The Study of Biomechanics and Clinical Anatomy on a Novel Plate Designed for Posterolateral Tibial Plateau Fractures via Anterolateral Approach

Abstract

There is no consensus about the optimal internal fixation selection for treatment of posterolateral tibial plateau fracture. This study described a novel plate through an anterolateral approach for posterolateral tibial plateau fractures (PTPFs). We evaluated the biomechanical performance of a novel plate and two conventional internal implants and investigated the anatomic feasibility of the novel plate. The fracture models were randomly assigned into six groups: Groups A–C were the model groups of posterolateral split fracture, fixed with the posterior buttress plate, the lateral locking plate, and the novel plate, respectively. Groups D–E were the model groups of posterolateral depression fracture, fixed with the posterior buttress plate, the lateral locking plate, and the novel plate, respectively. We evaluated the biomechanical performance of six model groups by the biomechanical testing and finite element analysis. Progressively increasing axial compressive loads were applied to each synthetic fracture model by using a customized indentor under 250–750 N loads. Meanwhile, we dissected 12 fresh frozen knee specimens and fixed them with the novel plate through the anterolateral approach. We recorded the adjacency of the novel plate to important anatomic structures. Biomechanical testing showed that the novel plate had the least displacement, followed by the posterior buttress plate, and the lateral plate had the most displacement in posterolateral split fracture. There was no significant difference in the displacement between the novel plate and the lateral plate at different loads in posterolateral depression fractures. And the posterior buttress plate showed the most displacement. In the finite element analysis, the maximum stress values of Groups A, B, and C were 383.76, 414.63, and 305.07 MPa under the load of 750 N, respectively. The maximum stress values of Groups D, E, and F were 474.28, 436.31, and 413.4 MPa under the load of 750 N, respectively. In the anatomic study, the placement of the novel plate had a low risk of damage to the important anatomic structures of knee posterolateral corner. The novel plate could be a great choice for the treatment of PTPFs due to better biomechanical performance and easy manipulation.

Operative Repair of a Schatzker II Tibial Plateau Fracture Using a Combined Anterolateral and Posterolateral Approach Without Fibular Head Osteotomy

“…Biomechanically, there is increased control and support of the posterolateral fragment with a posteriorly applied buttress plate. 3 Potential complications with this surgical approach include iatrogenic injury to the peroneal nerve, wound dehiscence, superficial or deep surgical site infection, and loss of reduction. In addition, there is limited distal posterolateral extension of the approach because of the bifurcation of the popliteal vessel into the anterior and posterior tibial arteries.…”

“…Biomechanically, there is increased control and support of the posterolateral fragment with a posteriorly applied buttress plate. 3…”

Biomechanical and Finite-Element Analysis of Femoral Pin-Site Fractures Following Navigation-Assisted Total Knee Arthroplasty

“…We analyzed the von Mises stress distribution, the maximum von Mises stress, and deformation in each simulation. The finite-element modeling and the procedure have been validated in our published study 20 .…”

Model Properties and Clinical Application in the Finite Element Analysis of Knee Joint: A Review

“…91 Ren et al proposed a plate for the treatment of posterolateral tibial plateau fracture (PLTPF) through an anterolateral approach and compared the new plate with a conventional one, verifying that the new plate was more convenient to operate and had better biomechanical properties. 92 Du et al compared the clinical effects and mechanical properties of different treatment methods for inferior pole fractures of the patella. 93 The anchor-loop plate had better biomechanical stability and clinical effect than the Kirschner wire tension band combined with patellar cerclage.…”

“…Ren et al . proposed a plate for the treatment of posterolateral tibial plateau fracture (PLTPF) through an anterolateral approach and compared the new plate with a conventional one, verifying that the new plate was more convenient to operate and had better biomechanical properties 92 . Du et al .…”