Xue Hang, Deng Junrong, Zhang Zhenhe, Knoedler Samuel, Panayi Adriana C, Knoedler Leonard, Mi Bobin, Liu Mengfei, Dai Guandong, Liu Guohui
Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
Front Med (Lausanne). 2023 Jul 3;10:1172377. doi: 10.3389/fmed.2023.1172377. eCollection 2023.
Due to the low incidence of posteromedial tibial plateau fractures and limited clinical data available, the optimal treatment for this type of fracture remains to be established. This type of fracture, also known as Hoffa-like fracture of the tibial plateau, shares a similar mechanism of injury with the Hoffa fracture of the femoral condyle. In the field of orthopedics, finite element analysis is considered a valuable method to guide clinical decision-making. In this study, four methods used for internal fixation of Hoffa-like fractures of the tibial plateau were compared using computer simulation and applying a finite element method (FEM). The methods compared were lateral L-plate fixation alone (Model A); lateral L-plate combined with posterior anti-slip plate (reconstruction plate/T-plate) fixation (Model B); lateral L-plate combined with posterior hollow nail fixation of the fracture block (Model C); and lateral L-plate combined with anterior hollow nail fixation of the fracture (Model D). The maximum displacement of the model and the maximum stress of the internal fixation material were analyzed by applying an axial load of 2,500 N. The results showed that, in the normal bone model, the maximum displacement of the fracture in Model A was 0.60032 mm, with improved stability through the addition of posterior lateral plate fixation in Model B and reduction of the displacement to 0.38882 mm. The maximum displacement in Model C and Model D was comparable, amounting to 0.42345 mm and 0.42273 mm, respectively. Maximum stress was 1235.6 MPa for Model A, 84.724 MPa for Model B, 99.805 MPa for Model C, and 103.19 MPa for Model D. In the internal fixation analysis of the osteoporotic fracture model, we observed patterns similar to the results of the normal bone model. The results indicated that Model B yielded the overall best results in the treatment of Hoffa-like fractures of the tibial plateau. The orthopedic surgeon may wish to implement these insights into the perioperative algorithm, thereby refining and optimizing clinical patient care. In addition, our findings pave the way for future research efforts.
由于胫骨平台后内侧骨折的发病率较低且可用的临床数据有限，此类骨折的最佳治疗方法仍有待确定。这种类型的骨折，也称为胫骨平台类Hoffa骨折，其损伤机制与股骨髁Hoffa骨折相似。在骨科领域，有限元分析被认为是指导临床决策的一种有价值的方法。在本研究中，使用计算机模拟并应用有限元方法（FEM）比较了用于胫骨平台类Hoffa骨折内固定的四种方法。比较的方法包括单纯外侧L形钢板固定（模型A）；外侧L形钢板联合后侧防滑钢板（重建钢板/T形钢板）固定（模型B）；外侧L形钢板联合骨折块后侧空心钉固定（模型C）；以及外侧L形钢板联合骨折前侧空心钉固定（模型D）。通过施加2500 N的轴向载荷分析模型的最大位移和内固定材料的最大应力。结果表明，在正常骨模型中，模型A骨折的最大位移为0.60032 mm，通过在模型B中增加后侧钢板固定提高了稳定性，位移减小至0.38882 mm。模型C和模型D的最大位移相当，分别为0.42345 mm和0.42273 mm。模型A的最大应力为1235.6 MPa，模型B为84.724 MPa，模型C为99.805 MPa，模型D为103.19 MPa。在骨质疏松性骨折模型的内固定分析中，我们观察到与正常骨模型结果相似的模式。结果表明，模型B在治疗胫骨平台类Hoffa骨折方面总体效果最佳。骨科医生不妨将这些见解应用于围手术期算法，从而改进和优化临床患者护理。此外，我们的研究结果为未来的研究工作铺平了道路。
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