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Jiang J, Xu D, Ji Z, Jia R, Wang F, Tan J, Hong H, Li J. Interfragmentary compression force and fixation stability of lateral tibial plateau fractures in normal and osteoporotic bones. J Orthop Res 2024. [PMID: 38472744 DOI: 10.1002/jor.25832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/12/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
Lateral platform collapse in fixations of lateral tibial plateau fractures (TPFs) using either double-lag screws fixation (DSF) or locking-plate fixation (LPF) is not rare. This study aimed to explore the effect of enhancing the interfragmentary compression force (IFCF) on fixation stability in lateral TPFs in normal and osteoporotic bones using finite element analysis. Finite element models of DSF in normal bone and LPF in normal and osteoporotic bones were established to simulate the fixations of lateral TPF. After model validation, axial compressive forces of 500, 1000, 1500, and 2500 N to the tibial plateau along with an IFCF of 0, 100, 200, and 300 N were applied. The maximum axial micromotion of the lateral fragment (MAM-LF), maximal translational micromotion of the lateral fragment (MTM-LF), peak von Mises stress (VMS), and peak equivalent elastic strain of the lateral fragment (EES-LF) were evaluated. The MAM-LF showed a decreasing trend as the IFCF increased in all models. For DSF models, the peak VMS of implants increased as the IFCF increased when the axial loads were 500 and 1000 N. The peak EES-LF decreased as the IFCF increased under axial loads of 1000, 1500, and 2500 N. For the normal and osteoporotic LPF models, the peak VMS of the implants decreased as the IFCF increased. Peak EES-LF decreased as IFCF increased. In conclusion, enhancing IFCF was beneficial in improving the fixation stability of lateral TPF. The optimal IFCF for DSF and LPF should be as high as reasonably feasible.
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Affiliation(s)
- Jiang Jiang
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Daqiang Xu
- Department of Orthopedics, Affiliated Hospital 6 of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - Zhenhua Ji
- Department of Rehabilitation Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan, China
| | - Rui Jia
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Fei Wang
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Anatomy, Nanchang Medical College, Nanchang, China
| | - Jinchuan Tan
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Hong Hong
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jianyi Li
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
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Keltz E, Mora AJ, Wulsten D, Rußow G, Märdian S, Duda GN, Heyland M. Is initial interfragmentary compression made to last? An ovine bone in vitro study. Injury 2021; 52:1263-1270. [PMID: 33423769 DOI: 10.1016/j.injury.2020.11.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/25/2020] [Indexed: 02/02/2023]
Abstract
Interfragmentary compression, a major principle of fracture treatment, is clinically not quantified and might be lost quickly even without functional loads. We designed an experimental study hypothesizing that (1) compression can be controlled using either lag screw or compression plate, and expecting similar initial compression, (2) loss of interfragmentary compression through relaxation within one hour is reduced with neutralization locking plate next to lag screw compared to compression plate. Twelve ovine femora (N=6) and humeri (N=6) were assigned into groups: Group 1 received a 45° oblique osteotomy at mid-diaphysis and was fixated using a 3.5 mm interfragmentary lag screw and locking compression plate (3.5 mm LCP, DePuy Synthes) as neutralization plate. Group 2 received a transverse osteotomy and was fixated with dynamic compression using compression plate (LCP). Interfragmentary pressure and relative bone fragment displacements were recorded over one hour. Median loss of compression over one hour time (relaxation) were 0.52% in Group 1, and 0.17% in Group 2 (p>0.05). Median rotational displacements amounted to 0.46° for Group 1, and 0.31° for Group 2, and axial displacement to a median of -20 μm in Group 1 and 25 μm in Group 2. Ovine bone interfragmentary stress relaxation maintains compression over the first hour for lag screw with neutralization plate for an oblique fracture line or compression plate for a transverse fracture line. Measured compression forces around 100 N could be overcome by physiological tension loading in bending or torsion, necessitating for instance tension band plating, additional lag screws or absolutive stability.
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Affiliation(s)
- Eran Keltz
- Division of Orthopedic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Alberto Jorge Mora
- Division of Trauma, Santiago University Clinical Hospital, Musculoskeletal Pathology Group, Laboratory 18, Institute IDIS, Servicio Galego de Saúde, Santiago de Compostela, Spain
| | - Dag Wulsten
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Germany
| | - Gabriele Rußow
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Germany; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Germany
| | - Sven Märdian
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Germany
| | - Mark Heyland
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Germany.
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Triana M, Gueorguiev B, Sommer C, Stoffel K, Agarwal Y, Zderic I, Helfen T, Krieg JC, Krause F, Knobe M, Richards RG, Lenz M. LagLoc-a new surgical technique for locking plate systems. J Orthop Res 2018; 36:2886-2891. [PMID: 29917270 DOI: 10.1002/jor.24069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/04/2018] [Indexed: 02/04/2023]
Abstract
Treatment of oblique and spiral fractures remains challenging. The aim of this study was to introduce and investigate the new LagLoc technique for locked plating with generation of interfragmentary compression, combining the advantages of lag screw and locking-head-screw techniques. Oblique fracture was simulated in artificial diaphyseal bones, assigned to three groups for plating with a seven-hole locking compression plate. Group I was plated with three locking screws in holes one, four, and seven. The central screw crossed the fracture line. In group II the central hole was occupied with a lag screw perpendicular to fracture line, whereas holes one and seven were occupied with locking screws. Group III was instrumented applying the LagLoc technique as follows. Hole four was predrilled perpendicularly to the plate, followed by overdrilling of the near cortex and insertion of a locking screw-crossing the fracture line-whose head was covered by a holding sleeve to prevent temporarily the locking in the plate hole and generate interfragmentary compression. Subsequently, the screw head was released and locked in the plate hole. Holes one and seven were occupied with locking screws. Interfragmentary compression in the fracture gap was measured using pressure sensors. All screws in the three groups were tightened with 4 Nm torque. Interfragmentary compression in group I (167 ± 25 N) was significantly lower in comparison to groups II (431 ± 21 N) and III (379 ± 59 N), p ≤ 0.005. The difference in compression between groups II and III remained not significant (p = 0.999). The new LagLoc technique offers an alternative tool to generate interfragmentary compression with the application of locking plates by combining the biomechanical advantages of lag screw and locking screw fixations. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2886-2891, 2018.
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Affiliation(s)
- Miguel Triana
- AO Research Institute Davos, Davos, Switzerland.,Department of Orthopaedic Surgery, Fundación Cardioinfantil, Bogotá, Colombia.,Hospital Infantil San José, Bogotá, Colombia.,Universities of Bosque, Bogotá, Colombia.,Fundación Universitaria Ciencias de la salud, Bogotá, Colombia
| | | | - Christoph Sommer
- Department of General and Trauma Surgery, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Karl Stoffel
- University of Basel, Basel, Switzerland.,Cantonal Hospital Baselland, Orthopedic and Musculoskeletal Traumatology Clinic, Bruderholz, Switzerland
| | | | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - Tobias Helfen
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - James C Krieg
- Division of Orthopaedic Trauma and Fracture Care, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fabian Krause
- Department of Orthopaedic Surgery, Inselspital, University of Berne, Bern, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Aachen, Germany
| | | | - Mark Lenz
- Department of Trauma, Hand and Reconstructive Surgery, Friedrich Schiller University Jena, Jena, Germany
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Biomechanical Evaluation of Interfragmentary Compression At Tibia Plateau Fractures In Vitro Using Different Fixation Techniques: A CONSORT-Compliant Article: Erratum. Medicine (Baltimore) 2015; 94:1. [PMID: 25803166 DOI: 10.1097/01.md.0000461920.68839.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
[In the article "Biomechanical Evaluation of Interfragmentary Compression At Tibia Plateau Fractures In Vitro Using Different Fixation Techniques: A CONSORT-compliant" article, which appeared in Volume 94, Issue 1 of Medicine, a line denoting dual authorship was omitted. K. Kojima and B. Gueorguiev contributed equally to the article.].
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