torsional force, and the intact fibula contributes to the improvement of fixed effects of these two internal fixation methods. When the fibula cannot be effectively fixed, the locking plate fixation has a better stability than the intramedullary nail.Moreover, there is no difference in the fracture healing after fixation with medial and lateral locking plates. However, a lower incidence of complications and better function recovery of the ankle joint can be realized after lateral locking plate fixation.

Key words: fractures, comminuted, fractures, cartilage, tibial fractures, fibula, ligaments

CLC Number:

R318

Xie Jing-jing, Song Xuan, Wang Zhan-chao, Chen Yu, Liu Chang-hai, Zhou Qiang, Lu Hua. Medial versus lateral locking plate for fixation of distal tibial fractures[J]. Chinese Journal of Tissue Engineering Research, doi: 10.3969/j.issn.2095-4344.2013.43.021.

Figures/Tables 4

2.1 胫骨远端骨折锁定钢板内固定的生物力学变化 2.1.1 胫骨远端骨折多引起踝关节稳定性破坏导致踝关节功能障碍刘畅[13]对不同损伤机制引起胫骨远端骨折的生物力学进行了研究。研究对象为成人新鲜小腿标本，测试中立位，背屈10°，跖屈30°位，加载1倍体质量60 kg，施加600 N压力时踝关节的应力分布值。结果显示，当加压600 N时，背伸10°位时，踝关节所受压强平均值为(1.338±0.136) MPa，接触面积平均值为(4 359.882±123.435) mm2，压力平均值为(582.568±11.415) N；当处于中立位时，踝关节所受压强平均值为(1.586±0.127) MPa，接触面积平均值为(3 687.260±118.423) mm2，压力平均值为(5 584.889± 10.468) N；当跖屈30°位时，踝关节所受压强平均值为(1.736±0.145) MPa，接触面积平均值为(3 358.709± 117.859) mm2，压力平均值为(582.856±11.024) N。研究显示胫骨远端骨折的类型和损伤时的功能位置有关，当跖屈位时距骨后部较窄的部分进入踝穴，接触面积变小，产生较大的压强，接触中心位于踝关节后侧部分，压缩暴力向后导致胫骨后踝骨折；中立位时，关节面相适应，压力分布分散，垂直暴力引起胫骨远端整个关节面中心性压缩或产生前后的Ｙ型骨折；背屈位时，距骨前部较宽部分进入踝穴，接触面积变大，接触中心位于踝关节前侧部分，距骨撞击踝穴前部分，形成胫骨前缘压缩。 2.1.2 胫骨远端骨折锁定钢板内固定的生物力学变化与髓内钉内固定的比较魏海强[14]以8对胫腓骨标本为研究对象，分为2组，每组4对。其中第1组为腓骨完整组，第2组为腓骨截骨组。对2组标本分别建造胫骨远端骨折模型，将腓骨完整组左侧用髓内钉固定，右侧用锁定钢板固定；将腓骨截骨组的标本于腓骨中段各截去0.5 cm后，于标本左侧用髓内钉固定，右侧用锁定钢板固定，并分别进行生物力学性能测试，结果见表3。"

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