Research progress on biomechanics for internal fixation in tibial plateau fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Jialun , ZHANG Yingze ,  ZHENG Zhanle

Department of Trauma Emergency Center, the Third Affiliated Hospital of Hebei Medical University, Shijiazhuang Hebei, 050051, P. R. China;

Corresponding?author：

ZHENG Zhanle, Email: lancelotzzl@163.com

Keywords：

Tibial plateau fracture; biomechanics; surgical treatment; internal fixation

DOI：

10.7507/1002-1892.202309077

Video：

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Objective To review the biomechanical research progress of internal fixation of tibial plateau fracture in recent years and provide a reference for the selection of internal fixation in clinic. Methods The literature related to the biomechanical research of internal fixation of tibial plateau fracture at home and abroad was extensively reviewed, and the biomechanical characteristics of the internal fixation mode and position as well as the biomechanical characteristics of different internal fixators, such as screws, plates, and intramedullary nails were summarized and analyzed. Results Tibial plateau fracture is one of the common types of knee fractures. The conventional surgical treatment for tibial plateau fracture is open or closed reduction and internal fixation, which requires anatomical reduction and strong fixation. Anatomical reduction can restore the normal shape of the knee joint; strong fixation provides good biomechanical stability, so that the patient can have early functional exercise, restore knee mobility as early as possible, and avoid knee stiffness. Different internal fixators have their own biomechanical strengths and characteristics. The screw fixation has the advantage of being minimally invasive, but the fixation strength is limited, and it is mostly applied to Schatzker typeⅠfracture. For Schatzker Ⅰ-Ⅳ fracture, unilateral plate fixation can be used; for Schatzker Ⅴand Ⅵ fracture, bilateral plates fixation can be used to provide stronger fixation strength and avoid the stress concentration. The intramedullary nails fixation has the advantages of less trauma and less influence on the blood flow of the fracture end, but the fixation strength of the medial and lateral plateau is limited; so it is more suitable for tibial plateau fracture that involves only the metaphysis. Choosing the most appropriate internal fixation according to the patient’s condition is still a major difficulty in the surgical treatment of tibial plateau fractures. Conclusion Each internal fixator has good fixation effect on tibial plateau fracture within the applicable range, and it is an important research direction to improve and innovate the existing internal fixator from various aspects, such as manufacturing process, material, and morphology.

Citation： LIU Jialun, ZHANG Yingze, ZHENG Zhanle. Research progress on biomechanics for internal fixation in tibial plateau fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(1): 113-118. doi: 10.7507/1002-1892.202309077 Copy

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1. 張英澤. 臨床創傷骨科流行病學. 北京: 人民衛生出版社, 2014: 290-291.
2. Burdin G. Arthroscopic management of tibial plateau fractures: surgical technique. Orthop Traumatol Surg Res, 2013, 99(1 Suppl): S208-S218.
3. Thomas Ch, Athanasiov A, Wullschleger M, et al. Current concepts in tibial plateau fractures. Acta Chir Orthop Traumatol Cech, 2009, 76(5): 363-373.
4. 于沂陽, 常恒瑞, 李石倫, 等. 2010年至2011年中國東部地區與西部地區成人脛骨平臺骨折的流行病學對比分析. 中華創傷骨科雜志, 2017, 19(10): 861-865.
5. 朱燕賓, 侯志勇, 金柱成, 等. 2010年至2011年華北五省市18所醫院脛骨平臺骨折流行病學調查研究. 中華創傷骨科雜志, 2020, 22(8): 682-686.
6. Greimel F, Weber M, Renkawitz T, et al. Minimally invasive treatment of tibial plateau depression fractures using balloon tibioplasty: Clinical outcome and absorption of bioabsorbable calcium phosphate cement. J Orthop Surg (Hong Kong), 2020, 28(1): 2309499020908721.
7. Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev, 2017, 1(5): 225-232.
8. Menzdorf L, Drenck T, Akoto R, et al. Clinical results after surgical treatment of posterolateral tibial plateau fractures (“apple bite fracture”) in combination with ACL injuries. Eur J Trauma Emerg Surg, 2020, 46(6): 1239-1248.
9. F?ndriks A, Tranberg R, Karlsson J, et al. Gait biomechanics in patients with intra-articular tibial plateau fractures-gait analysis at three months compared with age- and gender-matched healthy subjects. BMC Musculoskelet Disord, 2021, 22(1): 702.
10. Hashemi J, Chandrashekar N, Gill B, et al. The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint. J Bone Joint Surg (Am), 2008, 90(12): 2724-2734.
11. Krause M, Hubert J, Deymann S, et al. Bone microarchitecture of the tibial plateau in skeletal health and osteoporosis. Knee, 2018, 25(4): 559-567.
12. 朱燕賓, 陳偉, 張奇, 等. 脛骨平臺核心負重區的概念及其臨床意義. 中華骨科雜志, 2021, 41(3): 137-140.
13. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968—1975. Clin Orthop Relat Res, 1979, (138): 94-104.
14. Giordano V, Belangero WD, Sá BA, et al. Plate-screw and screw-washer stability in a Schatzker type-Ⅰ lateral tibial plateau fracture: a comparative biomechanical study. Rev Col Bras Cir, 2020, 47: e20202546.
15. Kfuri M, Schatzker J. Revisiting the Schatzker classification of tibial plateau fractures. Injury, 2018, 49(12): 2252-2263.
16. Parker PJ, Tepper KB, Brumback RJ, et al. Biomechanical comparison of fixation of type-Ⅰ fractures of the lateral tibial plateau. Is the antiglide screw effective? J Bone Joint Surg (Br), 1999, 81(3): 478-480.
17. Moran E, Zderic I, Klos K, et al. Reconstruction of the lateral tibia plateau fracture with a third triangular support screw: A biomechanical study. J Orthop Translat, 2017, 11: 30-38.
18. Petersen W, Zantop T, Raschke M. Tibial head fracture open reposition and osteosynthesis—arthroscopic reposition and osteosynthesis (ARIF). Unfallchirurg, 2006, 109(3): 235-244.
19. Weimann A, Heinkele T, Herbort M, et al. Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: a biomechanical study. BMC Musculoskelet Disord, 2013, 14: 120.
20. 張璽, 孫杰, 李方國, 等. 交叉排釘技術對防止脛骨外側平臺骨折術后關節面塌陷的價值. 中華骨科雜志, 2018, 38(15): 897-904.
21. Ren P, Niu H, Gong H, et al. Morphological, biochemical and mechanical properties of articular cartilage and subchondral bone in rat tibial plateau are age related. J Anat, 2018, 232(3): 457-471.
22. Ye X, Huang D, Perriman DM, et al. Influence of screw to joint distance on articular subsidence in tibial-plateau fractures. ANZ J Surg, 2019, 89(4): 320-324.
23. 孔祥如, 楊春, 單宇宙, 等. 脛骨近端外側鎖定接骨板排筏螺釘聯合Jail螺釘治療脛骨平臺外側塌陷骨折. 中華創傷雜志, 2022, 38(6): 510-516.
24. Salduz A, Birisik F, Polat G, et al. The effect of screw thread length on initial stability of Schatzker type 1 tibial plateau fracture fixation: a biomechanical study. J Orthop Surg Res, 2016, 11(1): 146.
25. Hasan S, Ayalon OB, Yoon RS, et al. A biomechanical comparison between locked 3.5-mm plates and 4.5-mm plates for the treatment of simple bicondylar tibial plateau fractures: is bigger necessarily better? J Orthop Traumatol, 2014, 15(2): 123-129.
26. 陳軼騰, 屠震宇, 嚴戰濤, 等. 單側和雙側鋼板內固定治療Schatzker Ⅵ型脛骨平臺骨折患者的臨床療效比較. 中華老年醫學雜志, 2017, 36(9): 992-994.
27. 楊宗酉, 程曉東, 朱煉, 等. 內側和外側鎖定鋼板固定Schatzker Ⅵ型脛骨平臺骨折的有限元分析. 中華創傷骨科雜志, 2018, 20(2): 157-161.
28. Neogi DS, Trikha V, Mishra KK, et al. Comparative study of single lateral locked plating versus double plating in type C bicondylar tibial plateau fractures. Indian J Orthop, 2015, 49(2): 193-198.
29. Lee AK, Cooper SA, Collinge C. Bicondylar tibial plateau fractures: A critical analysis review. JBJS Rev, 2018, 6(2): e4.
30. 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, 2020, 46(6): 1257-1266.
31. Chang H, Zhu Y, Zheng Z, et al. Meta-analysis shows that highly comminuted bicondylar tibial plateau fractures treated by single lateral locking plate give similar outcomes as dual plate fixation. Int Orthop, 2016, 40(10): 2129-2141.
32. Wei G, Niu X, Li Y, et al. Biomechanical analysis of internal fixation system stability for tibial plateau fractures. Front Bioeng Biotechnol, 2023, 11: 1199944.
33. Thamyongkit S, Abbasi P, Parks BG, et al. Weightbearing after combined medial and lateral plate fixation of AO/OTA 41-C2 bicondylar tibial plateau fractures: a biomechanical study. BMC Musculoskelet Disord, 2022, 23(1): 86.
34. Scolaro JA, Wright DJ, Lai W, et al. Fixation of extra-articular proximal tibia fractures: biomechanical comparison of single and dual implant constructs. J Am Acad Orthop Surg, 2022, 30(13): 629-635.
35. Kumar V, Singhroha M, Arora K, et al. A clinico-radiological study of bicondylar tibial plateau fractures managed with dual locking plates. J Clin Orthop Trauma, 2021, 21: 101563.
36. 王博, 王娟, 鄭占樂, 等. 自斷加壓骨栓聯合接骨板治療脛骨平臺骨折的療效. 中華創傷骨科雜志, 2021, 23(2): 111-115.
37. Lasanianos NG, Garnavos C, Magnisalis E, et al. A comparative biomechanical study for complex tibial plateau fractures: nailing and compression bolts versus modern and traditional plating. Injury, 2013, 44(10): 1333-1339.
38. Chen P, Lu H, Shen H, et al. Newly designed anterolateral and posterolateral locking anatomic plates for lateral tibial plateau fractures: a finite element study. J Orthop Surg Res, 2017, 12(1): 35.
39. Djuricic A, Gee A, Schemitsch EH, et al. Biomechanical design of a new percutaneous locked plate for comminuted proximal tibia fractures. Med Eng Phys, 2022, 104: 103801.
40. Yan B, Huang X, Xu Y, et al. A novel locking buttress plate designed for simultaneous medial and posterolateral tibial plateau fractures: concept and comparative finite element analysis. Orthop Surg, 2023, 15(4): 1104-1116.
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