Saint Louis University Hospital, United States.
Saint Louis University Hospital, United States.
Injury. 2022 Oct;53(10):3109-3114. doi: 10.1016/j.injury.2022.08.039. Epub 2022 Aug 23.
To assess dual plating versus lateral locked plate fixation of bicondylar tibial plateau fractures in an elderly cadaveric model with and without medial bone loss PARTICIPANTS: 10 pairs of elderly (range 78-93 years of age) fresh frozen tibias.
Bicondylar tibial plateau fractures were created reproducing AO/OTA 41 C1 (without medial bone loss) and C2 fractures (with medial bone loss). Cadavers were randomized to 4 different groups. Groups 1 and 2 were 41 C1 fractures and fixated with either dual or lateral plating, respectively. Groups 3 and 4 were fixated in a similar fashion with medial metaphyseal bone loss (41 C2 fracture) with dual plating Group 3 and lateral plating group 4. Lateral plating consisted of a 3.5 mm 5-hole lateral plate (ALPS, ZimmerBiomet) with 6 bicortical locking screws proximally and two diaphyseal screws. Dual plating groups underwent lateral plating and additional 3.5 mm 5-hole posteromedial 1/3 tubular plate (ZimmerBiomet) placed at the apex of the fracture with two shaft screws and one unicortical screw proximally. Specimens were tested in a Mechanical Testing System (MTS) machine loading both condyles.
Specimens were loaded to 300 N and coronal alignment obtained. Specimens were then cycled from 100 N to 700 N for 5000 cycles at 2 Hz. Average axial displacement, maximal displacement, average force and coronal alignment after 5000 cycles were recorded. Lastly, force to failure was recorded at 100 N/sec.
Mean axial displacement was 4.21 mm ranging from 3.12 mm in group 1 to 5.92 mm in group 4 (P = 0.51). Failure force averaged 3340 N ranging from 4342 N in group 1 to 2433 N in group 4 (P = 0.36). Maximal displacement ranged from 3.69 mm in group 1 to 7.37 mm in group 4 (P = 0.21). Change in coronal alignment ranged from 0.98° in group 1 to 1.97° in group 4 (P = 0.45). No statistically significant difference was noted between all four groups for all data points.
The results of this study demonstrate that a lateral locked plate may offer an alternative means of fixation in AO/OTA 41 C1 and C2 fractures.
在伴有和不伴有内侧骨丢失的老年尸体模型中，评估双钢板与外侧锁定钢板治疗双髁胫骨平台骨折的效果。
10 对老年（年龄 78-93 岁）新鲜冷冻胫骨。
创建双髁胫骨平台骨折，复制 AO/OTA 41 C1（无内侧骨丢失）和 C2 骨折（有内侧骨丢失）。尸体随机分为 4 组。第 1 组和第 2 组为 41 C1 骨折，分别采用双钢板或外侧钢板固定。第 3 组和第 4 组以类似的方式固定内侧干骺端骨丢失（41 C2 骨折），双钢板组 3 ，外侧钢板组 4。外侧钢板采用 3.5mm5 孔外侧钢板（ALPS，ZimmerBiomet），近端有 6 个双皮质锁定螺钉和 2 个骨干螺钉。双钢板组行外侧钢板固定，再在骨折顶点行 3.5mm5 孔后内侧 1/3 管状钢板（ZimmerBiomet）固定，近端有 2 个骨干螺钉和 1 个单皮质螺钉。标本在机械测试系统（MTS）机上加载两个髁进行测试。
标本加载 300N 并获得冠状位对线。然后，标本以 2Hz 频率从 100N 循环至 700N，循环 5000 次。记录 5000 次循环后的平均轴向位移、最大位移、平均力和冠状对线。最后，以 100N/sec 的速度记录失效力。
本研究结果表明，外侧锁定钢板可能是治疗 AO/OTA 41 C1 和 C2 骨折的一种替代固定方法。
