The study of biomechanics and finite element analysis on a novel plate for tibial plateau fractures via anterolateral supra-fibular-head approach

Abstract

For Schatzker type II split-depressed tibial plateau fractures involving the fractures of anterolateral and posterolateral columns (APC), the optimal fixation scheme is controversial. The objectives of this study were: (1) to introduce a newly designed plate for treating APC fractures via biomechanical tests and finite element analysis (FEA), and (2) to compare it with two conventional fixation methods. APC fracture models were created and randomly assigned to three groups (Groups A-C). Group A was fixed with a 3.5-mm lateral locking plate, Group B was fixed with a 3.5-mm lateral locking plate and two 3.5-mm cannulated screws (hybrid fixation). Group C was fixed with the newly designed plate. It is an arched locking plate for fixing the lateral tibial plateau via the anterolateral supra-fibular-head approach. Each fracture model experienced a gradually increasing axial compressive load ranging from 250 to 750 N using a customized indenter. Biomechanical analysis demonstrated that the newly designed plate showed the minimum displacement among the three methods, followed by the hybrid fixation method. Conversely, the 3.5-mm lateral locking plate displayed the maximum displacement in APC fractures (p < 0.05). FEA results indicated that at 750 N, the maximum displacements for Groups A-C were measured as 3.06 mm, 2.74 mm, and 2.08 mm, respectively. Moreover, the maximum stresses recorded for the implant in Groups A-C at 750 N were 208.32 MPa, 299.59 MPa, and 143.26 MPa, while for the bone, they were 47.12 MPa, 74.36 MPa, and 40.01 MPa. The overall trends at 250 N and 500 N were consistent with those observed at 750 N. In conclusion, due to good biomechanical performance and FEA results, the newly designed plate represents a promising choice for managing APC fractures of the tibial plateau.