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Ando J, Takahashi T, Matsumura T, Nibe Y, Takeshita K. Biomechanical comparisons of plate placement for medial tibial plateau fractures (Schatzker type IV): A biomechanical study using porcine tibias. Injury 2024; 55:111158. [PMID: 38579154 DOI: 10.1016/j.injury.2023.111158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 04/07/2024]
Abstract
INTRODUCTION Biomechanical studies on medial tibial plateau fractures (MTPFs) (Schatzker classification type IV) are currently few, while studies using locking plates (LPs) placed on medial proximal tibias are unavailable. Hence, we compared the biomechanical properties of plate osteosynthesis at the medial and anteromedial placements using large- and small-fragment LPs in porcine bones. MATERIALS AND METHODS MTPFs were internally fixed using LPs on 40 porcine tibias. Specimens were equally divided into four groups: medial placement using a large-fragment LP (LPs for the medial (LM) group), anteromedial placement using a large-fragment LP (LAM group), medial placement using a small-fragment LP (SM group), and anteromedial placement using a small-fragment LP (SAM group). The translation patterns of the constructs in each group were examined by cycling loading test (displacement and translation along the mechanical axis at 10-100, 100-500, 500-1000, 1000-1500, and 1500-2000 cycles). Then, articular gaps and step-off changes after 2000 cycles were compared among the four groups. RESULTS One-way analysis of variance (ANOVA) revealed no significant differences in displacement and translation during cyclic loading. One-way ANOVA followed by post hoc analysis revealed that the anterior gap was lower in LPs for the medial (LM) than in SM (P = 0.029) and SAM (P = 0.0026). The central gap was also lower in LM than in SM (P = 0.042) and SAM (P < 0.001), and it was lower in LAM than in SAM (P = 0.047). Likewise, the posterior gap was lower in LM than in LAM (P = 0.025) and SAM (P < 0.001). Furthermore, the central step-off of SAM was higher than that of LM, LAM, and SM (P < 0.001, P = 0.0014, and P = 0.0077, respectively). The posterior step-off was lower in LM than in SAM and LAM (P = 0.037 and P < 0.001), and it was also lower in SM than in SAM (P = 0.0082). CONCLUSION Medial LP placement for MTPFs in porcine bones resulted in significantly lower posterior step-offs after cyclic loading than anteromedial placement, and large-fragment LPs for MTPFs caused significantly lower fracture gaps in the central articular after cyclic loading than small-fragment LPs.
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Affiliation(s)
- Jiro Ando
- Department of Orthopedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, 1-15-4, Shimotsuke 329-0502, Japan.
| | - Tomohiro Matsumura
- Department of Emergency and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yoshiya Nibe
- Department of Orthopedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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Roy D, Das MC, Dhason R, Roy S, Datta S. Effect of matrix material property on the composite tibia fracture plate: a biomechanical study. Biomed Phys Eng Express 2024; 10:035026. [PMID: 38547526 DOI: 10.1088/2057-1976/ad38c4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
For the purpose of fixing tibia fractures, composite bone plates are suggested. Metal plates cause stress shielding, lessen the compression force at the fracture site, and have an impact on the healing process because they are significantly more rigid than bone. To prevent excessive shear strain and consequent instability at the fracture site, it is imperative to reduce stiffness in the axial direction without lowering stiffness in the transverse direction. Only a carefully crafted fiber reinforced composite with anisotropic properties will suffice to accomplish this. The purpose of the current study is to examine the impact of axial and shear movements at the fracture site on the fixing of metal and composite bone plates. After modeling the tibia with a 1 mm fracture gap, titanium plates, carbon/epoxy, carbon/PEEK, and carbon/UHMWPE composite bone plates were used to fix it. There are 6 holes on each of the 103 mm long plates. To determine the stresses and axial movement in the fracture site, anatomical 3D Finite Element (FE) models of the tibia with composite bone plates are built. The simulations that were run for various composite plate layouts and types give suggestions for selecting the best composite bone plate. Although the matrix material causes some variations in behaviors, most of the plates perform as well as or even better than metal plates. Thus, the appropriate composite combinations are recommended for a given fracture structure.
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Affiliation(s)
- Drupad Roy
- Department of Mechanical Engineering, MCKV Institute of Engineering, Liluah, Howrah 711204, West Bengal, India
| | - Manik Chandra Das
- Department of Industrial Engineering and Management, Maulana Abul Kalam Azad University of Technology, Haringhata, Nadia 741249, West Bengal, India
| | - Raja Dhason
- Departement of Mechanical Engineering, SRM Institute of Science and Technology, Kattakulathur, Chengalpattu Dist. 603203, Tamil Nadu, India
| | - Sandipan Roy
- Departement of Mechanical Engineering, SRM Institute of Science and Technology, Kattakulathur, Chengalpattu Dist. 603203, Tamil Nadu, India
| | - Shubhabrata Datta
- Departement of Mechanical Engineering, SRM Institute of Science and Technology, Kattakulathur, Chengalpattu Dist. 603203, Tamil Nadu, India
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van Haeringen MH, Kuijer PPFM, Daams JG, van Geenen RCI, Brinkman JM, Kerkhoffs GMMJ, van Heerwaarden RJ, Hoorntje A. Opening- and closing-wedge high tibial osteotomy are comparable and early full weight bearing is safe with angular stable plate fixation: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07229-3. [PMID: 36473985 DOI: 10.1007/s00167-022-07229-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/05/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to establish the gold standard for surgical technique, fixation, and rehabilitation for HTO in patients with unicompartmental knee osteoarthritis. METHODS Medline, Embase, and SPORTDiscus databases were searched up to April 2022. Included were (1) randomized controlled trials (RCTs) comparing opening-wedge HTO (owHTO) and closing-wedge HTO (cwHTO), (2) biomechanical studies and prospective patient studies comparing biomechanical and clinical results for plate fixators, and (3) RCTs comparing an early versus delayed full-weight-bearing (FWB) protocol. RESULTS The pooled results for the surgical technique showed no significant differences between owHTO and cwHTO for most PROMs on pain, activity, and risk for conversion to TKA. The cwHTO group showed a slightly better improvement in KOOS/WOMAC pain scores (4.51; 95% CI 1.18-7.85), and a significantly lower change in posterior tibial slope (p = 0.03). The pooled results for the fixation method showed the highest force at maximum failure for the Activmotion (Newclip Technics, France), Aescula (B. Braun Korea, Korea), 2nd generation Puddu (Arthrex Inc., USA), and TomoFix plate (Depuy Synthes, Switzerland). The pooled results for the rehabilitation protocol showed no significant differences between the early full-weight-bearing (FWB) group and the delayed FWB group for functional scores, complication rates, and delayed unions. CONCLUSION Both owHTO and cwHTO reduced pain and improved knee function. Locking plate fixation should be used for owHTO. An early FWB protocol has proven to be safe in patients with small corrections, no hinge fractures, and non-smokers. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- M H van Haeringen
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P P F M Kuijer
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J G Daams
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R C I van Geenen
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, The Netherlands
| | - J M Brinkman
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - G M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - R J van Heerwaarden
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - A Hoorntje
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Forgivingness of an Anteromedially Positioned Small Locked Plate for High Tibial Osteotomy in Case of Overcorrection and Lateral Hinge Fracture. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081265. [PMID: 36013443 PMCID: PMC9409794 DOI: 10.3390/life12081265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
High tibial osteotomy (HTO) represents a sensible treatment option for patients with moderate unicondylar osteoarthritis of the knee and extraarticular malalignment. The possibility of a continuously variable correction setting and a surgical approach low in complications has meant that the medial opening osteotomy has prevailed over the past decades. The objective of the present study was to determine whether anteromedially positioned small plates are nevertheless forgiving under biomechanically unfavourable conditions (overcorrection and lateral hinge fracture). In this study, a simulated HTO was performed on composite tibiae with a 10-mm wedge and fixed-angle anteromedial osteosynthesis with a small implant. Force was applied axially in a neutral mechanical axis, a slight and a marked overcorrection into valgus, with and without a lateral hinge fracture in each case. At the same time, a physiological gait with a dual-peak force profile and a peak load of 2.4 kN was simulated. Interfragmentary motion and rigidity were determined. The rigidity of the osteosynthesis increased over the cycles investigated. A slight overcorrection into valgus led to the lowest interfragmentary motion, compared with pronounced valgisation and neutral alignment. A lateral hinge fracture led to a significant decrease in rigidity and increase in interfragmentary motion. However, in no case was the limit of 1 mm interfragmentary motion critical for osteotomy healing exceeded. The degree of correction of the leg axis, and the presence of a lateral hinge fracture, have an influence on rigidity and interfragmentary motion. From a mechanically neutral axis ranging up to pronounced overcorrection, the implant investigated offers sufficient stability to allow healing of the osteotomy, even if a lateral hinge fracture is present.
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Key S, Demir S, Aydın O, Say Y, Erten M. A biomechanical study: Comparison of three different implant options in high Tibial osteotomy. Clin Biomech (Bristol, Avon) 2022; 98:105722. [PMID: 35863144 DOI: 10.1016/j.clinbiomech.2022.105722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/20/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many implant options could be preferable for fixation after osteotomy in varus knee medial compartment arthrosis. Due to usage characteristics, it is important to compare the biomechanical properties of them. For this purpose, we aimed to examine three different implant types biomechanically in our study. METHODS Ovine tibiae undergoing medial open-wedge high tibial osteotomy were fixed in vitro with three different implants using an angular wedge plate, a metal block plate and an external fixator system. The fixed ovine tibiae were subjected to axial tensile, axial loading and three-point bending tests in a test machine. All biomechanical tests were repeated five times, the maximum and minimum values were ignored, and the average values of the remaining three test results were taken into account. The test results were interpreted after converted into force-elongation curves in Trapezium-X software. FINDINGS Biomechanical test results revealed some differences between implant types. While the metal block plate had the highest axial tensile strength value, it was the fixation group showing the lowest strength in axial load tests. The used fixator system was the highest strength in axial load tests and the lowest strength in axial tensile tests. INTERPRETATION Considering the clinically significant forces related to the biomechanical stability of the three different implants used for high tibial osteotomy, the fixator system would appear to be slightly superior, although it should be noted that torsional forces, as well as parameters that could change in living tissue, might affect the results.
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Affiliation(s)
- Sefa Key
- Department of Orthopedics and Traumatology, Bingöl State Hospital, Bingöl, Turkey
| | - Sukru Demir
- Department of Orthopedics and Traumatology, Faculty of Medicine, Firat University, 23190 Elazig, Turkey
| | - Oğuz Aydın
- Department of Orthopedics and Traumatology, Faculty of Medicine, Firat University, 23190 Elazig, Turkey
| | - Yakup Say
- Department of Metallurgy and Materials Engineering, College of Engineering, Munzur University, Tunceli, Turkey
| | - Mehmet Erten
- Department of Medical Biochemistry, Public Health Lab, Malatya, Turkey.
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Zhang H, Fan Y, Wang R, Feng W, Chen J, Deng P, Qi X, Ye P, Li Y, Li J, Zeng J, Zeng Y. Research trends and hotspots of high tibial osteotomy in two decades (from 2001 to 2020): a bibliometric analysis. J Orthop Surg Res 2020; 15:512. [PMID: 33168047 PMCID: PMC7650161 DOI: 10.1186/s13018-020-01991-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/01/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The purpose of this study is to comprehensively analyze the global application trend of high tibial osteotomy (HTO) and identify promising research hotspots of HTO based on bibliometrics and visual analysis. METHODS Publications (articles and reviews) related to HTO from 2001 to 2020 were retrieved from the Web of Science Core Collection database (WOSCC). The country, institution, year, author, journal, average citations per item, H index, title, abstract, keywords of publication, and the top 10 cited articles were extracted and analyzed in detail. The VOSviewer software was used to analyze theco-occurrence of keywords to predict the hotspots of HTO. RESULTS A total of 1883 articles were included. In the past 20 years, the number of HTO articles has shown an increasing trend in general. The top 3 countries (the USA, Germany, and South Korea) accounted for 49.547% of all articles published. The USA has the largest number of publications. The University of Western Ontario is the largest contributor. The Knee Surgery Sports Traumatology Arthroscopy is the most influential journal. Professors Saito T and Imhoff AB are the leading scholars who made great achievements in the HTO field. The research direction can be divided into the following 5 clusters: "prognosis and outcome", "HTO combined with cartilage restoration techniques", "animal experimental research", "study on bone union and plate fixation at osteotomy", and "surgical technique research". CONCLUSION In terms of the trend of previous years, an increasing number of literatures related to HTO will be published in the future. The USA is a world leader in the field of HTO. South Korea presented great potential in this area. HTO combined with cartilage restoration techniques, postoperative prognosis and outcome, and surgical technique research may be the future hotspots in the field of HTO research.
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Affiliation(s)
- Haitao Zhang
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Yinuo Fan
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Rui Wang
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Wenjun Feng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Jinlun Chen
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Peng Deng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Xinyu Qi
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Pengcheng Ye
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Yijin Li
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Jiahao Li
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Jianchun Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Yirong Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China.
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Petersen W, Bierke S, Häner M. Kniegelenknahe Osteotomie bei unikompartimenteller Gonarthrose. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00378-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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