Keywords
comminuted fracture
osteosynthesis
mathematical modeling
How to Cite
Abstract
Introduction. Fractures of the tibial plateau are intra-articular injuries. The current debatable issue is the selection of a plate based on its functional capacity, which depends on the nature of the fracture and the position of the implant, and requires further study.
Objective. The study aims to investigate the stress values in a model of comminuted fractures of the proximal tibia under different types of stabilization when exposed to bending load in the sagittal plane.
Materials and Methods. A finite element model of the proximal epimetaphysis of the tibia with a comminuted fracture was created. Three variants of osteosynthesis were studied: (1) a plate on the medial side,
(2) a plate on the lateral side, and (3) two plates on both sides. A bending force was applied to the tibial plateau, acting from posterior to anterior.
Results. A plate applied on the lateral side provides the lowest stress levels in the bone elements of the model within the fracture zone. The exception is the bone fragments around the fixing screws passing through this plate, where the stress level exceeds 35.0 MPa. A plate applied on the medial side provides minimal stress around its fixing screws, but the stresses on the outer bone surfaces in the fracture zone increase and are several times higher than in the model with the lateral position of the plate; however, in absolute values, these stresses do not exceed 11.1 MPa. The variant of fixation with two plates provides the most optimal distribution of stresses in the model. Unilateral plate application may also be considered, taking into account the nature of the fracture, the number and size of fragments, technical difficulties of plate placement, etc.
Conclusions. Under bending load in the sagittal plane, osteosynthesis with two plates provides the lowest stresses. The exception is the area around the screws, where stresses in the bone fragments remain increased. In models with unilateral fixation of fragments, the main difference lies in stress levels near the screws: with the medial position of the plate, these values are several times lower than with the lateral position.
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