title: Treatment of distal intraarticular tibial fractures: A biomechanical evaluation of intramedullary nailing vs. angle-stable plate osteosynthesis.
abstract: In factures of the distal tibia with simple articular extension, the optimal surgical treatment remains debatable. In clinical practice, minimally invasive plate osteosynthesis and intramedullary nailing are both routinely performed. Comparative biomechanical studies of different types of osteosynthesis of intraarticular distal tibial fractures are missing due to the lack of an established model. The goal of this study was first to establish a biomechanical model and second to investigate, which are the biomechanical advantages of angle-stable plate osteosynthesis and intramedullary nailing of distal intraarticular tibial fractures. Seven 4(th) generation biomechanical composite tibiae featuring an AO 43-C2 type fracture were implanted with either osteosynthesis technique. After primary lag screw fixation, 4-hole Medial Distal Tibial Plate (MDTP) with triple proximal and quadruple distal screws or intramedullary nailing with double proximal and triple 4.0mm distal interlocking were implanted. The stiffness of the implant-bone constructs and interfragmentary movement were measured under non-destructive axial compression (350 and 600 N) and torsion (1.5 and 3Nm). Destructive axial compression testing was conducted with a maximal load of up to 1,200 N. No overall superior biomechanical results can be proclaimed for either implant type. Intramedullary nailing displays statistically superior results for axial loading in comparison to the MDTP. Torsional loading resulted in non-statistically significant differences for the two-implant types with higher stability in the MDTP group. From a biomechanical view, the load sharing intramedullary nail might be more forgiving and allow for earlier weight bearing in patients with limited compliance.
authors.affiliation: Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany. Electronic address: sebastian.kuhn@unimedizin-mainz.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kuhn
authors.affiliation: Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany; GRESPI EA 4694/Faculty of Sport Sciences, University of Reims Champagne-Ardenne, Reims, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Greenfield
authors.affiliation: Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Arand
authors.affiliation: Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany; Hochschule RheinMain University of Applied Sciences, Rüsselsheim, Germany.
authors.forename: Andrey
authors.initials: A
authors.lastname: Jarmolaew
authors.affiliation: Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Appelmann
authors.affiliation: Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Mehler
authors.affiliation: Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Pol M
authors.initials: PM
authors.lastname: Rommens
mesh_terms: D001696:Biomechanical Phenomena; D001858:Bone Nails; D001860:Bone Plates; D001863:Bone Screws; D005240:Feasibility Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D057072:Intra-Articular Fractures / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D013978:Tibial Fractures / Q000601:surgery*; D054159:Torsion, Mechanical; D016474:Weight-Bearing
keywords: angle-stable plate osteosynthesis; distal tibia; intraarticular fractures; intramedullary nailing; metaphyseal fractures