Effect of different bone grafting methods and internal fixation on mechanical stability of Schatzker type <b>Ⅱ</b> tibial plateau fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Zhongzheng ^1,2,3 , WANG Yuchuan ^1,2,3 , TIAN Siyu ¹ , WANG Zitao ² , ZHANG Ruipeng ^1,4 , LIAN Xiaodong ^1,2,3 , ZHENG Zhanle ^1,2,3 ,  ZHANG Yingze ^1,2,3,4,5

1. Trauma Emergency Center, Hebei Medical University Third Hospital, Shijiazhuang Hebei, 050051, P. R. China;
2. Knee Preservation Center, Hebei Medical University Third Hospital, Shijiazhuang Hebei, 050051, P. R. China;
3. Hebei Institute of Orthopaedics, Shijiazhuang Hebei, 050051, P. R. China;
4. Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Shijiazhuang Hebei, 050051, P. R. China;
5. Key Laboratory of Orthopaedic Intelligent Devices, National Health Commission, Shijiazhuang Hebei, 050051, P. R. China;

Corresponding author：

ZHANG Yingze, Email: yzling_liu@163.com

Keywords：

Tibial plateau fracture; structural iliac bone graft; compression bolt; internal fixator; biomechanics

DOI：

10.7507/1002-1892.202505055

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Objective To investigate the biomechanical characteristics of Schatzker type Ⅱ tibial plateau fracture fixed by different bone grafting methods and internal fixations. Methods Twenty-four embalmed specimens of adult knee joint were selected to make Schatzker type Ⅱ tibial plateau fracture models, which were randomly divided into 8 groups (groups A1-D1 and groups A2-D2, n=3). After all the fracture models were restored, non-structural iliac crest bone grafts were implanted in group A1-D1, and structural iliac crest bone grafts in groups A2-D2. Following bone grafting, group A was fixed with a lateral golf locking plate, group B was fixed with lateral golf locking plate combined compression bolt, group C was fixed with lateral tibial “L”-shaped locking plate, and group D was fixed with lateral tibial “L”-shaped locking plate combined compression bolt. Compression and cyclic loading tests were performed on a biomechanical testing machine. A distal femur specimen or a 4-cm-diameter homemade bone cement ball were used as a pressure application mould for each group of models. The specimens were loaded with local compression at a rate of 10 N/s and the mechanical loads were recorded when the vertical displacement of the split bone block reached 2 mm. Then, compressive and cyclic loading tests were conducted on the fixed models of each group. The specimens were compression loaded to 100, 400, 700, and 1 000 N at a speed of 10 N/s to record the vertical displacement of the split bone block. The specimens were also subjected to cyclic loading at 5 Hz and 10 N/s within the ranges 100-300, 100-500, 100-700, and 100-1 000 N to record the vertical displacement of the split bone block at the end of the entire cyclic loading test. The specimens were subjected to cyclic loading tests and the vertical displacement of the split bone block was recorded at the end of the test. Results When the vertical displacement of the collapsed bone block reached 2 mm, the mechanical load of groups A2-D2 was significantly greater than that of groups A1-D1 (P<0.05). The mechanical load of groups B and D was significantly greater than that of group A under the two bone grafting methods (P<0.05); the local mechanical load of group D was significantly greater than that of groups B and C under the structural iliac crest bone grafts (P<0.05). There was no significant difference (P>0.05) in the vertical displacement of the split bone blocks between the two bone graft methods when the compressive load was 100, 400, 700 N and the cyclic load was 100-300, 100-500, 100-700 N in groups A-D. However, the vertical displacement of bone block in groups A1-D1 was significantly greater than that in groups A2-D2 (P<0.05) when the compressive loading was 1 000 N and the cyclic load was 100-1 000 N. The vertical displacement of bone block in group B was significantly smaller than that in group A, and that in group D was significantly smaller than that in group C under the same way of bone graft (P<0.05). Conclusion Compared with non-structural iliac crest bone grafts implantation, structural iliac crest bone grafts is more effective in preventing secondary collapse of Schatzker type Ⅱ tibial plateau fracture, and locking plate combined with compression bolt fixation can provide better articular surface support and resistance to axial compression, and the lateral tibial “L”-shaped locking plate can better highlight its advantages of “raft” fixation and show better mechanical stability.

1.	Zeltser DW, Leopold SS. Classifications in brief: Schatzker classification of tibial plateau fractures. Clin Orthop Relat Res, 2013, 471(2): 371-374.
2.	Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium-2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma, 2007, 21(10 Suppl): S1-S133.
3.	Bowles RJ, Chadayammuri V, Baldini T, et al. Split-depressed lateral tibial plateau fractures: A comparison of augmented percutaneous screws versus augmented plate and screw construct in a cadaveric model. J Orthop Trauma, 2018, 32(7): e270-e275.
4.	Karunakar MA, Egol KA, Peindl R, et al. Split depression tibial plateau fractures: a biomechanical study. J Orthop Trauma, 2002, 16(3): 172-177.
5.	Wang Z, Zhu Y, Deng X, et al. Structural bicortical autologous iliac crest bone graft combined with the tunnel bone tamping method for the depressed tibial plateau fractures. Biomed Res Int, 2021, 2021: 1249734. doi: 10.1155/2021/1249734.
6.	鲁健, 任栋, 王鹏程. Schatzker Ⅱ型胫骨平台骨折2种内固定方法的生物力学对比研究. 河北医科大学学报, 2015, 36(10): 1149-1152.
7.	刘伟, 赖茂松, 熊浩等. 手术治疗伴劈裂骨块压缩骨折的 Schatzker Ⅲ型胫骨平台塌陷骨折. 临床骨科杂志, 2011, 14(3): 325-326.
8.	Frigg R, Appenzeller A, Christensen R, et al. The development of the distal femur Less Invasive Stabilization System (LISS). Injury, 2001, 32 Suppl 3: SC24-SC31.
9.	Ji F, Tong D, Tang H, et al. Minimally invasive percutaneous plate osteosynthesis (MIPPO) technique applied in the treatment of humeral shaft distal fractures through a lateral approach. Int Orthop, 2009, 33(2): 543-547.
10.	Myeroff C, Archdeacon M. Autogenous bone graft: donor sites and techniques. J Bone Joint Surg (Am), 2011, 93(23): 2227-2236.
11.	Koval KJ, Sanders R, Borrelli J, et al. Indirect reduction and percutaneous screw fixation of displaced tibial plateau fractures. J Orthop Trauma, 1992, 6(3): 340-346.
12.	Bai B, Kummer FJ, Sala DA, et al. Effect of articular step-off and meniscectomy on joint alignment and contact pressures for fractures of the lateral tibial plateau. J Orthop Trauma, 2001, 15(2): 101-106.
13.	Brown TD, Anderson DD, Nepola JV, et al. Contact stress aberrations following imprecise reduction of simple tibial plateau fractures. J Orthop Res, 1988, 6(6): 851-862.
14.	Russell TA, Leighton RK; Alpha-BSM Tibial Plateau Fracture Study Group. Comparison of autogenous bone graft and endothermic calcium phosphate cement for defect augmentation in tibial plateau fractures. A multicenter, prospective, randomized study. J Bone Joint Surg (Am), 2008, 90(10): 2057-2061.
15.	刘岗, 张进禄, 周东升, 等. 胫骨平台骨折的治疗和术后并发症的预防. 中国矫形外科杂志, 2003, 11(19): 1309-1311.
16.	Wang Z, Wang Y, Tian S, et al. Dual plating or dual plating combined with compression bolts for bicondylar tibial plateau fractures: a retrospective comparative study. Sci Rep, 2021, 11(1): 7768. doi: 10.1038/s41598-021-87510-6.
17.	Parker PJ, Tepper KB, Brumback RJ, et al. Biomechanical comparison of fixation of type-I fractures of the lateral tibial plateau. Is the antiglide screw effective? J Bone Joint Surg (Br), 1999, 81(3): 478-480.
18.	Wu CC, Tai CL. Plating treatment for tibial plateau fractures: a biomechanical comparison of buttress and tension band positions. Arch Orthop Trauma Surg, 2007, 127(1): 19-24.
19.	Twaddle BC, Knutson C, Tencer AF, et al. Biomechanical testing of buttress and raft plate fixation of lateral tibial plateau fractures. The 64th Annual Meeting of the American Academy of Orthopaedic Surgeons, Atlanta, Georgia, 1997.

1. Zeltser DW, Leopold SS. Classifications in brief: Schatzker classification of tibial plateau fractures. Clin Orthop Relat Res, 2013, 471(2): 371-374.
2. Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium-2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma, 2007, 21(10 Suppl): S1-S133.
3. Bowles RJ, Chadayammuri V, Baldini T, et al. Split-depressed lateral tibial plateau fractures: A comparison of augmented percutaneous screws versus augmented plate and screw construct in a cadaveric model. J Orthop Trauma, 2018, 32(7): e270-e275.
4. Karunakar MA, Egol KA, Peindl R, et al. Split depression tibial plateau fractures: a biomechanical study. J Orthop Trauma, 2002, 16(3): 172-177.
5. Wang Z, Zhu Y, Deng X, et al. Structural bicortical autologous iliac crest bone graft combined with the tunnel bone tamping method for the depressed tibial plateau fractures. Biomed Res Int, 2021, 2021: 1249734. doi: 10.1155/2021/1249734.
6. 鲁健, 任栋, 王鹏程. Schatzker Ⅱ型胫骨平台骨折2种内固定方法的生物力学对比研究. 河北医科大学学报, 2015, 36(10): 1149-1152.
7. 刘伟, 赖茂松, 熊浩等. 手术治疗伴劈裂骨块压缩骨折的 Schatzker Ⅲ型胫骨平台塌陷骨折. 临床骨科杂志, 2011, 14(3): 325-326.
8. Frigg R, Appenzeller A, Christensen R, et al. The development of the distal femur Less Invasive Stabilization System (LISS). Injury, 2001, 32 Suppl 3: SC24-SC31.
9. Ji F, Tong D, Tang H, et al. Minimally invasive percutaneous plate osteosynthesis (MIPPO) technique applied in the treatment of humeral shaft distal fractures through a lateral approach. Int Orthop, 2009, 33(2): 543-547.
10. Myeroff C, Archdeacon M. Autogenous bone graft: donor sites and techniques. J Bone Joint Surg (Am), 2011, 93(23): 2227-2236.
11. Koval KJ, Sanders R, Borrelli J, et al. Indirect reduction and percutaneous screw fixation of displaced tibial plateau fractures. J Orthop Trauma, 1992, 6(3): 340-346.
12. Bai B, Kummer FJ, Sala DA, et al. Effect of articular step-off and meniscectomy on joint alignment and contact pressures for fractures of the lateral tibial plateau. J Orthop Trauma, 2001, 15(2): 101-106.
13. Brown TD, Anderson DD, Nepola JV, et al. Contact stress aberrations following imprecise reduction of simple tibial plateau fractures. J Orthop Res, 1988, 6(6): 851-862.
14. Russell TA, Leighton RK; Alpha-BSM Tibial Plateau Fracture Study Group. Comparison of autogenous bone graft and endothermic calcium phosphate cement for defect augmentation in tibial plateau fractures. A multicenter, prospective, randomized study. J Bone Joint Surg (Am), 2008, 90(10): 2057-2061.
15. 刘岗, 张进禄, 周东升, 等. 胫骨平台骨折的治疗和术后并发症的预防. 中国矫形外科杂志, 2003, 11(19): 1309-1311.
16. Wang Z, Wang Y, Tian S, et al. Dual plating or dual plating combined with compression bolts for bicondylar tibial plateau fractures: a retrospective comparative study. Sci Rep, 2021, 11(1): 7768. doi: 10.1038/s41598-021-87510-6.
17. Parker PJ, Tepper KB, Brumback RJ, et al. Biomechanical comparison of fixation of type-I fractures of the lateral tibial plateau. Is the antiglide screw effective? J Bone Joint Surg (Br), 1999, 81(3): 478-480.
18. Wu CC, Tai CL. Plating treatment for tibial plateau fractures: a biomechanical comparison of buttress and tension band positions. Arch Orthop Trauma Surg, 2007, 127(1): 19-24.
19. Twaddle BC, Knutson C, Tencer AF, et al. Biomechanical testing of buttress and raft plate fixation of lateral tibial plateau fractures. The 64th Annual Meeting of the American Academy of Orthopaedic Surgeons, Atlanta, Georgia, 1997.

Chinese Journal of Reparative and Reconstructive Surgery

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