Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: a biomechanical study

Abstract

BackgroundThis study described a novel, minimally invasive reconstruction technique of lateral tibial plateau fractures using a three-screw jail technique and compared it to a conventional two-screw osteosynthesis technique. The benefit of an additional screw implanted in the proximal tibia from the anterior at an angle of 90° below the conventional two-screw reconstruction after lateral tibial plateau fracture was evaluated. This new method was called the jail technique.MethodsThe two reconstruction techniques were tested using a porcine model (n = 40). Fracture was simulated using a defined osteotomy of the lateral tibial plateau. Load-to-failure and multiple cyclic loading tests were conducted using a material testing machine. Twenty tibias were used for each reconstruction technique, ten of which were loaded in a load-to-failure protocol and ten cyclically loaded (5000 times) between 200 and 1000 N using a ramp protocol. Displacement, stiffness and yield load were determined from the resulting load displacement curve. Failure was macroscopically documented.ResultsIn the load-to-failure testing, the jail technique showed a significantly higher mean maximum load (2275.9 N) in comparison to the conventional reconstruction (1796.5 N, p < 0.001). The trend for better outcomes for the novel technique in terms of stiffness and yield load did not reach statistical significance (p > 0.05). In cyclic testing, the jail technique also showed better trends in displacement that were not statistically significant. Failure modes showed a tendency of screws cutting through the bone (cut-out) in the conventional reconstruction. No cut-out but a bending of the lag screws at the site of the additional third screw was observed in the jail technique.ConclusionsThe results of this study indicate that the jail and the conventional technique have seemingly similar biomechanical properties. This suggests that the jail technique may be a feasible alternative to conventional screw osteosynthesis in the minimally invasive reconstruction of lateral tibial plateau fractures. A potential advantage of the jail technique is the prevention of screw cut-outs through the cancellous bone.

Biomechanical evaluation of different surgical techniques for treating patellar tendon ruptures

“…This loading protocol is within the general range of loads reported in the literature and represents a relatively modest load level, imitating an accelerated rehabilitation protocol, with partial weight bearing and limited flexion angle post-operatively and increasing flexion angles and full weight bearing later in the rehabilitation process. Loading frequency was similar to that of other studies and appears to be within a physiological range of loading [27].…”

Diagnosis and Treatment of Anterior Tibial Plateau Fracture–Dislocation: A Case Series and Literature Review

“…Nevertheless, the introduction of the locking plate and rafting screw technique has greatly improved the treatment of severe tibial plateau fractures. [25][26][27] Furthermore, most anterior tibial plateau fracture-dislocations occur at a distance of approximately 1 to 2 cm from the joint surface, where the rafting screws in rafting technique are placed; therefore, the grip of the rafting screw on bone fragments would also be reduced. ►Fig.…”

Influence of reduction accuracy in lateral tibial plateau fractures on intra-articular friction – a biomechanical study

“…This is usually achieved by performing an anterolateral approach combined with an angle-stable plate osteosynthesis or screws. In selected cases a minimally invasive procedure with screws in conventional two-screw osteosynthesis technique or jail-technique can be performed [1]. Reduction control can thereby be done fluoroscopically or arthroscopically [2].…”