Anterolateral or Posteromedial Plate-Assisted Intramedullary Nailing for Fixation of Proximal Third Tibia Fractures: A Biomechanical Study
10.16156/j.1004-7220.2023.01.15
- VernacularTitle:前外侧或后内侧辅助钢板结合髓内钉固定胫骨近端 1 / 3 骨折的生物力学研究
- Author:
Yibo XU
1
;
Yao LU
1
;
Teng MA
1
;
Cheng REN
1
;
Ming LI
1
;
Liang SUN
1
;
Qiang HUANG
1
;
Qian WANG
1
;
Hanzhong XUE
1
;
Zhong LI
1
;
Kun ZHANG
1
Author Information
1. Department of Trauma Orthopaedics, Honghui Hospital, Xi′an Jiaotong University College of Medicine
- Publication Type:Journal Article
- Keywords:
proximal tibia fracture;
intramedullary nail;
assisted plate;
biomechanical test
- From:
Journal of Medical Biomechanics
2023;38(1):E104-E109
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the stability of plate-assisted intramedullary nailing for fixing proximal third tibiafractures, compare and observe biomechanical characteristics of anterolateral or posteromedial plate-assisted intramedullary nailing after fixation of proximal third tibia fractures. Methods Eight artificial tibia of 4th-generation sawbones were divided into two groups based on location of the assisted plate, namely, anterolateral plate group and posteromedial plate group, with 4 specimens in each group. Each two locking bolts were fixed to theintramedullary nail proximally and distally, and each three bicortical screws were fixed to the plate proximally and distally. The specimens were osteotomized with a 10-mm defect which located 0. 5 cm to the proximal locking bolt of intramedullary nail or 5-6 cm distally to the knee joint line, in order to simulate an AO/ OTA 41-A2 type proximal third tibia fracture after fixation of intramedullary nail. After osteotomy was finished, axial compression test, three point bending test, cyclic loading and overstress test were conducted by mechanical testing machine. The results of axial stiffness and three-point stiffness between two groups were compared and analyzed. Results Axial compression test showed that the average axial stiffness in posteromedial plate group was lower than that in anterolateral plate group, but no significantly statistical differences were found between the two groups. Three point bending test showed that the average bending stiffness in posteromedial plate group was significantly higher than that in anterolateral plate group when stimulating either varus stress (plate located at pressure side of the fracture, t = 3. 679, P<0. 05) or valgus stress (plate located at tension side of the fracture, t = 8. 975, P<0. 05). Conclusions Plate-assisted intramedullary nailing for fixation of proximal third tibia fractures can minimize the angulation malalignment, improve the stability of nailed proximal tibial fragment and allow the early weight bearing. Both anterolateral and posteromedial plate-assisted intramedullary nail can provide satisfactory axial stability for proximal third tibia fractures, while posteromedial plate-assisted intramedullary nail shows better bending stability than anterolateral plate in countering varus or valgus stress deformity. This study provides an essential basis for clinical decision making about plate-assisted intramedullary nailing for fixing proximal third tibia fractures.
