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Fixation of a split fracture of the lateral tibial plateau with a locking screw plate instead of cannulated screws would allow early weight bearing: a computational exploration

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Abstract

Purpose

To assess, with finite element (FE) calculations, whether immediate weight bearing would be possible after surgical stabilization either with cannulated screws or with a locking plate in a split fracture of the lateral tibial plateau (LTP).

Methods

A split fracture of the LTP was recreated in a FE model of a human tibia. A three-dimensional FE model geometry of a human femur-tibia system was obtained from the VAKHUM project database, and was built from CT images from a subject with normal bone morphologies and normal alignment. The mesh of the tibia was reconverted into a geometry of NURBS surfaces. A split fracture of the lateral tibial plateau was reproduced by using geometrical data from patient radiographs. A locking screw plate (LP) and a cannulated screw (CS) systems were modelled to virtually reduce the fracture and 80 kg static body-weight was simulated.

Results

While the simulated body-weight led to clinically acceptable interfragmentary motion, possible traumatic bone shear stresses were predicted nearby the cannulated screws. With a maximum estimation of about 1.7 MPa maximum bone shear stresses, the Polyax system might ensure more reasonable safety margins.

Conclusions

Split fractures of the LTP fixed either with locking screw plate or cannulated screws showed no clinically relevant IFM in a FE model. The locking screw plate showed higher mechanical stability than cannulated screw fixation. The locking screw plate might also allow full or at least partial weight bearing under static posture at time zero.

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Authors and Affiliations

  1. Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/Sant Quintí 89, 08041, Barcelona, Spain

    Ion Carrera & Pablo Eduardo Gelber

  2. ICATME-Hospital Universitari Quirón-Dexeus, Universitat Autònoma de Barcelona, Sabino de Arana 5-19, 08028, Barcelona, Spain

    Pablo Eduardo Gelber & Juan Carlos Monllau

  3. Department of Communication and information Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain

    Gaetan Chary, Miguel A. González-Ballester & Jerome Noailly

  4. Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain

    Gaetan Chary & Jerome Noailly

  5. ICREA, Pg. Lluis Companys 23, 08010, Barcelona, Spain

    Miguel A. González-Ballester

  6. Orthopaedic Surgery Department, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain

    Juan Carlos Monllau

Authors
  1. Ion Carrera
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  2. Pablo Eduardo Gelber
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  3. Gaetan Chary
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  4. Miguel A. González-Ballester
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  5. Juan Carlos Monllau
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  6. Jerome Noailly
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Correspondence to Ion Carrera.

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Carrera, I., Gelber, P.E., Chary, G. et al. Fixation of a split fracture of the lateral tibial plateau with a locking screw plate instead of cannulated screws would allow early weight bearing: a computational exploration. International Orthopaedics (SICOT) 40, 2163–2169 (2016). https://doi.org/10.1007/s00264-015-3106-y

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  • DOI: https://doi.org/10.1007/s00264-015-3106-y

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