Biomechanical Evaluation of a Fin-type Implant Compared to Traditional Buttress Plate for the Stabilization of the Posteromedial Fragment in Tibial Plateau Split Fractures

Abstract Background: Dealing with high-energy fractures of the tibial plateau remains a challenge despite advances in implants, surgical approaches, and imaging methods. Posterior buttress plate is most commonly used implant but the fixation stability is still a challenge. Recently, a newly designed tibial locking plate was introduced that aims to provide better fixation strength for tibial plateau split fracture. This study compared the biomechanical strength of three different posteromedial tibial plateau split fracture fixation methods. Methods: The tibial plateau fractures were simulated using a human tibiae model. Each fracture model was virtually implanted with one of the three following constructs, proximal medial tibial plate (PMT), proximal posterior medial tibial plate (PPMT), and posterior T-shaped buttress plate (TBP). Posteromedial fragment vertical subsidence was measured under 2000 N joint contact force. The maximum Equivalent stress on the bone plate and bone screw and the construct stiffness were determined.Results: The proximal medial tibial plate (PMT) allowed the least posteromedial fragment subsidence and produced higher construct stiffness than each of the other two constructs. However, the proximal posterior medial tibial plate (PPMT) showed higher stiffness than the T-shaped buttress plate (TBP). The maximum Equivalent stress was the smallest for the proximal medial tibial plate (PMT).Conclusion: This study showed that the proximal medial tibial locking plate or proximal posterior medial tibial locking plate were biomechanically more stable fixation methods for posteromedial split tibial plateau fractures.

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Arthroscopic-assisted reduction with bilateral buttress plate fixation of complex tibial plateau fractures

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2003.09.038 ◽

2003 ◽

Vol 19 (9) ◽

pp. 974-984 ◽

Cited By ~ 41

Author(s):

Yi-Sheng Chan ◽

Li-Jen Yuan ◽

Shou-Suei Hung ◽

Ching-Jen Wang ◽

Shang-Won Yu ◽

...

Keyword(s):

Tibial Plateau ◽

Plate Fixation ◽

Tibial Plateau Fractures ◽

Buttress Plate

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Plating as an operative management of intra articular fractures of the upper end of tibia: a prospective clinical study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174718 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1223

Author(s):

Namdev Gorgile ◽

Vinod Jagtap ◽

Yash Shah ◽

Vikas Rokade ◽

Girish Bartakke

Keyword(s):

Internal Fixation ◽

Tibial Plateau ◽

High Energy ◽

Early Mobilisation ◽

Anatomical Reduction ◽

Plating Technique ◽

Knee Stiffness ◽

Articular Fractures ◽

Buttress Plate ◽

Stable Internal Fixation

Background: Tibial plateau fracture management is challenging because of the severe displacement of the bony fragments, the concomitant depression and impaction of the cancellous subchondral bone, and the inevitable associated cartilage injury.Methods: A prospective cohort study of 25 patients who suffered high energy intra-articular fractures of proximal tibia was done and they were diagnosed and classified according to Schatzker’s classification. The study was done to study the outcomes of surgical management of high energy tibial plateau fractures with buttress plate, to achieve anatomical reduction and absolute stable internal fixation to prevent malunion, to achieve early mobilisation, to prevent post-operative knee stiffness and also to determine timing of operation after trauma and sequence of fixation of bicondylar fractures. All patients were treated with open reduction and internal fixation with a buttress plate either a lateral, medial or bicondylar plating.Results: Average radio-graphic bony union time was 12 weeks. Average full weight bearing time was 13 weeks. Knee stiffness improved with physiotherapy and full range was achieved on an average in 8 weeks, mean range of movement 0-124.5º was achieved. 4 patients (16%) developed infection. Conclusions: Fractures of upper end of tibia can be treated with the plating technique, to achieve anatomical reduction and stable internal fixation with 82% good functional outcome. The plating technique facilitates early mobilisation of injured joint and attains good range of movements. Minimal mal reduction does not seem to vitiate the results. The infection rate of 16% is of concern with this procedure, but responds well to antibiotics and surgical debridement.

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Anatomical and Clinical Rationale for Posterolateral Transfibular Approach for Internal Fixation of the Posterolateral Column of the Tibial Plateau

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2019-25-3-112-123 ◽

2019 ◽

Vol 25 (3) ◽

pp. 112-123

Author(s):

A. Yu. Kochish ◽

M. A. Kislitsyn ◽

I. G. Belen’kii ◽

B. A. Mayorov ◽

D. A. Starchik

Keyword(s):

Internal Fixation ◽

Surgical Approach ◽

Peroneal Nerve ◽

Tibial Plateau ◽

Common Peroneal Nerve ◽

Anterior Tibial Artery ◽

Tibial Condyle ◽

Anterior Tibial ◽

The Common ◽

Buttress Plate

Purpose of the study — to provide an anatomical rationale and evaluate the clinical application of posterolateral surgical approach with osteotomy of the fibular head for internal fixation of the posterior aspect of the lateral tibial condyle. Material and Methods. Anatomical topography research was performed on 14 lower limbs of 8 fresh cadavers. In the first series of research L-shaped plate was fixed on the posterolateral surface of lateral tibial condyle from the examined approach, then preparation was performed and measuring of distances from various parts of the plates to the common peroneal nerve and anterior tibial artery. In the second series the authors prepared histological topograms by transverse sectioning of plastinated specimens from the knee joint area after implantation of L-shaped buttress plates. Prospective observation clinical study included 20 patients who underwent internal fixation with L-shaped buttress plate from the examined approach for fracture of the posterolateral column of the tibial plateau, type 41В by AO classification. KSS and Lysholm scales were used to evaluate treatment outcomes at days 7–10 and in 1, 3, 6 and 9 months postoperatively. Data of the anatomical and clinical research was compared. Results. Compliance with the technique of posterolateral transfibular surgical approach allows to avoid risk of injury to the common peroneal nerve and anterior tibial arthery which on the specimen were always located safely away from implanted plates. All 20 clinical cases demonstrated good visualization of bone fragments and articular surface of the tibial plateau which ensured reliable reduction and fixation by L-shaped buttress plate. KSS excellent and good outcome scores amounted to 50% and 45%, respectively, while satisfactory score was reported in 5% of cases; Lysholm scale demonstrated 55% of excellent outcomes, 45% of good outcomes, and 5% of satisfactory outcomes. Safety of the approach was verified: no injuries to large blood vessels or iatrogenic neuropathies were reported as well as no large hematomas or infectious complications of the surgical wound in early postoperative period. Conclusion. Results of the present study proved the feasibility and safety of the posterolateral transfibular surgical approach for internal fixation procedures in patients with intraarticular fractures of posterolateral column of the tibial plateau.

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Biomechanical Evaluation of a New Anatomic Locking Buttress Plate for Posteromedial Tibial Plateau Fixation.

10.21203/rs.3.rs-631817/v1 ◽

2021 ◽

Author(s):

Kai Cheng Lin ◽

Yih Wen Tarng ◽

Hung-Wen Wei ◽

Kun-Jhih Lin

Keyword(s):

Tibial Plateau ◽

Locking Plate ◽

Equivalent Stress ◽

High Energy ◽

Tibial Plateau Fractures ◽

Surgical Approaches ◽

Fixation Methods ◽

Maximum Equivalent Stress ◽

Tibial Plate ◽

Buttress Plate

Abstract Background: Dealing with high-energy fractures of the tibial plateau remains a challenge despite advances in implants, surgical approaches, and imaging methods. Posterior buttress plate is most commonly used implant but the fixation stability is still a challenge. Recently, a newly designed tibial locking plate was introduced that aims to provide better fixation strength for tibial plateau split fracture. This study compared the biomechanical strength of three different posteromedial tibial plateau split fracture fixation methods. Methods: The tibial plateau fractures were simulated using a human tibiae model. Each fracture model was virtually implanted with one of the three following constructs, proximal medial tibial plate (PMT), proximal posterior medial tibial plate (PPMT), and posterior T-shaped buttress plate (TBP). Posteromedial fragment vertical subsidence was measured under 2000 N joint contact force. The maximum Equivalent stress on the bone plate and bone screw and the construct stiffness were determined.Results: The proximal medial tibial plate (PMT) allowed the least posteromedial fragment subsidence and produced higher construct stiffness than each of the other two constructs. However, the proximal posterior medial tibial plate (PPMT) showed higher stiffness than the T-shaped buttress plate (TBP). The maximum Equivalent stress was the smallest for the proximal medial tibial plate (PMT).Conclusion: This study showed that the proximal medial tibial locking plate or proximal posterior medial tibial locking plate were biomechanically more stable fixation methods for posteromedial split tibial plateau fractures.

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