title: Fixation of a split fracture of the lateral tibial plateau with a locking screw plate instead of cannulated screws would allow early weight bearing: a computational exploration.
abstract: To assess, with finite element (FE) calculations, whether immediate weight bearing would be possible after surgical stabilization either with cannulated screws or with a locking plate in a split fracture of the lateral tibial plateau (LTP).
  
  
  
  A split fracture of the LTP was recreated in a FE model of a human tibia. A three-dimensional FE model geometry of a human femur-tibia system was obtained from the VAKHUM project database, and was built from CT images from a subject with normal bone morphologies and normal alignment. The mesh of the tibia was reconverted into a geometry of NURBS surfaces. A split fracture of the lateral tibial plateau was reproduced by using geometrical data from patient radiographs. A locking screw plate (LP) and a cannulated screw (CS) systems were modelled to virtually reduce the fracture and 80 kg static body-weight was simulated.
  
  
  
  While the simulated body-weight led to clinically acceptable interfragmentary motion, possible traumatic bone shear stresses were predicted nearby the cannulated screws. With a maximum estimation of about 1.7 MPa maximum bone shear stresses, the Polyax system might ensure more reasonable safety margins.
  
  
  
  Split fractures of the LTP fixed either with locking screw plate or cannulated screws showed no clinically relevant IFM in a FE model. The locking screw plate showed higher mechanical stability than cannulated screw fixation. The locking screw plate might also allow full or at least partial weight bearing under static posture at time zero.
authors.affiliation: Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/Sant Quintí 89, 08041, Barcelona, Spain. dr.carrera@orthopaedic-trauma.eu.
authors.forename: Ion
authors.initials: I
authors.lastname: Carrera
authors.affiliation: Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/Sant Quintí 89, 08041, Barcelona, Spain.|ICATME-Hospital Universitari Quirón-Dexeus, Universitat Autònoma de Barcelona, Sabino de Arana 5-19, 08028, Barcelona, Spain.
authors.forename: Pablo Eduardo
authors.initials: PE
authors.lastname: Gelber
authors.affiliation: Department of Communication and information Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain.|Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain.
authors.forename: Gaetan
authors.initials: G
authors.lastname: Chary
authors.affiliation: Department of Communication and information Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain.|ICREA, Pg. Lluis Companys 23, 08010, Barcelona, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: González-Ballester
authors.affiliation: ICATME-Hospital Universitari Quirón-Dexeus, Universitat Autònoma de Barcelona, Sabino de Arana 5-19, 08028, Barcelona, Spain.|Orthopaedic Surgery Department, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Monllau
authors.affiliation: Department of Communication and information Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain.|Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain.
authors.forename: Jerome
authors.initials: J
authors.lastname: Noailly
mesh_terms: D001860:Bone Plates; D001863:Bone Screws; D020342:Finite Element Analysis; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D013978:Tibial Fractures / Q000503:physiopathology / Q000601:surgery*; D016474:Weight-Bearing
keywords: Bone fixation; Finite element; Fracture fixation; Interfragmentary motion; Tibial plateau fractures; Weight bearing