Biomechanical comparison of three fixation methods in the repair of posterolateral tibial plateau fracture

doi:10.3969/j.issn.2095-4344.2014.31.016

Abstract

Abstract:

BACKGROUND: Repair programs of posterolateral tibial plateau fracture included posterior plate screws, lateral plate screw and anterior and posterior lag screw fixation. To choose which fixation methods depends on clinical experiences of physicians. Study results are mainly clinical reports, and lack of mechanical evidence.
OBJECTIVE: To compare biomechanical changes in three fixed manners (lateral plate screw group, posterior plate screw group and anterior and posterior lag screw group) in the repair of posterolateral fracture of tibial plateau from the angle of biomechanics.
METHODS: A total of tibial specimens of six adult male antisepsis corpses (12 samples) were used for measuring bone mineral density of metaphysis. 1/2 posterolateral tibial plateau fracture model was established by electric pendulum saw. The model was randomly divided into three groups: lateral plate screw group, posterior plate screw group and anterior and posterior lag screw group. Finite element method and biomechanics were used to test axial displacement value and the maximal displacement distribution area under the axial loads of 250, 500, and 1 000 N.
RESULTS AND CONCLUSION: There was no significant difference in average bone density in three groups of metaphysis (P > 0.05). The minimum axial displacement of the fracture fragments was in the anterior and posterior lag screw group (0.013 521 mm), followed by posterior plate screw group (0.016 991 mm), and the maximum was visible in the lateral plate screw group (0.138 200 mm) under 250 N load. Displacement value was similar to the 250 N under 500 and 1 000 N. According to the results of biomechanics, displacement values of anterior and posterior lag screw was obviously less than the lateral plate screw group and posterior plate screw group (P < 0.05). There was no significant difference between the lateral plate screw group and posterior plate screw group (P > 0.05). The maximal displacement distribution area was proximal tibiofibular joint border zone in two methods. These data indicated that the biomechanical stability was most advantageous in the anterior and posterior lag screw group, and poorest in the lateral plate screw group. In the clinic, anterior and posterior lag screw fixation can be used as a first choice for repair of posterolateral tibial plateau fracture.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: prostheses and implants, internal fixators, tibial fractures, finite element analysis, biomechanics

CLC Number:

R318

Zhang Yan, Liang Xu, Fan Xin-bin, Shao Jin, Liu Yue, Ye Wei-guang, Wu Liang, Yang Tie-yi, . Biomechanical comparison of three fixation methods in the repair of posterolateral tibial plateau fracture[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(31): 5011-5016.

Figures/Tables 3

References

[1] Piposar J, Fowler JR, Gaughan JP, et al. Race may not affect [correct] outcomes in operatively treated tibia fractures.Clin Orthop Relat Res. 2012;470(5):1513-1517.
[2] Babis GC, Evangelopoulos DS, Kontovazenitis P, et al. High energy tibial plateau fractures treated with hybrid external fixation. J Orthop Surg Res. 2011;(14):35.
[3] Zura RD, Browne JM, Black MD,et al.Current management of high-energy tibial plateau fractures. Curr Orthop. 2007;21(3): 229-235.
[4] Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, et al. Complications after tibia plateau fracture surgery. Injury. 2006;37(6):475-484.
[5] Stauffer KD, Tuttle TA, Elkins AD, et al. Complications associated with 696 tibial plateau leveling osteotomies (2001-2003). J Am Anim Hosp Assoc. 2006;42(1):44-50.
[6] Cross WW 3rd, Levy BA, Morgan JA, et al. Periarticular raft constructs and fracture stability in split-depression tibial plateau fractures. Injury. 2013;44(6):796-801.
[7] Heikkilä JT, Kukkonen J, Aho AJ, et al. Bioactive glass granules: a suitable bone substitute material in the operative treatment of depressed lateral tibialplateau fractures: a prospective, randomized 1 year follow-up study. J Mater Sci Mater Med. 2011;22(4):1073-1080.
[8] Hsieh CH, Huang HT, Liu PC,et al. Anterior approach for posteromedial tibial plateau fractures. Kaohsiung J Med Sci. 2010;26(3):130-135.
[9] Luo CF, Hu CF, Gao H, et al. Three-column classification for tibial plateau fractures. Chin J Orthop Trauma 2009;11(3): 201-205.
[10] Luo CF, Sun H, Zhang B. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010;24(11): 683-692.
[11] Cooper HJ, Kummer FJ, Egol KA, et al.The effect of screw type on the fixation of depressed fragments in tibial plateau fractures. Bull Hosp Jt Dis. 2002;60:72-75.
[12] Ali AM, Yang L, Hashmi M, et al. Bicondylar tibial plateau fractures managed with the Sheffield Hybrid Fixator. Biomechanicalstudy and operative technique. Injury. 2001;32 Suppl 4:SD86-91.
[13] Ali AM, Saleh M, Bolongaro S, et al. The strength of different fixation techniques forbicondylar tibial plateau fractures-abiomechanical study. Clin Biomech. 2003; 18: 864-870.
[14] Yushkevich PA,Piven J, Hazlett HC,et al.User- guided 3D active contour segmentation of anatomical structures: Significantly improved efficiency andreliabiity. Neurolmage. 2006;3:1116-1128.
[15] Sonoda N, Chosa E, Totoribe K,et al. Biomechanical analysis for stress fractures of the anterior middle third of the tibia in athletes:nonlinear analysis using a three-dimensional finite element method. J Orthop Sci. 2003;4:505-513.
[16] Lacroix D, Prendergast PJ. Three-dimensional simulation of fracture repair in the human tibia. Comput Methods Biomech Biomed Engin. 2002;5: 369-376.
[17] 龚璐璐,杨铁毅,张岩,等.LISS钢板治疗胫骨远端骨折有限元建模及分析[J].生物医学工程进展,2010, 31(1):12-17.
[18] 孙江波,廖怀章,蒋勇,等.胫骨平台后柱骨折钢板固定的三维有限元分析[J].临床医学研究,2012, 29(5):813-817.
[19] Sonoda N, Chosa E, Totoribe K,et al. Biomechanical analysis for stress fractures of the anterior middle third of the tibia in athletes:nonlinear analysis using a three-dimensional finite element method. J Orthop Sci. 2003;8:505-513.
[20] Meng L, Zhang Y, Lu Y. Three-dimensional finite element analysis of mini-external fixation and Kirschner wire internal fixation in Bennettfracture treatment. Orthop Traumatol Surg Res. 2013;99(1):21-29,
[21] Kantardzi? I, Vasiljevi? D, Blazi? L,et al. Influence of cavity design preparation on stress values in maxillary premolar: a finite element analysis. Croat Med J. 2012;53(6):568-576.
[22] Herrera A, Ibarz E, Cegoñino J, et al. Applications of finite element simulation in orthopedic and trauma surgery. World J Orthop. 2012; 3(4): 25-41.
[23] Liu XS, Wang J, Zhou B,et al. Fast trabecular bone strength predictions of HR-pQCT and individual trabeculae segmentation-based plate and rod finite element model discriminate postmenopausal vertebral fractures. J Bone Miner Res. 2013;28(7):1666-1678.
[24] Varga P, Schefzig P, Unger E, et al. Finite element based estimation of contact areas and pressures of the human scaphoid in various functional positions of the hand. J Biomech. 2013;46(5):984-990.
[25] Nishiyama KK, Macdonald HM, Hanley DA, et al. Women with previous fragility fractures can be classified based on bone microarchitecture and finite element analysis measured with HR-pQCT. Osteoporos Int. 2013;24(5):1733-1740.
[26] Miranda MA. Locking plate technology and its role in osteoporotic fractures. Injury.2007;38(9):Suppl 3:S35-39.
[27] Will R, Englund R, Lubahn J, et al. Locking plates have increased torsionalstiffness compared to standard plates in a segmental defect model of claviclefracture. Arch Orthop Trauma Surg. 2011;131(6):841–847.
[28] Jia YW, Cheng LM, Yu GR, et al. A finite element analysis of the pelvic reconstruction using fibular transplantation fixed with four different rod-screw systems after type I resection. Chin Med J. 2008;121(4):321-326.
[29] Graeff C, Marin F, Petto H,et al. High resolution quantitative computed tomography-based assessment of trabecular microstructure and strength estimates by finite-element analysis of the spine, but not DXA, reflects vertebral fracture status in men with glucocorticoid-induced osteoporosis. Bone. 2013;52(2):568-577.
[30] 张国柱,蒋协远,王满宜.CT扫描对胫骨平台骨折分型及治疗的影响[J].中华创伤骨科杂志,2006,8(4):326-329.
[31] 谢祖宏,吕亮,胡汉敏,等.胫骨平台骨折后需早期康复锻炼但不宜过早负重锻炼[J].中国临床康复, 2002, 6(2): 238-239.
[32] Howard NE, Phaff M, Aird J,et al. Does human immunodeficiency virus status affect early wound healing in open surgically stabilised tibial fractures?: A prospective study. Bone Joint J. 2013;95-B(12):1703-1707.
[33] Uchiyama S, Itsubo T, Nakamura K,et al. Effect of early administration of alendronate after surgery for distal radial fragility fracture on radiological fracture healing time.Bone Joint J. 2013;95-B(11):1544-1550.
[34] Matsunaga FT, Tamaoki MJ, Matsumoto MH, et al. Treatment of the humeral shaft fractures--minimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace: study protocol for a randomised controlled trial. Trials. 2013;14:246.
[35] Urita A, Iwasaki N, Kondo M, et al. Effect of low-intensity pulsed ultrasound on bone healing at osteotomy sites after forearm bone shortening. J Hand Surg Am. 2013;38(3): 498-503.
[36] Epari DR, Kassi JP, Schell H., et al. Timely fracture-healing requires optimization of axial fixation stability. J Bone Joint Surg Am. 2007:89(7):1575-1585.
[37] Guo LX,Teo EC,Qiu TX.Prediction of biomechanical characteristics of intact and injured lower thoracic spine segment under different loads. J Musculoskel Res. 2004;8: 87-99.
[38] 巴雪峰,孙改生,凯瑟尔.等. 胫骨平台骨折的治疗新进展[J].中国矫形外科杂志,2012,20(12):1104-1107.
[39] 冯卫,郝廷,郝增涛,等.3种股骨近端髓内钉固定股骨转子间骨折的有限元分析[J].中国矫形外科杂志,2012,20(8):730-733.