Comparative finite element analysis between three surgical techniques for the treatment of type VI schatzker tibial plateau fractures

Abstract

Introduction: Open reduction internal fixation (ORIF) and external fixation are traditional surgical techniques for treating type VI Schatzker tibial plateau fractures. A newly developed technique integrates the intramedullary tibial nail with condylar bolts. This finite element study investigated the mechanical response of three surgical techniques for fixing type VI Schatzker tibial plateau fractures. We compared the intramedullary nail-bolt (IMNB) technique with the single lateral locking plate (SLLP) and dual plating (DP) techniques.
Materials&Methods: A 4th generation Sawbone model of a left tibia with a Type VI tibial plateau fracture was scanned using computed tomography and reconstructed into a 3D model. The plates were digitally reconstructed using 3D scanning technology, while the screws, condylar bolt, and nail were replicated using commercial computer-aided design software. An application engineer guided by a surgeon, virtually positioned the bone-implant construct for the three surgical techniques to align with physical constructs from a previous in-vitro biomechanical study. A commercial finite element analysis software was used for the computer simulation, with the tibial plateau subjected to uniaxial loads at 500, 1000, and 1500 Newton while the distal tip of the tibia remained fixed. Measurements of vertical subsidence, horizontal diastasis, and passive construct stiffness were recorded and compared to those of the previous in-vitro biomechanical experiment.
Results: DP had the highest stiffness, followed by IMNB and SLLP techniques. DP also resulted in smaller values for measured subsidence and diastasis compared to SLLP and IMNB. The simulation results aligned with those of the in-vitro biomechanical study
Conclusions: The simulation results may further support the initial suggestion of the in-vitro biomechanical study that the IMNB technique is a biomechanically suitable method for fixing Type VI Schatzker injuries.