title: Peak loading during walking is not associated with fracture migration following tibial plateau fracture: A preliminary case series.
abstract: Tibial plateau fractures are common, but little evidence exists for their postoperative management, especially when recommending if patients should weight bear at all, partially, or as tolerated. In this study, we describe the loads passing through the fracture construct and the associated fracture migration over the first year following surgery. Nine patients were treated with open reduction and internal fixation and instructed to weight bear as tolerated. Fracture loading and migration were assessed at 2, 12, 26, and 52 weeks postoperative. Fracture loading was calculated as the knee joint reaction force (peak, average, the angle of the force vector, and the point of force application) using gait analysis and an inverse dynamics musculoskeletal model. Fracture migration was assessed using radiostereometric analysis. The fractures were progressively loaded during the rehabilitation phase. The point of application of the load shifted from neutral to medial by week 26 for all patients. Migration during the first postoperative year was within current clinical acceptable limits. The peak load during walking at each time point was not associated with fracture fragment migration and does not appear to exceed the elastic limit of the fracture construct.
authors.affiliation: Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia.|Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA, Australia.
authors.forename: Dominic
authors.initials: D
authors.lastname: Thewlis
authors.affiliation: Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA, Australia.|Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Callary
authors.affiliation: Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia.
authors.forename: Francois
authors.initials: F
authors.lastname: Fraysse
authors.affiliation: Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA, Australia.|Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Lucian B
authors.initials: LB
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D005684:Gait; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009142:Musculoskeletal Physiological Phenomena; D011446:Prospective Studies; D013977:Tibia / Q000473:pathology*; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors; D016138:Walking / Q000502:physiology*; D016474:Weight-Bearing
keywords: inverse dynamics; musculoskeletal model; open reduction and internal fixation; radiostereometric analysis