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Biomechanical aspects of the posteromedial split in bicondylar tibial plateau fractures—a finite-element investigation

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

To gain principal insight into fixation techniques of a posteromedial split fragment in bicondylar tibial plateau fractures.

Methods

A computer simulation was performed, applying the finite-element method (FEM) to compare four methods of fixation of the posteromedial split fragment: lateral plate (model 1), lateral plate and kickstand screw (model 2), lateral plate and two antero-posterior lag screws (model 3), and lateral and posteromedial plate (model 4). The displacement of the fragment and material stresses in implants and bone under 2500 N axial load were analyzed.

Results

Maximal displacement of the posteromedial split fragment of 2.8 mm was found with a sole lateral plate. An added kickstand screw decreased the displacement to 1.46 mm. Added lag screws improved stability by a factor 4, with a maximal displacement of 0.76 mm. The double-plate configuration revealed 0.27 mm, a decrease of the displacement by a factor 10 compared to model 1. An additional analysis of posteromedial fragment displacements with osteoporotic bone, simulated by dividing the elastic modulus of the bone by a factor 2, turned out to be of relevant impact. For model 1, the calculations did not converge. The influence of bone quality was found to be 70% in model 2, 60% in model 3, and 40% in model 4.

Conclusions

The results indicate that the additional fixation of a posteromedial split fracture by plate osteosynthesis might be advantageous in bicondylar tibial plateau fractures treated with lateral plating. This might be even more important in patients with low bone quality.

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References

  1. McNamara IR, et al. Surgical fixation methods for tibial plateau fractures. Cochrane database Syst Rev. 2015;9:009679.

    Google Scholar 

  2. Lee T-C, Huang H-T, Lin Y-C, Chen C-H, Cheng Y-M, Chen J-C. Bicondylar tibial plateau fracture treated by open reduction and fixation with unilateral locked plating. Kaohsiung J Med Sci. 2013;29(10):568–77.

    Article  Google Scholar 

  3. Lee AK, Cooper SA, Collinge C. Bicondylar tibial plateau fractures. JBJS Rev. 2018;6(2):e4.

    Article  Google Scholar 

  4. McGonagle L, Cordier T, Link BC, Rickman MS, Solomon LB. Tibia plateau fracture mapping and its influence on fracture fixation. J OrthopTraumatol. 2019;20(1):12.

    Google Scholar 

  5. Barei DP, Mara TJ, Taitsman LA, Dunbar RP, Nork SE. Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns. J Orthop Trauma. 2008;8:9.

    Google Scholar 

  6. Hake ME, Goulet JA. Open reduction and internal fixation of the posteromedial tibial plateau via the lobenhoffer approach. J Orthop Trauma. 2016;30(Suppl 2):S35–6.

    Article  Google Scholar 

  7. Samsami S, Pätzold R, Winkler M, Herrmann S, Augat P. The effect of coronal splits on the structural stability of bi-condylar tibial plateau fractures: a biomechanical investigation. Arch Orthop Trauma Surg. 2020;2:8.

    Google Scholar 

  8. Hua K, Jiang X, Zha Y, Chen C, Zhang B, Mao Y. Retrospective analysis of 514 cases of tibial plateau fractures based on morphology and injury mechanism. J Orthop Surg Res. 2019;14(1):267.

    Article  Google Scholar 

  9. Chen H-W, Chen C-Q, Yi X-H. Posterior tibial plateau fracture: a new treatment-oriented classification and surgical management. Int J ClinExp Med. 2015;8(1):472–9.

    Google Scholar 

  10. Eggli S, Hartel MJ, Kohl S, Haupt U, Exadaktylos AK, Röder C. Unstable bicondylar tibial plateau fractures: a clinical investigation. J Orthop Trauma. 2008;22(10):673–9.

    Article  Google Scholar 

  11. Pätzold R, Friederichs J, von Rüden C, Panzer S, Bühren V, Augat P. The pivotal role of the coronal fracture line for a new three-dimensional CT-based fracture classification of bicondylar proximal tibial fractures. Injury. 2017;48(10):2214–20.

    Article  Google Scholar 

  12. Boeck HOP. Posteromedial tibial plateau fractures. Operative treatment by posterior approach. ClinOrthopRelat Res. 1995;320:125–8.

    Google Scholar 

  13. Georgiadis GM. Combined anterior and posterior approaches for complex tibial plateau fractures. J Bone Joint Surg Br. 1994;76(2):285–9.

    Article  CAS  Google Scholar 

  14. Zeng ZM, Luo CF, Putnis S, Zeng BF. Biomechanical analysis of posteromedial tibial plateau split fracture fixation. Knee. 2011a;2:14.

    Google Scholar 

  15. Yoo BJ, Beingessner DM, Barei DP. Stabilization of the posteromedial fragment in bicondylar tibial plateau fractures: a mechanical comparison of locking and nonlocking single and dual plating methods. J Trauma Inj Infect Crit Care. 2010;69(1):148–55.

    Article  Google Scholar 

  16. Horwitz DS, Bachus KN, Craig MA, Peters CL. A biomechanical analysis of internal fixation of complex tibial plateau fractures. J Orthop Trauma. 1999;13(8):545–9.

    Article  CAS  Google Scholar 

  17. Koh Y-G, Son J, Kwon SK, Kim HJ, Kang K-T. Biomechanical evaluation of opening-wedge high tibial osteotomy with composite materials using finite-element analysis. Knee. 2018;25(6):977–87.

    Article  Google Scholar 

  18. Luo C-A, Hwa S-Y, Lin S-C, Chen C-M, Tseng C-S. Placement-induced effects on high tibial osteotomized construct - biomechanical tests and finite-element analyses. BMC MusculoskeletDisord. 2015;16(1):235.

    Article  Google Scholar 

  19. Lasanianos NG, Garnavos C, Magnisalis E, Kourkoulis S, Babis GC. A comparative biomechanical study for complex tibial plateau fractures: nailing and compression bolts versus modern and traditional plating. Injury. 2013;44(10):1333–9.

    Article  Google Scholar 

  20. Koh Y-G, Lee J-A, Lee H-Y, Chun H-J, Kim H-J, Kang K-T. Design optimization of high tibial osteotomy plates using finite element analysis for improved biomechanical effect. J OrthopSurg Res. 2019;14(1):219.

    Google Scholar 

  21. Chen Y-N, et al. Biomechanical investigation of the type and configuration of screws used in high tibial osteotomy with titanium locking plate and screw fixation. J OrthopSurg Res. 2019;14(1):35.

    Google Scholar 

  22. Wolfram U, Schwiedrzik J. Post-yield and failure properties of cortical bone. Bonekey Rep. 2016;5:7.

    Article  Google Scholar 

  23. Little RB, Wevers HW, Siu D, Cooke TDV. A three-dimensional finite element analysis of the upper tibia. J BiomechEng. 1986;108(2):111–9.

    Article  CAS  Google Scholar 

  24. Chang C-W, et al. Biomechanical investigation of tibial tubercle osteotomy fixed with various screw configurations. Injury. 2019;50(2):263–71.

    Article  Google Scholar 

  25. Huang X, Zhi Z, Yu B, Chen F. Stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture: a comparative finite element study. J OrthopSurg Res. 2015;10(1):182.

    Google Scholar 

  26. Ren D, Liu Y, Zhou B, Lu J, Wang P. A novel design of a plate for posterolateral tibial plateau fractures based on computed tomography mapping of the proximal tibiofibular joint. Med Sci Monit. 2018;24:9300–6.

    Article  Google Scholar 

  27. Homminga J, Mccreadie BR, Weinans H, Huiskes R. The dependence of the elastic properties of osteoporotic cancellous bone on volume fraction and fabric. J Biomech. 2003;36(10):1461–7.

    Article  Google Scholar 

  28. Mistry K, Bhoil R, Sood D, Suthar P. Calculation of the reference bone mineral density values in North Indian population using phantomless quantitative computed tomography. J Orthop Allied Sci. 2018;6(1):33.

    Article  Google Scholar 

  29. Higgins TF, Kemper D, Klatt J. Incidence and morphology of the posteromedial fragment in bicondylar tibial plateau fractures. J Orthop Trauma. 2009;3:9.

    Google Scholar 

  30. Cuéllar VG, Martinez D, Immerman I, Oh C, Walker PS, Egol KA. A biomechanical study of posteromedial tibial plateau fracture stability. J Orthop Trauma. 2015;29(7):325–30.

    Article  Google Scholar 

  31. Weaver MJ, et al. Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures. Injury. 2012;43(6):864–9.

    Article  Google Scholar 

  32. Zeng Z-M, Luo C-F, Putnis S, Zeng B-F. Biomechanical analysis of posteromedial tibial plateau split fracture fixation. Knee. 2011b;18(1):51–4.

    Article  Google Scholar 

  33. www.sawbones.com/biomechanical-product-info, “Biomechanical Materials for Precise, Repeatable Testing,” 2018. .

  34. Golovakha ML, et al. Comparison of theoretical fixation stability of three devices employed in medial opening wedge high tibial osteotomy: a finite element analysis. BMC MusculoskeletDisord. 2014;15(1):230.

    Article  Google Scholar 

  35. Yildirim G, Walker PS, Sussman-Fort J, Aggarwal G, White B, Klein GR. The contact locations in the knee during high flexion. Knee. 2007;14(5):379–84.

    Article  Google Scholar 

  36. Kutzner I, et al. Loading of the knee joint during activities of daily living measured in vivo in five subjects. J Biomech. 2010;43(11):2164–73.

    Article  CAS  Google Scholar 

  37. Gösling T, Schandelmaier P, Marti A, Hufner T, Partenheimer A, Krettek C. Less invasive stabilization of complex tibial plateau fractures. J Orthop Trauma. 2004;18(8):546–51.

    Article  Google Scholar 

  38. Beitz K-H. Wolfgang. DUBBEL - Taschenbuchfür den Maschinenbau: Küttner; 1995.

    Google Scholar 

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Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany

    J. Dehoust, M. Münch, K. Seide, T. Barth & K.-H. Frosch

  2. Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    K.-H. Frosch

  3. Institute for Integrated Circuits, Technical University Hamburg, Hamburg, Germany

    T. Barth

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  1. J. Dehoust
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  2. M. Münch
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Correspondence to J. Dehoust.

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Conflict of interest

Karl-Heinz Frosch received grants and fees for research and teaching activities from Arthrex, Inc. (Naples, USA).

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Dehoust, J., Münch, M., Seide, K. et al. Biomechanical aspects of the posteromedial split in bicondylar tibial plateau fractures—a finite-element investigation. Eur J Trauma Emerg Surg 46, 1257–1266 (2020). https://doi.org/10.1007/s00068-020-01538-3

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  • DOI: https://doi.org/10.1007/s00068-020-01538-3

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