Abstract
In factures of the distal tibia with simple articular extension, the optimal surgical
treatment remains debatable. In clinical practice, minimally invasive plate osteosynthesis
and intramedullary nailing are both routinely performed. Comparative biomechanical
studies of different types of osteosynthesis of intraarticular distal tibial fractures
are missing due to the lack of an established model. The goal of this study was first
to establish a biomechanical model and second to investigate, which are the biomechanical
advantages of angle-stable plate osteosynthesis and intramedullary nailing of distal
intraarticular tibial fractures. Seven 4th generation biomechanical composite tibiae featuring an AO 43-C2 type fracture were
implanted with either osteosynthesis technique. After primary lag screw fixation,
4-hole Medial Distal Tibial Plate (MDTP) with triple proximal and quadruple distal
screws or intramedullary nailing with double proximal and triple 4.0mm distal interlocking
were implanted. The stiffness of the implant-bone constructs and interfragmentary
movement were measured under non-destructive axial compression (350 and 600 N) and
torsion (1.5 and 3Nm). Destructive axial compression testing was conducted with a
maximal load of up to 1,200 N. No overall superior biomechanical results can be proclaimed
for either implant type. Intramedullary nailing displays statistically superior results
for axial loading in comparison to the MDTP. Torsional loading resulted in non-statistically
significant differences for the two-implant types with higher stability in the MDTP
group.
From a biomechanical view, the load sharing intramedullary nail might be more forgiving
and allow for earlier weight bearing in patients with limited compliance.
Keywords
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References
- The epidemiology of tibial fractures.J Bone Joint Surg Br. 1995; 77: 417-421
- The epidemiology of open long bone fractures.Injury. 1998; 29: 529-534
- Plate versus nail for distal tibial fractures: a systematic review and meta-analysis.J Orthop Trauma. 2014; 28: 542-548
- Comparison study of two surgical options for distal tibia fracture-minimally invasive plate osteosynthesis vs. open reduction and internal fixation.Int Orthop. 2011; 35: 737-742
- Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures.Int Orthop. 2008; 32: 697-703
- Extending the Indication of Intramedullary Nailing of Tibial Fractures.Eur J Trauma Emerg Surg. 2007; 33: 159-169
- Extending the indications of intramedullary nailing with the Expert Tibial Nail.Acta Chir Orthop Traumatol Cech. 2008; 75: 77-87
- [Intramedullary nailing of the distal tibia illustrated with the Expert(TM) tibia nail].Oper Orthop Traumatol. 2011; 23: 397-410
- Extending the indications of intramedullary nailing with the Expert Tibial Nail.Acta Chir Orthop Traumatol Cech. 2008; 75: 77-87
- The results of closed intramedullary nailing for intra-articular distal tibial fractures.J Orthop Trauma. 2014; 28: 108-113
- Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement.J Orthop Trauma. 1997; 11: 200-205
- The mechanical effect of blocking screws (“Poller screws”) in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails.J Orthop Trauma. 1999; 13: 550-553
- The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails.J Bone Joint Surg Br. 1999; 81: 963-968
- Distal metaphyseal fractures of tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation.J Trauma. 2005; 59 (discussion 23): 1219-1223
- A randomised pilot trial of “locking plate” fixation versus intramedullary nailing for extra-articular fractures of the distal tibia.J Bone Joint Surg Br. 2012; 94: 704-708
- Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures.J Orthop Trauma. 2011; 25: 736-741
- Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures.J Orthop Surg Res. 2014; 9: 35
- The Retrograde Tibial Nail: presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures.Injury. 2014; 45: S81-S86
- A biomechanical analysis of internal fixation of complex tibial plateau fractures.J Orthop Trauma. 1999; 13: 545-549
- Does it really spin? Intramedullary nailing of segmental tibial fractures–a cadaveric study.Injury. 2015; 46: 643-648
- Insertion of distal locking screws of tibial intramedullary nails: a comparison between the free-hand technique and the SURESHOT™ Distal Targeting System.Injury. 2014; 45: 405-407
- To fix or not to fix? The role of fibular fixation in distal shaft fractures of the leg.Injury. 2014; 45: 408-411
- A randomised prospective study of two different combined internal and external fixation techniques for distal tibia shaft fractures.Injury. 2014; 45: 1990-1995
- Outcomes following combined intramedullary nail and plate fixation for complex tibia fractures: A multi-centre study.Injury. 2015; 46: 1097-1101
- Intramedullary nailing versus plating for extra-articular distal tibial metaphyseal fracture: a systematic review and meta-analysis.Injury. 2014; 45: 667-676
- Comparison of minimally invasive percutaneous plate osteosynthesis with open reduction and internal fixation for treatment of extra-articular distal tibia fractures.Injury. 2013; 44: 1102-1106
- Age-related variations in the microstructure of human tibial cancellous bone.J Orthop Res. 2002; 20: 615-621
- Biomechanical comparison of locked plate osteosynthesis, reamed and unreamed nailing in conventional interlocking technique, and unreamed angle stable nailing in distal tibia fractures.J Trauma Acute Care Surg. 2012; 73: 933-938
- Structural properties of fourth-generation composite femurs and tibias.J Biomech. 2008; 41: 3282-3284
- Mechanical evaluation of large-size fourth-generation composite femur and tibia models.Ann Biomed Eng. 2010; 38: 613-620
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