Biomechanical Analysis of Operative Methods in the Treatment of Extra-Articular Fracture of the Proximal Tibia.
10.4055/cios.2014.6.3.312
- Author:
Seong Man LEE
1
;
Chang Wug OH
;
Jong Keon OH
;
Joon Woo KIM
;
Hyun Joo LEE
;
Chang Soo CHON
;
Byoung Joo LEE
;
Hee Soo KYUNG
Author Information
1. Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea. cwoh@knu.ac.kr
- Publication Type:Original Article
- Keywords:
Proximal tibial fracture;
Locking plate;
Nail;
Biomechanical study
- MeSH:
Biomechanical Phenomena;
Bone Nails;
Bone Plates;
Fracture Fixation, Internal/*instrumentation;
Fractures, Comminuted/physiopathology/*surgery;
Humans;
Models, Anatomic;
Tibial Fractures/physiopathology/*surgery
- From:Clinics in Orthopedic Surgery
2014;6(3):312-317
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: To determine relative fixation strengths of a single lateral locking plate, a double construct of a locking plate, and a tibial nail used in treatment of proximal tibial extra-articular fractures. METHODS: Three groups of composite tibial synthetic bones consisting of 5 specimens per group were included: lateral plating (LP) using a locking compression plate-proximal lateral tibia (LCP-PLT), double plating (DP) using a LCP-PLT and a locking compression plate-medial proximal tibia, and intramedullary nailing (IN) using an expert tibial nail. To simulate a comminuted fracture model, a gap osteotomy measuring 1 cm was created 8 cm below the knee joint. For each tibia, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 25 mm/min until tibial failure. RESULTS: Under axial loading, fixation strength of DP (14,387.3 N; standard deviation [SD], 1,852.1) was 17.5% greater than that of LP (12,249.3 N; SD, 1,371.6), and 60% less than that of IN (22,879.6 N; SD, 1,578.8; p < 0.001, Kruskal-Wallis test). For ultimate displacement under axial loading, similar results were observed for LP (5.74 mm; SD, 1.01) and DP (4.45 mm; SD, 0.96), with a larger displacement for IN (5.84 mm; SD, 0.99). The median stiffness values were 2,308.7 N/mm (range, 2,147.5 to 2,521.4 N/mm; SD, 165.42) for the LP group, 4,128.2 N/mm (range, 3,028.1 to 4,831.0 N/mm; SD, 832.88) for the DP group, and 5,517.5 N/mm (range, 3,933.1 to 7,078.2 N/mm; SD, 1,296.19) for the IN group. CONCLUSIONS: During biomechanical testing of a simulated comminuted proximal tibial fracture model, the DP proved to be stronger than the LP in terms of ultimate strength. IN proved to be the strongest; however, for minimally invasive osteosynthesis, which may be technically difficult to perform using a nail, the performance of the DP construct may lend credence to the additional use of a medial locking plate.
