From the Department of Orthopaedic Surgery, University of California Irvine, Orange, CA (Scolaro, Wright, and Lai), the Princeton University, Princeton, NJ (Fraipont and Kwak), the Cornell University, Ithaca, NY (Hitchens), and the Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA (McGarry and Lee).
J Am Acad Orthop Surg. 2022 Jul 1;30(13):629-635. doi: 10.5435/JAAOS-D-21-01089. Epub 2022 Apr 19.
This biomechanical study seeks to define the relative effectiveness of contemporary single and dual implant constructs for fixation of an extra-articular proximal tibia fracture model.
An extra-articular proximal tibia fracture model was created using synthetic tibias. Four constructs were tested. Constructs included (1) lateral locked plate (LLP), (2) intramedullary nail (IMN), (3) combined LLP and IMN (PN), and (4) LLP and medial locked plate. Specimens were axially loaded through the medial plateau to evaluate construct stiffness and the ability to resist varus collapse.
Dual implant constructs were stiffer than single implant constructs in this model. Although DP and PN were stiffer than IMN at all loads tested, the difference was notable only for DP at higher loads. Isolated LLP provided insufficient stability to be tested at higher loads.
Dual plate fixation provides the greatest resistance to varus collapse. In the clinical setting, consideration must be given to the fracture morphology, desired construct stiffness, and soft-tissue envelope in selecting the optimal construct to be used.
本生物力学研究旨在比较单枚和双枚植入物固定关节外胫骨近端骨折模型的相对有效性。
采用合成胫骨制作关节外胫骨近端骨折模型。测试了 4 种植入物固定方式。固定方式包括：（1）外侧锁定钢板（LLP），（2）髓内钉（IMN），（3）LLP 和 IMN 联合固定（PN），（4）LLP 和内侧锁定钢板。通过内侧平台轴向加载标本，以评估固定方式的刚度和抵抗内翻塌陷的能力。
在该模型中，双枚植入物固定方式比单枚植入物固定方式更坚固。尽管 DP 和 PN 在所有测试负荷下均比 IMN 坚固，但仅在较高负荷下 DP 与 IMN 之间的差异显著。单独使用 LLP 提供的稳定性不足，无法在较高负荷下进行测试。
双钢板固定方式对内翻塌陷具有最大的抵抗力。在临床实践中，在选择要使用的最佳固定方式时，必须考虑骨折形态、所需的固定方式刚度和软组织情况。
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