Optimal biomechanical choice of implant placement in various pilon fracture types: a finite element study
Abstract Background The research on the biomechanical characteristics of individual implant placement for pilon fractures based on the different initial direction of fracture displacement is still insufficient. This study’s aim is to compare the stress distribution in bones and implants with various...
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BMC
2024-11-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-024-08076-8 |
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| author | Peizhao Liu Xianzhong Mei Zhixiang Wang Feng Xu Xianhua Cai Kangquan Shou Shijun Wei |
| author_facet | Peizhao Liu Xianzhong Mei Zhixiang Wang Feng Xu Xianhua Cai Kangquan Shou Shijun Wei |
| author_sort | Peizhao Liu |
| collection | DOAJ |
| description | Abstract Background The research on the biomechanical characteristics of individual implant placement for pilon fractures based on the different initial direction of fracture displacement is still insufficient. This study’s aim is to compare the stress distribution in bones and implants with various pilon fracture types. Methods Varus, valgus, dorsiflexion, and plantarflexion type fractures were categorized as type I, II, III, and IV, respectively. The buttress plate was placed medially in subtypes IA and IIB, whereas it was placed anterolaterally in subtypes IB and IIA; The anterior or posterior buttress plate was utilized in subtypes IIIA and IVA, the lag screws were applied in subtypes IIIB and IVB. The maximum equivalent stress of tibia (TI-Smax) and implants (IF-Smax), stress of fracture fragments (Sfe), and axial displacement values of the fracture fragments (ADfe) in each subtype were analyzed when the ankle was in a neutral position, 15° of varus and valgus in types I and II, 15° of dorsiflexion and plantarflexion in types III and IV. Results Under the same axial stress loading conditions, TI-Smax, Sfe, ADfe of subtypes IA and IIA were significantly lower than subtypes IB and IIB, while IF-Smax of subtypes IA and IIA were obviously larger than subtypes IB and IIB. Additionally, TI-Smax, Sfe, ADfe of subtypes IIIA and IVA were considerably lower as IF-Smax met expectations compared to subtypes IIIB and IVB. Conclusion Based on these results, when making decisions for open reduction and internal fixation in various pilon fractures, the choice and placement of the implant can be recommended as follows: the medial buttress plate for varus types; the anterolateral plate for valgus types; the anterior plate for dorsiflexion types; the posterior plate for plantarflexion types. |
| format | Article |
| id | doaj-art-6528e614997848c8bdbb801805edbe85 |
| institution | DOAJ |
| issn | 1471-2474 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | BMC Musculoskeletal Disorders |
| spelling | doaj-art-6528e614997848c8bdbb801805edbe852025-08-20T02:51:48ZengBMCBMC Musculoskeletal Disorders1471-24742024-11-012511910.1186/s12891-024-08076-8Optimal biomechanical choice of implant placement in various pilon fracture types: a finite element studyPeizhao Liu0Xianzhong Mei1Zhixiang Wang2Feng Xu3Xianhua Cai4Kangquan Shou5Shijun Wei6Department of Orthopedics, General Hospital of Central Theater Command of PLA, (Wuhan General Hospital of Guangzhou Command, Previously), Hubei ProvinceDepartment of Orthopedics, Shenzhen Pingle Orthopedic HospitalDepartment of OrthopedicsDepartment of Orthopedics, General Hospital of Central Theater Command of PLA, (Wuhan General Hospital of Guangzhou Command, Previously), Hubei ProvinceDepartment of Orthopedics, South China Hospital, Medical School, Shenzhen UniversityDepartment of Orthopedics, The First College of Clinical Medical School, China Three Gorges University and Yichang Central People’s HospitalDepartment of Orthopedics, General Hospital of Central Theater Command of PLA, (Wuhan General Hospital of Guangzhou Command, Previously), Hubei ProvinceAbstract Background The research on the biomechanical characteristics of individual implant placement for pilon fractures based on the different initial direction of fracture displacement is still insufficient. This study’s aim is to compare the stress distribution in bones and implants with various pilon fracture types. Methods Varus, valgus, dorsiflexion, and plantarflexion type fractures were categorized as type I, II, III, and IV, respectively. The buttress plate was placed medially in subtypes IA and IIB, whereas it was placed anterolaterally in subtypes IB and IIA; The anterior or posterior buttress plate was utilized in subtypes IIIA and IVA, the lag screws were applied in subtypes IIIB and IVB. The maximum equivalent stress of tibia (TI-Smax) and implants (IF-Smax), stress of fracture fragments (Sfe), and axial displacement values of the fracture fragments (ADfe) in each subtype were analyzed when the ankle was in a neutral position, 15° of varus and valgus in types I and II, 15° of dorsiflexion and plantarflexion in types III and IV. Results Under the same axial stress loading conditions, TI-Smax, Sfe, ADfe of subtypes IA and IIA were significantly lower than subtypes IB and IIB, while IF-Smax of subtypes IA and IIA were obviously larger than subtypes IB and IIB. Additionally, TI-Smax, Sfe, ADfe of subtypes IIIA and IVA were considerably lower as IF-Smax met expectations compared to subtypes IIIB and IVB. Conclusion Based on these results, when making decisions for open reduction and internal fixation in various pilon fractures, the choice and placement of the implant can be recommended as follows: the medial buttress plate for varus types; the anterolateral plate for valgus types; the anterior plate for dorsiflexion types; the posterior plate for plantarflexion types.https://doi.org/10.1186/s12891-024-08076-8Pilon fractureDistal tibial fractureFracture displacementImplantsButtress plateFinite element analysis |
| spellingShingle | Peizhao Liu Xianzhong Mei Zhixiang Wang Feng Xu Xianhua Cai Kangquan Shou Shijun Wei Optimal biomechanical choice of implant placement in various pilon fracture types: a finite element study BMC Musculoskeletal Disorders Pilon fracture Distal tibial fracture Fracture displacement Implants Buttress plate Finite element analysis |
| title | Optimal biomechanical choice of implant placement in various pilon fracture types: a finite element study |
| title_full | Optimal biomechanical choice of implant placement in various pilon fracture types: a finite element study |
| title_fullStr | Optimal biomechanical choice of implant placement in various pilon fracture types: a finite element study |
| title_full_unstemmed | Optimal biomechanical choice of implant placement in various pilon fracture types: a finite element study |
| title_short | Optimal biomechanical choice of implant placement in various pilon fracture types: a finite element study |
| title_sort | optimal biomechanical choice of implant placement in various pilon fracture types a finite element study |
| topic | Pilon fracture Distal tibial fracture Fracture displacement Implants Buttress plate Finite element analysis |
| url | https://doi.org/10.1186/s12891-024-08076-8 |
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