Abstract
PurposeDistal tibial fractures generally require post-operative weight-bearing restrictions. Especially geriatric patients are unable to follow these recommendations. To increase post-operative implant stability and enable early weight-bearing, augmentation of the primary osteosynthesis by cerclage is desirable. The purpose of this study was to identify the stabilizing effects of a supplemental cable cerclage following plate fixation of distal tibial spiral fractures compared to solitary plate osteosynthesis.MethodsIn eight synthetic tibiae, a reproducible spiral fracture (AO/OTA 42-A1.1c) was stabilized by angle stable plate fixation. Each specimen was statically loaded under combined axial and torsional loads to simulate partial (200 N, 2 Nm) and full (750 N, 7 Nm) weight-bearing. Tests were repeated with supplemental cable cerclage looped around the fracture zone. In a subsequent stepwise increased dynamic load scenario, construct stiffness and interfragmentary movements were analyzed.ResultsWith supplemental cable cerclage, construct stiffness almost tripled compared to solitary plate osteosynthesis (2882 ± 739 N/mm vs. 983 ± 355 N/mm; p < 0.001). Under full weight-bearing static loads, a supplemental cerclage revealed reduced axial (− 55%; p = 0.001) and shear movement (− 83%; p < 0.001), and also lowered shear movement (− 42%; p = 0.001) compared to a solitary plate under partial weight-bearing. Under dynamic loads supplemental cerclage significantly reduced axial (p = 0.005) as well as shear movements (p < 0.001).ConclusionSupplemental cable cerclage significantly increases fixation stiffness and reduces shear movement in distal tibial spiral fractures. This stabilizing effect enables from a biomechanical point of view immediate mobilization without any weight-bearing restrictions, which may improve the quality of care of orthopedic patients and may trigger a change towards early weight-bearing regimes, especially geriatric patients would benefit from.
Highlights
Tibial shaft fractures represent the most common long bone fractures
Simulation of partial weight-bearing resulted in axial interfragmentary movement of 0.3 ± 0.1 mm for the PlateOnly group, which was increased to 1.1 ± 0.3 mm under full weightbearing conditions (p < 0.001) (Fig. 3)
Partial weight-bearing conditions resulted in shear movements of 0.6 ± 0.1 mm for PlateOnly constructs, which almost quadrupled to 2.1 ± 0.7 mm by applying full weight-bearing loads (p = 0.001) (Fig. 4)
Summary
The most prevalent types are spiral fractures (AO/OTA 42-A1), representing 34%, and oblique fractures (AO/OTA 42-A2), representing 17% [1]. These fractures occur in young males due to high-energy trauma and in elderly individuals as a consequence of low-energy trauma or stumbling [1]. The intention of supplemental cerclage wiring is to reduce movements at the fracture site by converting shear forces into axial loading. This supplemental cerclage, might not be able to increase the stability of fracture fixation for more transverse, comminuted or complex fractures [9], but has the potential to improve implant stability for either spiral or oblique fractures [10]
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