Bone substitute first or screws first? A biomechanical comparison of two operative techniques for tibial-head depression fractures

Hoelscher-Doht, Stefanie; Jordan, Martin; Bonhoff, Christina; Frey, Sönke P.; Blunk, Torsten; Meffert, Rainer H.

doi:10.1007/s00776-014-0613-4

Cited by 13 publications

(28 citation statements)

References 14 publications

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“…Seventy two synthetic bones (Synbone 1110, SYNBONE®, Switzerland) were used as specimens because they have similar biomechanical qualities to elderly human bones as proved in a previous study [ 10 , 13 , 14 ]. The bones were cut at the diaphysis 20 cm below the tibial plateau and embedded in 5° valgus in a custom made device [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

“…When comparing commonly used calcium phosphate bone substitutes to a traditional bone graft, biomechanical studies have revealed an equal or even better primary stability for the bone substitutes [ 7 , 8 ]. In previous biomechanical investigations of tibial head depression fractures, the need to use a bone substitute, preferably a drillable substitute, to reduce a secondary loss of reduction of the depressed articular fracture fragment has been demonstrated [ 9 , 10 ]. Despite this, no studies, which have compared possible osteosyntheses and the effect of different bone substitutes in tibial head depression fractures, could be located.…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical analysis of different osteosyntheses and the combination with bone substitute in tibial head depression fractures

Jordan

Zimmermann

Gho

et al. 2016

BMC Musculoskelet Disord

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BackgroundTibial head depression fractures demand a high level of fracture stabilization to prevent a secondary loss of reduction after surgery. Elderly individuals are at an increased risk of developing these fractures, and biomechanical investigations of the fractures are rare. Therefore, the aim of this study was to systematically analyze different types of osteosyntheses in combination with two commonly used bone substitutes.MethodsLateral tibial head depression fractures were created in synthetic bones. After reduction, the fractures were stabilized with eight different treatment options of osteosynthesis alone or in combination with a bone substitute. Two screws, 4 screws and a lateral buttress plate were investigated. As a bone substitute, two common clinically used calcium phosphate cements, Norian® Drillable and ChronOS™ Inject, were applied. Displacement of the articular fracture fragment (mm) during cyclic loading, stiffness (N/mm) and maximum load (N) in Load-to-Failure tests were measured.ResultsThe three different osteosyntheses (Group 1: 2 screws, group 2: 4 screws, group 3: plate) alone revealed a significantly higher displacement compared to the control group (Group 7: ChronOS™ Inject only) (Group 1, 7 [p < 0.01]; group 2, 7 [p = 0.04]; group 3, 7 [p < 0.01]). However, the osteosyntheses in combination with bone substitute exhibited no differences in displacement compared to the control group. The buttress plate demonstrated a higher normalized maximum load than the 2 and 4 screw osteosynthesis. Comparing the two different bone substitutes to each other, ChronOS™ inject had a significantly higher stiffness and lower displacement than Norian® Drillable.ConclusionsThe highest biomechanical stability under maximal loading was provided by a buttress plate osteosynthesis. A bone substitute, such as the biomechanically favorable ChronOS™ Inject, is essential to reduce the displacement under lower loading.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Biomechanical analysis of different osteosyntheses and the combination with bone substitute in tibial head depression fractures

Jordan

Zimmermann

Gho

et al. 2016

BMC Musculoskelet Disord

Self Cite

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“…While no studies on plateau fractures comparing screw combinations exist, there are some similar studies in the literature, although they do not compare fully and partially threaded screws [20]. Fixation of medial malleoli fractures with fully threaded cortical screw has an advantage compared to unicortical partially threaded lag screws [21, 22].…”

Section: Discussionmentioning

confidence: 99%

The effect of screw thread length on initial stability of Schatzker type 1 tibial plateau fracture fixation: a biomechanical study

et al. 2016

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BackgroundThis study compares the cyclic loading properties and failure loads of two screw combinations on a synthetic Schatzker type 1 tibia fracture model. Our hypothesis was that after adequate compression with first a partially threaded screw, addition of a fully threaded screw would provide more stability than an addition of a second partially threaded screw.MethodsThe Schatzker type 1 tibial plateau fracture model was created. Fixation was obtained in group A (n = 10) with two partially threaded screws and in group B (n = 10) with one fully threaded screw and one partially threaded screw. Load-displacement evaluation was made at each 1000-cycle interval up to 10,000 cycles. Failure load was identified as the load creating a 2-mm displacement. Two-factor (groups and periods) repeated measurement analysis of variance and independent sample t tests were used.ResultsAccording to the two-factor repeated analysis, there was no significant difference for periods (p = 0.29) and time-period interaction (p = 0.59) (Wilk’s Lambda F value, 1.507 and 0.871, respectively). In the test of between-subject effects, there was no significant difference between groups in terms of cyclic loadings (p = 0.06, F = 4.065). However, in the t test for each 1000-cycle interval, the value of mean displacement in group B was significantly lower than that in group A in the initial, 1000-, 2000-, and 3000-cycle intervals (p = 0.023, 0.031, 0.025, 0.043, respectively). The mean displacement and standard deviations increased with the number of cycles. The mean range of displacement initially was 0.66 mm for group A and 0.36 mm for group B. The mean range of displacement after 10,000 cycles was 0.79 mm for group A and 0.44 mm for group B. The mean failure load value was 682 ± 234 N for group A and 835 ± 245 N for group B. In independent sample t tests, there were no significant differences between the two groups in terms of failure load (p > 0.05).ConclusionsObtaining fixation with one partially and one fully threaded screw can minimize displacement at the fracture site at early cyclic loadings.

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“…The use of bone grafting in conventionally treated plateau fractures is associated with superior results [ 34 ]. Bone graft, using either autogenous (autologous) bone or bone substitutes, is packed within the subarticular osseous defect following fracture reduction and preferably before internal fixation [ 5 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…The early restoration of normal joint function is the goal of treatment of depressed fractures of the tibial plateau. The principles of treatment include arthroscopically assisted or open anatomic reduction followed by stable internal fixation [ 1 - 5 ]. The reduction and internal fixation may be performed through open, limited open or percutaneous incision approaches [ 6 - 8 ].…”

Section: Introductionmentioning

confidence: 99%

Autograft Transfer from the Ipsilateral Femoral Condyle in Depressed Tibial Plateau Fractures

Sferopoulos¹

2014

TOORTHJ

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Introduction : The rationale for operative treatment of depressed tibial plateau fractures is anatomic reduction, stable fixation and grafting. Grafting options include autogenous bone graft or bone substitutes.Methods : The autograft group included 18 patients with depressed tibial plateau fractures treated with autogenous bone grafting from the ipsilateral femoral condyle following open reduction and internal fixation. According to Schatzker classification, there were 9 type II, 4 type III, 2 type IV and 3 type V lesions. The average time to union and the hospital charges were compared with the bone substitute group. The latter included 17 patients who had an excellent outcome following treatment of split and/or depressed lateral plateau fractures, using a similar surgical technique but grafting with bone substitutes (allografts).Results : Excellent clinical and radiological results were detected in the autograft group after an average follow-up of 28 months (range 12-37). The average time to union in the autograft group was 14 weeks (range 12-16), while in the bone substitute group it was 18 weeks (range 16-20). The mean total cost was 1276 Euros for the autograft group and 2978 Euros for the bone substitute group.Discussion : The use of autogenous graft from the ipsilateral femoral condyle following open reduction and internal fixation of depressed tibial plateau fractures provided enough bone to maintain the height of the tibial plateau and was not associated with any donor site morbidity. Using this method, the surgical time was not significantly elongated and the rehabilitation was not affected. It also exhibited faster fracture healing without postoperative loss of reduction and it was less expensive than the use of bone substitutes.

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Bone substitute first or screws first? A biomechanical comparison of two operative techniques for tibial-head depression fractures

Cited by 13 publications

References 14 publications

Biomechanical analysis of different osteosyntheses and the combination with bone substitute in tibial head depression fractures

Biomechanical analysis of different osteosyntheses and the combination with bone substitute in tibial head depression fractures

The effect of screw thread length on initial stability of Schatzker type 1 tibial plateau fracture fixation: a biomechanical study

Autograft Transfer from the Ipsilateral Femoral Condyle in Depressed Tibial Plateau Fractures

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