Abstract
PurposeThe purpose of this study is to compare the stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture.MethodsA three-dimensional (3D) finite element model of the medial tibial plateau fracture (Schatzker type IV fracture) was created. An axial force of 2500 N with a distribution of 60 % to the medial compartment was applied to simulate the axial compressive load on an adult knee during single-limb stance. The equivalent von Mises stress, displacement of the model relative to the distal tibia, and displacement of the implants were used as the output measures.ResultsThe mean stress value of the plate-screw fixation system was 18.78 MPa, which was significantly (P < 0.001) smaller than that of the screw fixation system. The maximal value of displacement (sum) in the plate-screw fixation system was 2.46 mm, which was lower than that in the screw fixation system (3.91 mm). The peak stress value of the triangular fragment in the plate-screw fixation system model was 42.04 MPa, which was higher than that in the screw fixation model (24.18 MPa). But the mean stress of the triangular fractured fragment in the screw fixation model was significantly higher in terms of equivalent von Mises stress (EVMS), x-axis, and z-axis (P < 0.001).ConclusionsThis study demonstrated that the load transmission mechanism between plate-screw fixation system and screw fixation system was different and the stability provided by the plate-screw fixation system was superior to the screw fixation system.
Highlights
Tibial plateau fractures account for approximately 9.2 % of all tibia fractures [1, 2], which involve the articular surface of the proximal tibia that supports the opposing femoral condyle
Three cancellous screws with a 16-mm partial thread and a diameter of 6.5 mm made up the screw fixation system
In the screw fixation system, the maximal stress was found in the middle section of the most distal screw
Summary
Tibial plateau fractures account for approximately 9.2 % of all tibia fractures [1, 2], which involve the articular surface of the proximal tibia that supports the opposing femoral condyle. As tibial plateau fractures are often caused by high-energy trauma with displaced fractured fragments, surgical approaches are often needed to maintain anatomical reduction and to prevent the development of devastating complications [3]. To maintain the stability of the fractured tibial plateau, various approaches have been developed. Locked plates with open reduction and internal fixation (ORIF) techniques and percutaneous lag screws with arthroscopyassisted reduction and fixation techniques are the two most frequently used surgical approaches. The former provides stability to the fractured tibial plateau by locking head screws and the contour of the plate itself, and the lag screws maintain their fixation through compression and buttressing effect with lesser soft-tissue dissection [4]. The comparative biomechanics between these two different implants has not been demonstrated and analyzed computationally
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