A biomechanical comparison between locked 3.5-mm plates and 4.5-mm plates for the treatment of simple bicondylar tibial plateau fractures: is bigger necessarily better?

Abstract

BackgroundEvolution of periarticular implant technology has led to stiffer, more stable fixation constructs. However, as plate options increase, comparisons between different sized constructs have not been performed. The purpose of this study is to biomechanically assess any significant differences between 3.5- and 4.5-mm locked tibial plateau plates in a simple bicondylar fracture model.Materials and methodsA total of 24 synthetic composite bone models (12 Schatzker V and 12 Schatzker VI) specimens were tested. In each group, six specimens were fixed with a 3.5-mm locked proximal tibia plate and six specimens were fixed with a 4.5-mm locking plate. Testing measures included axial ramp loading to 500 N, cyclic loading to 10,000 cycles and axial load to failure.ResultsIn the Schatzker V comparison model, there were no significant differences in inferior displacement or plastic deformation after 10, 100, 1,000 and 10,000 cycles. In regards to axial load, the 4.5-mm plate exhibited a significantly higher load to failure (P = 0.05). In the Schatzker VI comparison model, there were significant differences in inferior displacement or elastic deformation after 10, 100, 1,000, and 10,000 cycles. In regards to axial load, the 4.5-mm plate again exhibited a higher load to failure, but this was not statistically significant (P = 0.21).ConclusionsIn the advent of technological advancement, periarticular locking plate technology has offered an invaluable option in treating bicondylar tibial plateau fractures. Comparing the biomechanical properties of 3.5- and 4.5-mm locking plates yielded no significant differences in cyclic loading, even in regards to elastic and plastic deformation. Not surprisingly, the 4.5-mm plate was more robust in axial load to failure, but only in the Schatzker V model. In our testing construct, overall, without significant differences, the smaller, lower-profile 3.5-mm plate seems to be a biomechanically sound option in the reconstruction of bicondylar plateau fractures.

Comparison of the pre-shaped anatomical locking plate of 3.5 mm versus 4.5 mm for the treatment of tibial plateau fractures

“…Radiologic results were equally comparable in terms of rate and time of consolidation but also of quality of articular reduction, which highlights the stability of the reduction for the two types of implants, thus confirming biomechanical data [11].…”

“…Thus, according to our experience, in the short term there were few repercussions on the existence of malunions. To our knowledge, the clinical tolerance of locking plates was rarely studied, even though this was discusses by Hasan et al [11]. The different studies showed at the most the number of material ablations, with different figures ranging from 5 to 11 % [14,17,[25][26][27][28][29][30][31][32][33][34][35][36].…”

“…Recently Hasan et al [11] compared the mechanical properties of 3.5-mm and 4.5-mm locking plates with a bicondylar tibial plateau model. No difference was noticed in cyclic loading or for elastic and plastic deformation, nevertheless, 4.5-mm plates are significantly more resistant in terms of axial loading but only for Schatzker V fractures [12].…”

Diagnosis and Treatment of Anterior Tibial Plateau Fracture–Dislocation: A Case Series and Literature Review

“…Nevertheless, the introduction of the locking plate and rafting screw technique has greatly improved the treatment of severe tibial plateau fractures. [25][26][27] Furthermore, most anterior tibial plateau fracture-dislocations occur at a distance of approximately 1 to 2 cm from the joint surface, where the rafting screws in rafting technique are placed; therefore, the grip of the rafting screw on bone fragments would also be reduced. ►Fig.…”

Surgical Management of Tibial Plateau Fractures With 3.5 mm Simple Plates

“…Also, for better stabilization of fragments in comminuted fractures, 3.5 mm screws or K-wire can be used near the articular surface with raft screws or wire ( 30 , 31 ). Moreover, there is no significant difference in the biomechanical properties between locked 3.5 mm and 4.5 mm plates ( 32 ). It has been shown that in cancellous bone, 3.5 mm screws have equivalent pullout strength in comparison to 4.5 mm and 6.5 mm screws ( 32 , 33 ).…”