Low profile fragment specific plate fixation of lateral tibial plateau fractures - A technical note

Modern osteosynthesis of periarticular fractures: The role of provisional fixation revisited

Periarticular fractures are complex injuries affecting the joint articular surface, the subchondral area, the metaphyseal region, the surrounding soft tissue envelope and not infrequently the ligamentous structures. The management of these injuries has evolved over the years, from one stage to two stage procedures thus facilitating soft tissue resuscitation, adequate pre-operative planning and the use of biologics optimizing the conditions for definitive fixation for a successful long-term outcome. Provisional fixation constitutes an essential step in the surgical treatment of these fractures. Herein, the role of provisional fixation as well as strategies on how they should be applied are discussed. The aim is to revisit this important step of provisional fracture fixation since its introduction by Albin Lambotte, in the early 1900's.

Two-level fixation with headless compression screws for tibial plateau fractures

PURPOSE

Reduction and fixation of tibial plateau fractures associated with small, "floating" intra-articular fragments proposes a challenge. We use fully threaded headless compression screws for (interfragmentary) fixation of such fragments before final plate fixation when standard fixation of intra-articular fragments with k-wires or lag screws is deemed insufficient. Our aim is to describe our technique and clinical experience of this two-level fixation.

METHODS

Between 2006 and 2021, 29 patients with a comminuted tibial plateau fracture were treated with this two-level fixation in this retrospective case series. Clinical baseline and surgical variables were collected for all patients. Clinical outcome variables were available for 28 patients with a median follow-up of 16.5 months (IQR 5-24). Functional outcomes were measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS) and reported by 22 patients at a median of 5.2 years (IQR 3.5-9.8).

RESULTS

Reduction was anatomic or good in 82% of cases, fair in 14%, and a malreduction in 4%. Arthrosis was graded as grade 0 in 25% of cases, 1 in 39%, 2 in 21%, and 3 in 14%. Flexion was 110 degrees (IQR 100-130). Five patients had an extension deficit of 5 to 10 degrees. Median KOOS for symptoms and stiffness was 69 points (IQR 45-78), for pain 71 (IQR 45-88), for ADL 85 (IQR 52-95), for sports 30 (IQR 11-55), and for quality of life 34 (IQR 19-56).

CONCLUSION

The use of fully threaded headless compression screws is a simple and helpful addition in the treatment of comminuted tibial plateau fractures.

Optimal Design and Biomechanical Analysis of a Biomimetic Lightweight Design Plate for Distal Tibial Fractures: A Finite Element Analysis

The treatment of fractures of the distal tibia can be problematic due to the insubstantial soft-tissue covering this part of the anatomy. This study investigates a novel strategy for minimally invasive plate osteosynthesis of distal tibia fractures called bionic lightweight design plating. Following the structure of the animal trabecular bone, we utilized topological mathematical methods to redesign the material layout of the internal fixation device to fulfill the desired lightweight design within given boundary conditions. The results showed that this method can maintain the same stability of the construct as the original plate after a reduction in the original volume by 30%, and the differences in strain energy of plates and maximum node displacement of constructs between the constructs [RP construct vs. LP construct] were not statistically significant (p > 0.05). In the safety assessment of the constructs, the peak stress of plates between constructs was found to not be statistically significantly different under a doubled physiological load (p > 0.05). The average stress of the plates’ elements exceeding the allowable stress was analyzed, and no statistically significant differences were found between the two constructs under axial compression stress conditions (p > 0.05). The average stress of the plates’ elements in the redesigned plating construct under torsional stress conditions was 3.08% less than that of the locked plating construct (p < 0.05). Under the double physiological load condition, 89% of the elements of the plate in the redesigned plating construct and 85% of the elements of the plate in the locked plating construct were lower than the maximum safe stress of the plate, which was 410 MPa (secondary allowable stresses). That reminds us the topology optimization offer a possible way to improve the capacity of soft tissue protection while ensuring the safety of the RP construct by reducing the volume of the implants.