Skip to main content
Erschienen in: European Journal of Trauma and Emergency Surgery 1/2012

01.02.2012 | Original Article

Biomechanical comparison of two locking plate systems for the distal tibia

verfasst von: F. Högel, S. Hoffmann, P. Weninger, V. Bühren, P. Augat

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 1/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

Distal tibia fractures are known to be difficult to stabilize and nonunions often occur because of a relative instability of the fragments. Therefore, it was of interest to ascertain how different locking plates behave regarding stiffness and interfragmentary movement in comminuted distal tibia fractures.

Methods

A locked medial plate (AxSOS) for the medial distal tibia and a locked medial plate (LCP) for the distal medial tibia were compared biomechanically under compression and torsional load. The tibiae were osteotomized in distal intersection between 4/5 and 5/5, with a gap of 10 mm after instrumentation. For compression force, a load of 350 N was applied and for torsion, a torque of 0–10 Nm and back to 0 over −5-Nm intervals was performed. Stiffness was calculated from the machine data and interfragmentary movement was measured with an optoelectronic measurement device.

Results

Under compression load, the stiffness showed no significant differences between the AxSOS plate compared to the LCP. Significant differences were seen in the interfragmentary movement, where the LCP showed 1.03 mm compared to 0.6 mm for the AxSOS plate. In torsional testing, the AxSOS plate showed significantly higher stiffness than the LCP. The AxSOS plate and the LCP showed similar values for interfragmentary movement under torsional load.

Conclusion

The treatment of distal tibia fractures with angle-stable medial AxSOS plate showed less interfragmentary movement and higher stiffness than fracture fixation with a locked medial LCP. Even if there are no significant differences in torsional testing, plating of the distal tibia should be performed with a steel plate from the biomechanical view.
Literatur
1.
Zurück zum Zitat Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia—results in 20 patients. Injury. 2006;37(9):877–87.PubMedCrossRef Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia—results in 20 patients. Injury. 2006;37(9):877–87.PubMedCrossRef
2.
Zurück zum Zitat Dai JP, Yan YQ, Yu YF, Zhou X. Curative effect comparison of two methods of treatment for distal tibial fractures. Zhongguo Gu Shang. 2009;22(5):361–3.PubMed Dai JP, Yan YQ, Yu YF, Zhou X. Curative effect comparison of two methods of treatment for distal tibial fractures. Zhongguo Gu Shang. 2009;22(5):361–3.PubMed
3.
Zurück zum Zitat Bahari S, Lenehan B, Khan H, McElwain JP. Minimally invasive percutaneous plate fixation of distal tibia fractures. Acta Orthop Belg. 2007;73(5):635–40.PubMed Bahari S, Lenehan B, Khan H, McElwain JP. Minimally invasive percutaneous plate fixation of distal tibia fractures. Acta Orthop Belg. 2007;73(5):635–40.PubMed
4.
Zurück zum Zitat Yamaji T, Ando K, Wolf S, Augat P, Claes L. The effect of micromovement on callus formation. J Orthop Sci. 2001;6:571–5.PubMedCrossRef Yamaji T, Ando K, Wolf S, Augat P, Claes L. The effect of micromovement on callus formation. J Orthop Sci. 2001;6:571–5.PubMedCrossRef
5.
Zurück zum Zitat Augat P, Burger J, Schorlemmer S, Henke T, Peraus M, Claes L. Shear movement at the fracture site delays healing in a diaphyseal fracture model. J Orthop Res. 2003;21:1011–7.PubMedCrossRef Augat P, Burger J, Schorlemmer S, Henke T, Peraus M, Claes L. Shear movement at the fracture site delays healing in a diaphyseal fracture model. J Orthop Res. 2003;21:1011–7.PubMedCrossRef
6.
Zurück zum Zitat Bhandari M, Guyatt GH, Swiontkowski MF, Schemitsch EH. Treatment of open fractures of the shaft of the tibia. J Bone Joint Surg Br. 2001;83:62–8.PubMedCrossRef Bhandari M, Guyatt GH, Swiontkowski MF, Schemitsch EH. Treatment of open fractures of the shaft of the tibia. J Bone Joint Surg Br. 2001;83:62–8.PubMedCrossRef
7.
Zurück zum Zitat Kuner EH, Berwarth H, Lücke SV. Behandlungsprinzipien bei aseptischen Pseudarthrosen. Orthopäde. 1996;25:394–404.PubMedCrossRef Kuner EH, Berwarth H, Lücke SV. Behandlungsprinzipien bei aseptischen Pseudarthrosen. Orthopäde. 1996;25:394–404.PubMedCrossRef
8.
Zurück zum Zitat Cui Y, Wang YJ, Hua QK, Cai SQ, Yan LM, Chen KJ. Biomechanical research in treating unstable Pilon fracture with anatomic plate of distal tibia. Zhongguo Gu Shang. 2009;22(7):519–21.PubMed Cui Y, Wang YJ, Hua QK, Cai SQ, Yan LM, Chen KJ. Biomechanical research in treating unstable Pilon fracture with anatomic plate of distal tibia. Zhongguo Gu Shang. 2009;22(7):519–21.PubMed
9.
Zurück zum Zitat Lau TW, Leung F, Chan CF, Chow SP. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop. 2008;32(5):697–703.PubMedCrossRef Lau TW, Leung F, Chan CF, Chow SP. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop. 2008;32(5):697–703.PubMedCrossRef
11.
Zurück zum Zitat Morrison JB. The mechanics of the knee joint in relation to normal walking. J Biomech. 1970;3:51–61.PubMedCrossRef Morrison JB. The mechanics of the knee joint in relation to normal walking. J Biomech. 1970;3:51–61.PubMedCrossRef
12.
Zurück zum Zitat Bergmann G, Deuretzbacher G, Heller M, Graichen F, Rohlmann A, Strauss J, Duda GN. Hip contact forces and gait patterns from routine activities. J Biomech. 2001;34:859–71.PubMedCrossRef Bergmann G, Deuretzbacher G, Heller M, Graichen F, Rohlmann A, Strauss J, Duda GN. Hip contact forces and gait patterns from routine activities. J Biomech. 2001;34:859–71.PubMedCrossRef
13.
Zurück zum Zitat Andriacchi TP, Alexander EJ, Toney MK, Dyrby C, Sum J. A point cluster method for in vivo motion analysis: applied to a study of knee kinematics. J Biomech Eng. 1998;120:743–9.PubMedCrossRef Andriacchi TP, Alexander EJ, Toney MK, Dyrby C, Sum J. A point cluster method for in vivo motion analysis: applied to a study of knee kinematics. J Biomech Eng. 1998;120:743–9.PubMedCrossRef
14.
Zurück zum Zitat Mehler D, Hansen M, Rommens PM. Biomechanische Untersuchungen Verschiedener Osteosynthesen an der proximalen Tibia: Vorstellung einer neuartigen meßgeometrischen Anordnung. Biomedizinische Technik. 2003;48:319–24.PubMedCrossRef Mehler D, Hansen M, Rommens PM. Biomechanische Untersuchungen Verschiedener Osteosynthesen an der proximalen Tibia: Vorstellung einer neuartigen meßgeometrischen Anordnung. Biomedizinische Technik. 2003;48:319–24.PubMedCrossRef
15.
Zurück zum Zitat Gaebler C, Stanzl-Tschegg S, Laube W, Vécsei V. The fatigue strength of small diameter tibial nails. Injury. 2000;32:401–5.CrossRef Gaebler C, Stanzl-Tschegg S, Laube W, Vécsei V. The fatigue strength of small diameter tibial nails. Injury. 2000;32:401–5.CrossRef
16.
Zurück zum Zitat Hansen M, Mehler D, Hessmann MH, Blum J, Rommens PM. Intramedullary stabilization of extraarticular proximal tibial fractures: a biomechanical comparison of intramedullary and extramedullary implants including a new proximal tibia nail (PTN). J Orthop Trauma. 2007;21:701–9.PubMedCrossRef Hansen M, Mehler D, Hessmann MH, Blum J, Rommens PM. Intramedullary stabilization of extraarticular proximal tibial fractures: a biomechanical comparison of intramedullary and extramedullary implants including a new proximal tibia nail (PTN). J Orthop Trauma. 2007;21:701–9.PubMedCrossRef
17.
Zurück zum Zitat Heller MO, Bergmann G, Deuretzbacher G, Dürselen L, Pohl M, Claes L, Haas NP, Duda GN. Musculo-skeletal loading conditions at the hip during walking and stair climbing. J Biomech. 2001;34:883–93.PubMedCrossRef Heller MO, Bergmann G, Deuretzbacher G, Dürselen L, Pohl M, Claes L, Haas NP, Duda GN. Musculo-skeletal loading conditions at the hip during walking and stair climbing. J Biomech. 2001;34:883–93.PubMedCrossRef
18.
Zurück zum Zitat Jöllenbeck T, Schönle C. Die Teilbelastung nach Knie- oder Hüft-totalendoprothese: Unmöglichkeit der Einhaltung, ihre Ursachen und Abhilfen. Z Orthop Ihre Grenzgeb. 2005;143:124–8.CrossRef Jöllenbeck T, Schönle C. Die Teilbelastung nach Knie- oder Hüft-totalendoprothese: Unmöglichkeit der Einhaltung, ihre Ursachen und Abhilfen. Z Orthop Ihre Grenzgeb. 2005;143:124–8.CrossRef
19.
Zurück zum Zitat Hoenig M, Gao F, Kinder J, Zhang LQ, Collinge C, Merk BR. Extra-articular distal tibia fractures: a mechanical evaluation of 4 different treatment methods. J Orthop Trauma. 2010;24(1):30–5.PubMedCrossRef Hoenig M, Gao F, Kinder J, Zhang LQ, Collinge C, Merk BR. Extra-articular distal tibia fractures: a mechanical evaluation of 4 different treatment methods. J Orthop Trauma. 2010;24(1):30–5.PubMedCrossRef
20.
Zurück zum Zitat Augat P, Margevicius K, Simon J, Wolf S, Suger G, Claes L. Local tissue properties in bone healing: influence of size and stability of the osteotomy gap. J Orthop Res. 1998;16:475–81.PubMedCrossRef Augat P, Margevicius K, Simon J, Wolf S, Suger G, Claes L. Local tissue properties in bone healing: influence of size and stability of the osteotomy gap. J Orthop Res. 1998;16:475–81.PubMedCrossRef
21.
Zurück zum Zitat Claes L, Augat P, Suger G, Wilke HJ. Influence of size and stability of the osteotomy gap on the success of fracture healing. J Orthop Res. 1997;15:577–84.PubMedCrossRef Claes L, Augat P, Suger G, Wilke HJ. Influence of size and stability of the osteotomy gap on the success of fracture healing. J Orthop Res. 1997;15:577–84.PubMedCrossRef
22.
Zurück zum Zitat Claes LE, Heigele CA, Neidlinger-Wilke C, Kaspar D, Seidl W, Margevicius KJ, Augat P. Effects of mechanical factors on the fracture healing process. Clin Orthop Relat Res. 1998;355:S132–47.PubMedCrossRef Claes LE, Heigele CA, Neidlinger-Wilke C, Kaspar D, Seidl W, Margevicius KJ, Augat P. Effects of mechanical factors on the fracture healing process. Clin Orthop Relat Res. 1998;355:S132–47.PubMedCrossRef
23.
Zurück zum Zitat Aro HT, Chao EY. Bone-healing patterns affected by loading, fracture fragment stability, fracture type, and fracture site compression. Clin Orthop Relat Res. 1993;293:8–17.PubMed Aro HT, Chao EY. Bone-healing patterns affected by loading, fracture fragment stability, fracture type, and fracture site compression. Clin Orthop Relat Res. 1993;293:8–17.PubMed
24.
Zurück zum Zitat Goodship AE, Watkins PE, Rigby HS, Kenwright J. The role of fixator frame stiffness in the control of fracture healing. An experimental study. J Biomech. 1993;26:1027–35.PubMedCrossRef Goodship AE, Watkins PE, Rigby HS, Kenwright J. The role of fixator frame stiffness in the control of fracture healing. An experimental study. J Biomech. 1993;26:1027–35.PubMedCrossRef
25.
Zurück zum Zitat Kenwright J, Goodship AE. Controlled mechanical stimulation in the treatment of tibial fractures. Clin Orthop Relat Res. 1989;241:36–47.PubMed Kenwright J, Goodship AE. Controlled mechanical stimulation in the treatment of tibial fractures. Clin Orthop Relat Res. 1989;241:36–47.PubMed
26.
Zurück zum Zitat Schildhauer TA, Robie B, Muhr G, Köller M. Bacterial adherence to tantalum versus commonly used orthopedic metallic implant materials. J Orthop Trauma. 2006;20(7):476–84.PubMedCrossRef Schildhauer TA, Robie B, Muhr G, Köller M. Bacterial adherence to tantalum versus commonly used orthopedic metallic implant materials. J Orthop Trauma. 2006;20(7):476–84.PubMedCrossRef
27.
Zurück zum Zitat Soong M, van Leerdam R, Guitton TG, Got C, Katarincic J, Ring D. Fracture of the distal radius: risk factors for complications after locked volar plate fixation. J Hand Surg Am. 2011;36(1):3–9.PubMedCrossRef Soong M, van Leerdam R, Guitton TG, Got C, Katarincic J, Ring D. Fracture of the distal radius: risk factors for complications after locked volar plate fixation. J Hand Surg Am. 2011;36(1):3–9.PubMedCrossRef
28.
Zurück zum Zitat Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am. 2006;31(3):359–65.PubMedCrossRef Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am. 2006;31(3):359–65.PubMedCrossRef
Metadaten
Titel
Biomechanical comparison of two locking plate systems for the distal tibia
verfasst von
F. Högel
S. Hoffmann
P. Weninger
V. Bühren
P. Augat
Publikationsdatum
01.02.2012
Verlag
Springer-Verlag
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 1/2012
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-011-0123-4

Weitere Artikel der Ausgabe 1/2012

European Journal of Trauma and Emergency Surgery 1/2012 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.