Anterolateral Versus Medial Plating of Distal Extra-articular Tibia Fractures: A Biomechanical Model

Abstract

Both medial and anterolateral plate applications have been described for the treatment of distal tibia fractures, each with distinct advantages and disadvantages. The objective of this study was to compare the biomechanical properties of medial and anterolateral plating constructs used to stabilize simulated varus and valgus fracture patterns of the distal tibia. In 16 synthetic tibia models, a 45° oblique cut was made to model an Orthopedic Trauma Association type 43-A1.2 distal tibia fracture in either a varus or valgus injury pattern. Each fracture was then reduced and plated with a precontoured medial or anterolateral distal tibia plate. The specimens were biomechanically tested in axial and torsional loading, cyclic axial loading, and load to failure. For the varus fracture pattern, medial plating showed less fracture site displacement and rotation and was stiffer in both axial and torsional loading (P<.05). For the valgus fracture pattern, there was no statistically significant difference between medial and anterolateral plating. There were no significant differences between the 2 constructs for either fracture pattern with respect to ultimate load, displacement, or energy absorption in load to failure testing. When used to stabilize varus fracture patterns, medial plates showed superior biomechanical performance compared with anterolateral plates. In this application, the medial plates functioned in anti-glide mode. For valgus fracture patterns, no biomechanical differences between anterolateral and medial plating were observed. In clinical practice, surgeons should take this biomechanical evidence into account when devising a treatment strategy for fixation of distal tibia fractures.

Medial Column Support in Pilon Fractures Using Percutaneous Intramedullary Large Fragment Fixation

“…reoperation. 6,8,[15][16][17] Recent work illustrates the importance of medial column stabilization in comminuted pilon fractures to decrease the risk of developing a nonunion 9,18 and to prevent varus failure patterns. 19,20 For pilon fractures that are not amenable to an open, medial-based approach, the use of large fragment percutaneous fixation may offer further protection against varus deformity and nonunion while minimizing potential wound complications.…”

Supraintercondylar fracture of the proximal phalanx of the hallux

“…Two articles showed the use of a miniplate on the medial surface of the phalanx of the hallux as an alternative method for osteosynthesis in the treatment of fractures of the proximal phalanx of the hallux (14,15) . Ideally, however, the plate should be applied on the stress side of the fracture, in order to generate compression forces during plantar weight bearing, thus constituting the ideal surgical approach (15)(16)(17) . As scant subcutaneous tissue is present on the proximal phalanx, the plate must have a low profile to reduce soft tissue irritation.…”

Evaluation of the Stability of Internal Fixation Constructs in a Low Distal Tibia Extra-articular Cadaveric Fracture Model: A Comparative Biomechanical Study

“…A load of approximately 150 N; equivalent to 15.6 kg, was applied with an actuator speed of 0.05 mm/sec (within the elastic limit) on the implanted tibia, followed by unloading at a reduced speed of 0.0025 mm/sec. The load and displacement curves were recorded, and the mean slope was calculated between 50 and 150 N (linear elastic region) [ 9 , 10 , 12 ].…”

“…Extramedullary implants like locked plates also need to be used cautiously because of complications like implant prominence and wound dehiscence [ 7 , 8 ]. The current literature on the comparison of the stability of different osteosynthesis modalities for low, extra-articular distal tibia fractures is sparse [ 9 , 10 ]. Hence, this study was conducted to compare the biomechanical stability of four different internal fixation constructs in a low, unstable, distal tibia, extra-articular fracture model (AO type 43A3).…”