Biomechanical analysis of operative methods in the treatment of extra-articular fracture of the proximal Tibia
- Authors
- Lee, S.-M.; Oh, C.-W.; Oh, J.-K.; Kim, J.-W.; Lee, H.-J.; Chon, C.-S.; Lee, B.-J.; Kyung, H.-S.
- Issue Date
- 2014
- Publisher
- Korean Orthopaedic Association
- Keywords
- Biomechanical study; Locking plate; Nail; Proximal tibial fracture
- Citation
- CiOS Clinics in Orthopedic Surgery, v.6, no.3, pp.312 - 317
- Indexed
- SCOPUS
KCI
- Journal Title
- CiOS Clinics in Orthopedic Surgery
- Volume
- 6
- Number
- 3
- Start Page
- 312
- End Page
- 317
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/100767
- DOI
- 10.4055/cios.2014.6.3.312
- ISSN
- 2005-291x
- 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;/? < 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. © 2014, by The Korean Orthopaedic Association. All rights reserved.
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