Yan Lifeng, Zhan Yu, Xie Xuetao, Wang Yukai, Zhang Yingqi, Luo Congfeng
Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
Ann Transl Med. 2022 Jul;10(13):727. doi: 10.21037/atm-22-750.
The surgical treatment of posterolateral tibial plateau fractures involves a challenging and diverse set of considerations, one of which is the lack of proper and satisfactory internal fixations to purchase posterolateral fragments. Evaluating the configuration of internal fixations is often overlooked, despite it being important to outcomes of fracture fixation. This study aimed to (I) propose a new digital methodology of internal fixation evaluation that based on actual fracture cases and (II) evaluate the fixation effectiveness of four commercially available proximal tibial lateral plate-screw constructs for posterolateral fragments.
Tibial plateau fractures involving the posterolateral column were retrospectively reviewed. The reconstructed three-dimensional (3D) fracture models were virtually reduced, and targeted internal fixations were modeled digitally in specialized software. Four implants from three manufacturers (DePuy Synthes, Westchester, NY, USA; Zimmer, Warsaw, IN, USA; and Biomet, Warsaw, IN, USA) were placed on each fracture in an optimal position to simulate surgical fixation and quantitatively evaluate fixation effectiveness. The fragment was considered to be "captured" if it was purchased by at least two screws. The 3D fracture maps and heat maps were created by graphically superimposing all uncaptured fracture fragments onto a tibia template.
This study included 144 posterolateral tibial plateau fractures. When not using screws in a variable angle (VA) manner, the fixation effectiveness for posterolateral fragments was 58.3% for the DePuy Synthes locking compression plates (LCP), 47.9% for the DePuy Synthes VA-LCP, 50.7% for the Zimmer plate, and 43.8% for the Biomet plate. In contrast, the capturing rates boosted to 76.4% and 71.5% when utilizing VA screws in the DePuy Synthes VA-LCP and the Biomet plate. The high-frequency uncaptured areas tended to concentrate on the rim of the posterolateral wall and were mainly distributed in the posterior 1/2 to 3/4 of the parallel position of the fibula head.
The proposed new digital methodology was demonstrated feasible and may improve the quantitative evaluation of the implants and optimize the design of implants. The commercially available proximal tibial lateral plate-screw constructs were insufficient in capturing posterolateral fragments, and design-improved or additional implants may be necessitated.
胫骨平台后外侧骨折的手术治疗涉及一系列具有挑战性且多样的考量因素，其中之一是缺乏合适且令人满意的内固定装置来固定后外侧骨折块。尽管内固定装置的构型对骨折固定效果很重要，但评估其构型往往被忽视。本研究旨在：（I）基于实际骨折病例提出一种新的内固定评估数字方法；（II）评估四种市售近端胫骨外侧钢板 - 螺钉结构对后外侧骨折块的固定效果。
回顾性分析涉及后外侧柱的胫骨平台骨折。对重建的三维（3D）骨折模型进行虚拟复位，并在专业软件中对目标内固定装置进行数字建模。将来自三个制造商（美国纽约韦斯特切斯特的DePuy Synthes；美国印第安纳州华沙的Zimmer；以及美国印第安纳州华沙的Biomet）的四种植入物放置在每个骨折的最佳位置，以模拟手术固定并定量评估固定效果。如果骨折块被至少两颗螺钉固定，则认为该骨折块被“捕获”。通过将所有未被捕获的骨折碎片图形叠加到胫骨模板上创建3D骨折图和热图。
本研究纳入144例胫骨平台后外侧骨折。当不采用可变角度（VA）螺钉时，DePuy Synthes锁定加压钢板（LCP）对后外侧骨折块的固定效果为58.3%，DePuy Synthes VA - LCP为47.9%，Zimmer钢板为50.7%，Biomet钢板为43.8%。相比之下，在DePuy Synthes VA - LCP和Biomet钢板中使用VA螺钉时，捕获率分别提高到76.4%和71.5%。高频未捕获区域倾向于集中在后外侧壁边缘，主要分布在腓骨头平行位置的后1/2至3/4处。
所提出的新数字方法被证明是可行的，可能会改善对植入物的定量评估并优化植入物设计。市售近端胫骨外侧钢板 - 螺钉结构在固定后外侧骨折块方面不足，可能需要改进设计或增加植入物。
