title: Biomechanical analysis of different osteosyntheses and the combination with bone substitute in tibial head depression fractures.
abstract: Tibial head depression fractures demand a high level of fracture stabilization to prevent a secondary loss of reduction after surgery. Elderly individuals are at an increased risk of developing these fractures, and biomechanical investigations of the fractures are rare. Therefore, the aim of this study was to systematically analyze different types of osteosyntheses in combination with two commonly used bone substitutes.
  
  
  
  Lateral tibial head depression fractures were created in synthetic bones. After reduction, the fractures were stabilized with eight different treatment options of osteosynthesis alone or in combination with a bone substitute. Two screws, 4 screws and a lateral buttress plate were investigated. As a bone substitute, two common clinically used calcium phosphate cements, Norian® Drillable and ChronOS™ Inject, were applied. Displacement of the articular fracture fragment (mm) during cyclic loading, stiffness (N/mm) and maximum load (N) in Load-to-Failure tests were measured.
  
  
  
  The three different osteosyntheses (Group 1: 2 screws, group 2: 4 screws, group 3: plate) alone revealed a significantly higher displacement compared to the control group (Group 7: ChronOS™ Inject only) (Group 1, 7 [p < 0.01]; group 2, 7 [p = 0.04]; group 3, 7 [p < 0.01]). However, the osteosyntheses in combination with bone substitute exhibited no differences in displacement compared to the control group. The buttress plate demonstrated a higher normalized maximum load than the 2 and 4 screw osteosynthesis. Comparing the two different bone substitutes to each other, ChronOS™ inject had a significantly higher stiffness and lower displacement than Norian® Drillable.
  
  
  
  The highest biomechanical stability under maximal loading was provided by a buttress plate osteosynthesis. A bone substitute, such as the biomechanically favorable ChronOS™ Inject, is essential to reduce the displacement under lower loading.
authors.affiliation: Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Clinics of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Jordan
authors.affiliation: Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Clinics of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Zimmermann
authors.affiliation: Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia.
authors.forename: Sheridan A
authors.initials: SA
authors.lastname: Gho
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University Clinics of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
authors.forename: Soenke P
authors.initials: SP
authors.lastname: Frey
authors.affiliation: Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Clinics of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Blunk
authors.affiliation: Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Clinics of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany.
authors.forename: Rainer H
authors.initials: RH
authors.lastname: Meffert
authors.affiliation: Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Clinics of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany. hoelscher_s@ukw.de.|Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia. hoelscher_s@ukw.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hoelscher-Doht
mesh_terms: D001696:Biomechanical Phenomena; D001843:Bone Cements / Q000627:therapeutic use*; D001860:Bone Plates; D001863:Bone Screws; D018786:Bone Substitutes / Q000627:therapeutic use*; D002130:Calcium Phosphates / Q000627:therapeutic use*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D057072:Intra-Articular Fractures / Q000601:surgery*; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*
chemical_list: D001843:Bone Cements; D018786:Bone Substitutes; D002130:Calcium Phosphates; C496047:Norian SRS Cement
keywords: Biomechanical test; Cyclic test; Static test; Tibial fracture fixation; Tibial head fracture