Massey Patrick A, Scalisi Wayne, Duval Chloe, Lowery Michael, Chauvin Brad, Solitro Giovanni F
Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
Louisiana State University Health Sciences Center, Louisiana State University School of Medicine, Shreveport, Louisiana.
JB JS Open Access. 2025 Feb 3;10(1). doi: 10.2106/JBJS.OA.24.00094. eCollection 2025 Jan-Mar.
External fixation of tibial plateau fractures commonly provides temporary stabilization before definitive fixation with plate and screws. The purpose of this study was to determine if an external fixator pin hole distal to a tibial plate in a synthetic fracture model would increase the risk of fracture after fixation. Another objective was to determine the ideal configuration when placing tibial plate screws near an external fixator pin hole.
Thirty synthetic tibiae were tested and evenly divided into 5 groups. Tibial plateau plates were placed with 4 different screw configurations for the distal-most screw near the external fixator pin hole. The 5 groups tested were control (fixation with no external fixator hole), unicortical (distal fixation with a unicortical locking screw), bicortical (distal fixation with a bicortical locking screw), oblique (distal fixation with an oblique cortical screw angled 30° proximally from the external fixator hole), and hole-bridging (hole-bridging fixation in which the plate was placed bridging the external fixator hole). The bone surrogates were potted and tested using an Instron 8874 Testing System.
There was a significant difference in failure load among the 5 groups (p = 0.005). The mean peak loads were 1,259 N (control), 835 N (unicortical), 831 N (bicortical), 943 N (oblique), and 993 N (hole-bridging). There was a higher failure load in the control group compared with the bicortical group (p = 0.007) and the unicortical group (p = 0.007). There was no difference in failure load between the control group and the hole-bridging group (p = 0.16) and the oblique group (p = 0.067).
External fixator pin holes distal to a tibial plateau plate may increase the risk of tibial fracture through the pin hole. This risk may be mitigated by placing the distal screw oblique and angled proximally away from the external fixator pin hole or by placing the external fixator pin proximally with subsequent bridging of the external fixator pin hole with the plate.
胫骨平台骨折的外固定通常在使用钢板螺钉进行确定性固定之前提供临时稳定。本研究的目的是确定在合成骨折模型中，胫骨钢板远端的外固定器针孔是否会增加固定后骨折的风险。另一个目的是确定在靠近外固定器针孔处放置胫骨钢板螺钉时的理想构型。
测试30根合成胫骨，并将其均匀分为5组。对于靠近外固定器针孔的最远端螺钉，胫骨平台钢板采用4种不同的螺钉构型进行放置。测试的5组分别为对照组（无外固定器孔的固定）、单皮质组（用单皮质锁定螺钉进行远端固定）、双皮质组（用双皮质锁定螺钉进行远端固定）、斜行组（用从外固定器孔向近端成30°角的斜行皮质螺钉进行远端固定）和跨孔组（钢板跨外固定器孔放置的跨孔固定）。将骨替代物装入盆中，使用英斯特朗8874测试系统进行测试。
5组之间的失效载荷存在显著差异（p = 0.005）。平均峰值载荷分别为1259 N（对照组）、835 N（单皮质组）、831 N（双皮质组）、943 N（斜行组）和993 N（跨孔组）。与双皮质组（p = 0.007）和单皮质组（p = 0.007）相比，对照组的失效载荷更高。对照组与跨孔组（p = 0.16）和斜行组（p = 0.067）之间的失效载荷没有差异。
胫骨平台钢板远端的外固定器针孔可能会增加通过针孔发生胫骨骨折的风险。通过将远端螺钉斜行并向近端远离外固定器针孔放置，或者通过将外固定器针向近端放置并随后用钢板跨外固定器针孔，可以减轻这种风险。
