Zhou Zulong, Fang Run, Liu Yulong, Liu Mingxiang, Kong Lingchao, Ning Rende
The Third Affiliated Hospital of Anhui Medical University, No. 390, Huaihe Road, Luyang District, Hefei City, Anhui Province, China.
BMC Musculoskelet Disord. 2025 May 23;26(1):509. doi: 10.1186/s12891-025-08770-1.
This study aims to evaluate the biomechanical performance of five different internal fixation strategies for Schatzker type IV-C tibial plateau fractures using three-dimensional finite element analysis. By analyzing stress distribution and displacement patterns under physiological load, we seek to identify optimal fixation modalities for clinical application.
We established a three-dimensional finite element model of Schatzker IV-C tibial plateau fractures and evaluated five internal fixation modalities via finite element analysis. These modalities included a medial plate (Model 1), a medial plate with two posterior tension screws (Model 2), a medial plate with two lateral tension screws (Model 3), a posterior medial double plate (Model 4), and a medial lateral double plate (Model 5). To simulate the biomechanics of unilateral knee axial compression during normal adult gait, an axial force of 1,200 newtons (N) was applied, with 60% of the force distributed to the medial plate. We comprehensively analyzed equivalent von Mises stresses, displacements, and equivalent stress-displacement plots for each fixation.
Model 5 demonstrated the best overall performance in terms of internal fixation stress (91.46 MPa) and fracture block stress (10.826 MPa), suggesting optimal stress distribution and fracture block protection. Model 3 performed best in terms of internal fixation displacement (4.391 mm), suggesting an advantage in fracture block stability. While the models performed well in several areas, the double plate fixation scheme was superior in terms of stress distribution and fracture stability. It is ideal for managing complex fractures.
A single medial plate (Model 1) provides adequate fixation and stability for fractures without the lateral intercondylar ridge. Lag screws with the medial plate (Models 2 and 3) effectively reduce stress and minimize trauma. Double plate on the posterior medial side (Model 4) significantly enhances fixation and prevents displacement for complex fractures. Medial-lateral double plate fixation (Model 5) provides the most favorable biomechanical stability for fractures with extensive lateral plateau comminution. However, balance the benefits against increased complexity, particularly in patients with compromised soft tissue or high functional demands. Selecting internal fixation based on the fracture line can optimize outcomes and speed recovery.
本研究旨在利用三维有限元分析评估Schatzker IV - C型胫骨平台骨折的五种不同内固定策略的生物力学性能。通过分析生理负荷下的应力分布和位移模式，我们试图确定临床应用中的最佳固定方式。
我们建立了Schatzker IV - C型胫骨平台骨折的三维有限元模型，并通过有限元分析评估了五种内固定方式。这些方式包括内侧钢板（模型1）、带两枚后张力螺钉的内侧钢板（模型2）、带两枚外侧张力螺钉的内侧钢板（模型3）、后内侧双钢板（模型4）和内外侧双钢板（模型5）。为模拟正常成人步态期间单侧膝关节轴向压缩的生物力学，施加了1200牛顿（N）的轴向力，其中60%的力分布在内侧钢板上。我们全面分析了每种固定方式的等效冯·米塞斯应力、位移和等效应力 - 位移图。
模型5在内固定应力（91.46兆帕）和骨折块应力（10.826兆帕）方面表现出最佳的整体性能，表明应力分布最佳且对骨折块的保护效果最佳。模型3在内固定位移（4.391毫米）方面表现最佳，表明在骨折块稳定性方面具有优势。虽然这些模型在几个方面表现良好，但双钢板固定方案在应力分布和骨折稳定性方面更具优势。它对于处理复杂骨折是理想的选择。
单一内侧钢板（模型1）为没有外侧髁间嵴的骨折提供了足够的固定和稳定性。内侧钢板加拉力螺钉（模型2和3）有效地降低了应力并使创伤最小化。后内侧双钢板（模型4）显著增强了固定并防止了复杂骨折的位移。内外侧双钢板固定（模型5）为伴有广泛外侧平台粉碎性骨折的骨折提供了最有利的生物力学稳定性。然而，要权衡其益处与增加的复杂性，特别是在软组织受损或功能需求较高的患者中。根据骨折线选择内固定可以优化治疗结果并加速康复。
