Institute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany.
Institute for Biomechanics, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
Eur J Trauma Emerg Surg. 2022 Feb;48(1):621-628. doi: 10.1007/s00068-020-01503-0. Epub 2020 Sep 28.
Distal tibial fractures generally require post-operative weight-bearing restrictions. Especially geriatric patients are unable to follow these recommendations. To increase post-operative implant stability and enable early weight-bearing, augmentation of the primary osteosynthesis by cerclage is desirable. The purpose of this study was to identify the stabilizing effects of a supplemental cable cerclage following plate fixation of distal tibial spiral fractures compared to solitary plate osteosynthesis.
In eight synthetic tibiae, a reproducible spiral fracture (AO/OTA 42-A1.1c) was stabilized by angle stable plate fixation. Each specimen was statically loaded under combined axial and torsional loads to simulate partial (200 N, 2 Nm) and full (750 N, 7 Nm) weight-bearing. Tests were repeated with supplemental cable cerclage looped around the fracture zone. In a subsequent stepwise increased dynamic load scenario, construct stiffness and interfragmentary movements were analyzed.
With supplemental cable cerclage, construct stiffness almost tripled compared to solitary plate osteosynthesis (2882 ± 739 N/mm vs. 983 ± 355 N/mm; p < 0.001). Under full weight-bearing static loads, a supplemental cerclage revealed reduced axial (- 55%; p = 0.001) and shear movement (- 83%; p < 0.001), and also lowered shear movement (- 42%; p = 0.001) compared to a solitary plate under partial weight-bearing. Under dynamic loads supplemental cerclage significantly reduced axial (p = 0.005) as well as shear movements (p < 0.001).
Supplemental cable cerclage significantly increases fixation stiffness and reduces shear movement in distal tibial spiral fractures. This stabilizing effect enables from a biomechanical point of view immediate mobilization without any weight-bearing restrictions, which may improve the quality of care of orthopedic patients and may trigger a change towards early weight-bearing regimes, especially geriatric patients would benefit from.
胫骨远端骨折通常需要术后负重限制。特别是老年患者无法遵循这些建议。为了增加术后植入物的稳定性并实现早期负重，通过环扎来增强主要的内固定是可取的。本研究的目的是确定在胫骨远端螺旋骨折的钢板固定后，附加的电缆环扎与单独的钢板内固定相比，对稳定的影响。
在八个合成胫骨中，通过角度稳定钢板固定来稳定可重复的螺旋骨折（AO/OTA 42-A1.1c）。每个标本都在轴向和扭转负荷的组合下进行静态加载，以模拟部分（200 N，2 Nm）和完全（750 N，7 Nm）负重。使用附加的电缆环扎在骨折区域周围缠绕，重复测试。在随后的逐步增加的动态负荷情况下，分析了结构的刚性和断端间的运动。
与单独的钢板内固定相比，附加的电缆环扎使结构的刚性几乎增加了两倍（2882 ± 739 N/mm 比 983 ± 355 N/mm；p < 0.001）。在完全负重的静态负荷下，与部分负重相比，附加的环扎减少了轴向（-55%；p = 0.001）和剪切运动（-83%；p < 0.001），并且还降低了剪切运动（-42%；p = 0.001）。在动态负荷下，附加的环扎显著减少了轴向（p = 0.005）和剪切运动（p < 0.001）。
附加的电缆环扎显著增加了胫骨远端螺旋骨折的固定刚性，并减少了剪切运动。这种稳定作用使从生物力学的角度来看，可以立即进行活动而无需任何负重限制，这可能会提高骨科患者的护理质量，并可能引发向早期负重方案的转变，特别是老年患者将受益。
