Forna Norin, Munteanu Florin, Butnaru Moldoveanu Sînziana Anca, Savin Liliana, Sîrbu Paul Dan, Puha Bogdan
Department of Surgery II, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.
Department of Biomedical Sciences, Faculty of Medical Bioengineering, 'Grigore T. Popa' University of Medicine and Pharmacy, 700454 Iasi, Romania.
Exp Ther Med. 2022 Mar;23(3):198. doi: 10.3892/etm.2022.11121. Epub 2022 Jan 5.
Bicondylar tibial plateau fractures pose many challenges in surgical treatment. The aim of the present study was to analyze three methods of reduction, single medial, single lateral, and dual plating, for the treatment of a bicondylar tibial plateau fracture, through finite element analysis (FEA). A simple metaphyseal fracture, type C1.1 (AO-41) was modeled on a CT-derived 3D model of the knee. Lateral and medial proximal tibial polyaxial plates with screws were modeled and placed accordingly for the three methods of reduction. Simulation of physiological type loading corresponding to the maximal weight acceptance phase during a slow walking gait cycle was performed using FEA. Values of stress and strain were recorded near the fracture lines. Dual plating provided a decrease of stress and strain in the tibial plateau area. However, the differences in the values among the three cases were small. The stress concentration areas were located in the vicinity of the fracture, predominantly in the area of the tibial plateau. Considering the limitations of the present study, the results revealed that dual plating leads to smaller stress and strain values near the fracture lines in the tibial plateau area. However, values obtained for single lateral plating are close in range. Considering the complexity of the surgical approach for dual plating, single lateral plating may be a solution for good reduction with fewer surgical risks and complications. Further studies on the C1.1 fracture (AO-41) are needed to analyze the complex issue of reducing and stabilizing such a fracture and to characterize the postoperative state while providing predictable parameters for an optimal result.
双髁胫骨平台骨折的手术治疗面临诸多挑战。本研究旨在通过有限元分析（FEA），分析三种复位方法，即单内侧、单外侧和双钢板固定，用于治疗双髁胫骨平台骨折。在基于CT的膝关节三维模型上构建了一个简单的干骺端骨折模型，C1.1型（AO-41）。对胫骨近端外侧和内侧的多轴钢板及螺钉进行建模，并根据三种复位方法进行相应放置。使用有限元分析模拟了慢步行走步态周期中最大承重阶段的生理类型载荷。记录骨折线附近的应力和应变值。双钢板固定使胫骨平台区域的应力和应变有所降低。然而，三种情况之间的值差异较小。应力集中区域位于骨折附近，主要在胫骨平台区域。考虑到本研究的局限性，结果显示双钢板固定导致胫骨平台区域骨折线附近的应力和应变值较小。然而，单外侧钢板固定获得的值在范围内与之接近。考虑到双钢板固定手术入路的复杂性，单外侧钢板固定可能是一种既能实现良好复位又能降低手术风险和并发症的解决方案。需要对C1.1型骨折（AO-41）进行进一步研究，以分析复位和稳定此类骨折的复杂问题，并在为获得最佳结果提供可预测参数的同时，描述术后状态。
