Biomechanical analysis of tibial plateau posterolateral fracture fragment fixation and introduction of a lateral tibia plateau hook plate system

Chien-Shun Wang; Hsuan-Wen Wang; Kun-Chun Chen; Chun-Li Lin

doi:10.1016/j.jos.2023.06.009

Biomechanical analysis of tibial plateau posterolateral fracture fragment fixation and introduction of a lateral tibia plateau hook plate system

J Orthop Sci. 2023 Jun 29:S0949-2658(23)00181-1. doi: 10.1016/j.jos.2023.06.009. Online ahead of print.

Authors

Chien-Shun Wang¹, Hsuan-Wen Wang², Kun-Chun Chen², Chun-Li Lin³

Affiliations

¹ Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, 112201, Taiwan; Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112201, Taiwan.
² Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan; Medical Device Innovation and Translation Center, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan.
³ Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan; Medical Device Innovation and Translation Center, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan. Electronic address: studpj@gmail.com.

PMID: 37393110
DOI: 10.1016/j.jos.2023.06.009

Abstract

Background: Fixing the posterolateral fragments of tibial plateau fractures has been challenging owing to potential neurovascular injuries and fibular head blocks. Several surgical approaches and fixation techniques have been reported, with distinct limitations. We propose a novel lateral tibia plateau hook plate system and compare its biomechanical stability with other fixation methods.

Methods: Twenty-four synthetic tibia models were simulated to present posterolateral tibial plateau fractures. These models were randomly assigned to three groups. Group A models were fixed with the lateral tibia plateau hook plate system, Group B with variable-angle anterolateral locking compression plates, and Group C with direct posterior buttress plates. The models' biomechanical stability was evaluated using static (gradually increased axial compressive loads) and fatigue (cyclically loaded from 100 to 600 N for 2000 cycles each) tests.

Results: Groups A and C models exhibited comparable axial stiffness, subsidence load, failure load, and displacement in the static test. Group A model exhibited higher subsidence and failure loads than Group B model. Groups A and C models exhibited comparable displacement at 100 N cyclic loading in the fatigue test. Group C model was more stable at higher loads. Group C model endured the highest subsidence cycle numbers, followed by Groups A and B models.

Conclusions: The lateral tibia plateau hook plate system provided similar static biomechanical stability as the direct posterior buttress plates and comparable dynamic stability under limited axial loading. This system is a potential posterolateral treatment choice owing to its convenience and safety, in treating tibia plateau fractures.

Keywords: Biomechanical study; Fracture; Lateral tibia plateau hook plate system; Posterolateral fragment; Tibia plateau.