title: Biomechanical analysis of operative methods in the treatment of extra-articular fracture of the proximal tibia.
abstract: BACKGROUND
  To determine relative fixation strengths of a single lateral locking plate, a double construct of a locking plate, and a tibial nail used in treatment of proximal tibial extra-articular fractures.
  
  
  METHODS
  Three groups of composite tibial synthetic bones consisting of 5 specimens per group were included: lateral plating (LP) using a locking compression plate-proximal lateral tibia (LCP-PLT), double plating (DP) using a LCP-PLT and a locking compression plate-medial proximal tibia, and intramedullary nailing (IN) using an expert tibial nail. To simulate a comminuted fracture model, a gap osteotomy measuring 1 cm was created 8 cm below the knee joint. For each tibia, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 25 mm/min until tibial failure.
  
  
  RESULTS
  Under axial loading, fixation strength of DP (14,387.3 N; standard deviation [SD], 1,852.1) was 17.5% greater than that of LP (12,249.3 N; SD, 1,371.6), and 60% less than that of IN (22,879.6 N; SD, 1,578.8; p < 0.001, Kruskal-Wallis test). For ultimate displacement under axial loading, similar results were observed for LP (5.74 mm; SD, 1.01) and DP (4.45 mm; SD, 0.96), with a larger displacement for IN (5.84 mm; SD, 0.99). The median stiffness values were 2,308.7 N/mm (range, 2,147.5 to 2,521.4 N/mm; SD, 165.42) for the LP group, 4,128.2 N/mm (range, 3,028.1 to 4,831.0 N/mm; SD, 832.88) for the DP group, and 5,517.5 N/mm (range, 3,933.1 to 7,078.2 N/mm; SD, 1,296.19) for the IN group.
  
  
  CONCLUSIONS
  During biomechanical testing of a simulated comminuted proximal tibial fracture model, the DP proved to be stronger than the LP in terms of ultimate strength. IN proved to be the strongest; however, for minimally invasive osteosynthesis, which may be technically difficult to perform using a nail, the performance of the DP construct may lend credence to the additional use of a medial locking plate.
authors.affiliation: Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Seong-Man
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Chang-Wug
authors.initials: CW
authors.lastname: Oh
authors.affiliation: Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Jong-Keon
authors.initials: JK
authors.lastname: Oh
authors.affiliation: Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Joon-Woo
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Hyun-Joo
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Solco Biomedical Institute, Pyeongtaek, Korea.
authors.forename: Chang-Soo
authors.initials: CS
authors.lastname: Chon
authors.affiliation: Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Byoung-Joo
authors.initials: BJ
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Hee-Soo
authors.initials: HS
authors.lastname: Kyung
mesh_terms: D001696:Biomechanical Phenomena; D001858:Bone Nails; D001860:Bone Plates; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D018460:Fractures, Comminuted / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008953:Models, Anatomic; D013978:Tibial Fractures / Q000503:physiopathology / Q000601:surgery*
keywords: Biomechanical study; Locking plate; Nail; Proximal tibial fracture