The effect of coronal splits on the structural stability of bi-condylar tibial plateau fractures: a biomechanical investigation

Abstract

Introduction Surgical treatment of bi-condylar tibial plateau fractures is still challenging due to the complexity of the fracture and the difficult surgical approach. Coronal fracture lines are associated with a high risk of fixation failure. However, previous biomechanical studies and fracture classifications have disregarded coronal fracture lines. Materials and methods This study aimed to develop a clinically relevant fracture model (Fracture C) and compare its mechanical behavior with the traditional Horwitz model (Fracture H). Twelve samples of fourth-generation tibia Sawbones were utilized to realize two fracture models with (Fracture C) or without (Fracture H) a coronal fracture line and both fixed with lateral locking plates. Loading of the tibial plateau was introduced through artificial femur condyles to cyclically load the fracture constructs until failure. Stiffness, fracture gap movements, failure loads as well as relative displacements and rotations of fracture fragments were measured. Results The presence of a coronal fracture line reduced fracture construct stiffness by 43% (p = 0.013) and decreased the failure load by 38% from 593 ± 159 to 368 ± 63 N (p = 0.016). Largest displacements were observed at the medial aspect between the tibial plateau and the tibial shaft in the longitudinal direction. Again, the presence of the coronal fracture line reduced the stability of the fragments and created increased joint incongruities. Conclusions Coronal articular fracture lines substantially affect the mechanical response of tibia implant structures specifically on the medial side. With this in mind, utilizing a clinically relevant fracture model for biomechanical evaluations regarding bi-condylar tibial plateau fractures is strongly recommended.

Tibial plateau fractures: three dimensional fracture mapping and morphologic measurements

“…Samsami et al found that coronal plane fracture lines significantly affect the mechanical response of tibial implant structures, especially medially, through their study [29]. Yet, this type of fracture models was not distinguishable by Schatzker classification.…”

Fractures around Trochanteric Nails: The “Vergilius Classification System”

“…Moreover, two other members of the research group questioned the relevance of fracture fragmentation because, in their personal experience, most of the PNFs were simple 2 fragment fractures. However, most of the members of the research group were in agreement that fracture morphology and fragmentation must be considered relevant because they affect primary fracture stability [ 24 , 25 ] and guide the fixation technique (i.e., the choice between relative or absolute stability) [ 26 ]. For example, the intrinsic stability and the difficulty in obtaining nail-periosteum contact in femoral spiral fractures make mandatory the use of locked nails or plates [ 24 ].…”

Biomechanical Comparison of 2 Double Plating Methods in a Coronal Fracture Model of Bicondylar Tibial Plateau Fractures

“…One reason for the current controversy regarding the ideal fixation method for bicondylar tibial plateau fractures is related to the inadequacy of previous fracture classifications and fracture models in representing clinical morphology of the fracture site. 9,26 In clinical studies, there is no consistency about types and positions of plates used for fracture management. Therefore, applying the coronal fracture model, developed and evaluated in our institution, 9,26 we compared 2 kinds of double locked plating techniques with different positions of the medial locking plates.…”

“…27,28 Mechanical performance of osteosynthesis constructs was characterized with static and dynamic global stiffness, IFM, relative rotations of fracture fragments, survival rates, failure load, and failure cycles, which all of them were defined in our previous publication. 26 The fixation methods were statistically compared using independent t tests with a significance level of P , 0.05. The Kaplan-Meier survival analyses with log-rank tests were also used to evaluate the effects of fixation methods on sample survival rates during the fatigue test (IBM SPSS Statistics 19, Chicago, IL).…”