Biomechanical analysis of operative methods in the treatment of extra-articular fracture of the proximal Tibia

Seong Man Lee, Chang Wug Oh, Jong-Keon Oh, Joon Woo Kim, Hyun Joo Lee, Chang Soo Chon, Byoung Joo Lee, Hee Soo Kyung

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: To determine relative fixation strengths of a single lateral locking plate, a double construct of a locking plate, and a tibial nail used in treatment of proximal tibial extra-articular fractures. Methods: Three groups of composite tibial synthetic bones consisting of 5 specimens per group were included: lateral plating (LP) using a locking compression plate-proximal lateral tibia (LCP-PLT), double plating (DP) using a LCP-PLT and a locking compression plate-medial proximal tibia, and intramedullary nailing (IN) using an expert tibial nail. To simulate a comminuted fracture model, a gap osteotomy measuring 1 cm was created 8 cm below the knee joint. For each tibia, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 25 mm/min until tibial failure. Results: Under axial loading, fixation strength of DP (14,387.3 N; standard deviation [SD], 1,852.1) was 17.5% greater than that of LP (12,249.3 N; SD, 1,371.6), and 60% less than that of IN (22,879.6 N; SD, 1,578.8;/? < 0.001, Kruskal-Wallis test). For ultimate displacement under axial loading, similar results were observed for LP (5.74 mm; SD, 1.01) and DP (4.45 mm; SD, 0.96), with a larger displacement for IN (5.84 mm; SD, 0.99). The median stiffness values were 2,308.7 N/mm (range, 2,147.5 to 2,521.4 N/mm; SD, 165.42) for the LP group, 4,128.2 N/mm (range, 3,028.1 to 4,831.0 N/mm; SD, 832.88) for the DP group, and 5,517.5 N/mm (range, 3,933.1 to 7,078.2 N/mm; SD, 1,296.19) for the IN group. Conclusions: During biomechanical testing of a simulated comminuted proximal tibial fracture model, the DP proved to be stronger than the LP in terms of ultimate strength. IN proved to be the strongest; however, for minimally invasive osteosynthesis, which may be technically difficult to perform using a nail, the performance of the DP construct may lend credence to the additional use of a medial locking plate.

Original languageEnglish
Pages (from-to)312-317
Number of pages6
JournalCiOS Clinics in Orthopedic Surgery
Volume6
Issue number3
DOIs
Publication statusPublished - 2014 Jan 1

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Intramedullary Fracture Fixation
Tibia
Joints
Nails
Weight-Bearing
Comminuted Fractures
Therapeutics
Tibial Fractures
Knee Joint
Osteotomy
Bone and Bones

Keywords

  • Biomechanical study
  • Locking plate
  • Nail
  • Proximal tibial fracture

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Biomechanical analysis of operative methods in the treatment of extra-articular fracture of the proximal Tibia. / Lee, Seong Man; Oh, Chang Wug; Oh, Jong-Keon; Kim, Joon Woo; Lee, Hyun Joo; Chon, Chang Soo; Lee, Byoung Joo; Kyung, Hee Soo.

In: CiOS Clinics in Orthopedic Surgery, Vol. 6, No. 3, 01.01.2014, p. 312-317.

Research output: Contribution to journalArticle

Lee, Seong Man ; Oh, Chang Wug ; Oh, Jong-Keon ; Kim, Joon Woo ; Lee, Hyun Joo ; Chon, Chang Soo ; Lee, Byoung Joo ; Kyung, Hee Soo. / Biomechanical analysis of operative methods in the treatment of extra-articular fracture of the proximal Tibia. In: CiOS Clinics in Orthopedic Surgery. 2014 ; Vol. 6, No. 3. pp. 312-317.
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abstract = "Background: To determine relative fixation strengths of a single lateral locking plate, a double construct of a locking plate, and a tibial nail used in treatment of proximal tibial extra-articular fractures. Methods: Three groups of composite tibial synthetic bones consisting of 5 specimens per group were included: lateral plating (LP) using a locking compression plate-proximal lateral tibia (LCP-PLT), double plating (DP) using a LCP-PLT and a locking compression plate-medial proximal tibia, and intramedullary nailing (IN) using an expert tibial nail. To simulate a comminuted fracture model, a gap osteotomy measuring 1 cm was created 8 cm below the knee joint. For each tibia, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 25 mm/min until tibial failure. Results: Under axial loading, fixation strength of DP (14,387.3 N; standard deviation [SD], 1,852.1) was 17.5{\%} greater than that of LP (12,249.3 N; SD, 1,371.6), and 60{\%} less than that of IN (22,879.6 N; SD, 1,578.8;/? < 0.001, Kruskal-Wallis test). For ultimate displacement under axial loading, similar results were observed for LP (5.74 mm; SD, 1.01) and DP (4.45 mm; SD, 0.96), with a larger displacement for IN (5.84 mm; SD, 0.99). The median stiffness values were 2,308.7 N/mm (range, 2,147.5 to 2,521.4 N/mm; SD, 165.42) for the LP group, 4,128.2 N/mm (range, 3,028.1 to 4,831.0 N/mm; SD, 832.88) for the DP group, and 5,517.5 N/mm (range, 3,933.1 to 7,078.2 N/mm; SD, 1,296.19) for the IN group. Conclusions: During biomechanical testing of a simulated comminuted proximal tibial fracture model, the DP proved to be stronger than the LP in terms of ultimate strength. IN proved to be the strongest; however, for minimally invasive osteosynthesis, which may be technically difficult to perform using a nail, the performance of the DP construct may lend credence to the additional use of a medial locking plate.",
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AU - Lee, Seong Man

AU - Oh, Chang Wug

AU - Oh, Jong-Keon

AU - Kim, Joon Woo

AU - Lee, Hyun Joo

AU - Chon, Chang Soo

AU - Lee, Byoung Joo

AU - Kyung, Hee Soo

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N2 - Background: To determine relative fixation strengths of a single lateral locking plate, a double construct of a locking plate, and a tibial nail used in treatment of proximal tibial extra-articular fractures. Methods: Three groups of composite tibial synthetic bones consisting of 5 specimens per group were included: lateral plating (LP) using a locking compression plate-proximal lateral tibia (LCP-PLT), double plating (DP) using a LCP-PLT and a locking compression plate-medial proximal tibia, and intramedullary nailing (IN) using an expert tibial nail. To simulate a comminuted fracture model, a gap osteotomy measuring 1 cm was created 8 cm below the knee joint. For each tibia, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 25 mm/min until tibial failure. Results: Under axial loading, fixation strength of DP (14,387.3 N; standard deviation [SD], 1,852.1) was 17.5% greater than that of LP (12,249.3 N; SD, 1,371.6), and 60% less than that of IN (22,879.6 N; SD, 1,578.8;/? < 0.001, Kruskal-Wallis test). For ultimate displacement under axial loading, similar results were observed for LP (5.74 mm; SD, 1.01) and DP (4.45 mm; SD, 0.96), with a larger displacement for IN (5.84 mm; SD, 0.99). The median stiffness values were 2,308.7 N/mm (range, 2,147.5 to 2,521.4 N/mm; SD, 165.42) for the LP group, 4,128.2 N/mm (range, 3,028.1 to 4,831.0 N/mm; SD, 832.88) for the DP group, and 5,517.5 N/mm (range, 3,933.1 to 7,078.2 N/mm; SD, 1,296.19) for the IN group. Conclusions: During biomechanical testing of a simulated comminuted proximal tibial fracture model, the DP proved to be stronger than the LP in terms of ultimate strength. IN proved to be the strongest; however, for minimally invasive osteosynthesis, which may be technically difficult to perform using a nail, the performance of the DP construct may lend credence to the additional use of a medial locking plate.

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KW - Biomechanical study

KW - Locking plate

KW - Nail

KW - Proximal tibial fracture

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