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. 张英泽. 临床创伤骨科流行病学. 北京: 人民卫生出版社, 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. 于沂阳, 常恒瑞, 李石伦, 等. 2010年至2011年中国东部地区与西部地区成人胫骨平台骨折的流行病学对比分析. 中华创伤骨科杂志, 2017, 19(10): 861-865.
5. 朱燕宾, 侯志勇, 金柱成, 等. 2010年至2011年华北五省市18所医院胫骨平台骨折流行病学调查研究. 中华创伤骨科杂志, 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. Fändriks 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. 朱燕宾, 陈伟, 张奇, 等. 胫骨平台核心负重区的概念及其临床意义. 中华骨科杂志, 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. 张玺, 孙杰, 李方国, 等. 交叉排钉技术对防止胫骨外侧平台骨折术后关节面塌陷的价值. 中华骨科杂志, 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, 杨春, 单宇宙, 等. 胫骨近端外侧锁定接骨板排筏螺钉联合Jail螺钉治疗胫骨平台外侧塌陷骨折. 中华创伤杂志, 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. 陈轶腾, 屠震宇, 严战涛, 等. 单侧和双侧钢板内固定治疗Schatzker Ⅵ型胫骨平台骨折患者的临床疗效比较. 中华老年医学杂志, 2017, 36(9): 992-994.
27. 杨宗酉, 程晓东, 朱炼, 等. 内侧和外侧锁定钢板固定Schatzker Ⅵ型胫骨平台骨折的有限元分析. 中华创伤骨科杂志, 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, 郑占乐, 等. 自断加压骨栓联合接骨板治疗胫骨平台骨折的疗效. 中华创伤骨科杂志, 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.
41. Lu Y, Bai H, Wang Q, et al. The study of biomechanics and finite element analysis on a novel plate for tibial plateau fractures via anterolateral supra-fibular-head approach. Sci Rep, 2023, 13(1): 13516.
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