Standard versus customised locking plates for fixation of schatzker ii tibial plateau fractures |
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| Institution: | 1. Department of Orthopaedic Surgery, National University Hospital Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore 119228;2. Centre for Additive Manufacturing, National University of Singapore, 3 Research Link, #05-01, Innovation 4.0 Building, Singapore 117602;3. Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore 119228;1. Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany;2. Centre for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany;1. Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China, 100853;2. Medical School of Chinese PLA, Beijing, China, 100853;3. National Clinical Research Centre for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China, 100853;4. Department of Nephrology, State Key Laboratory of Kidney Disease, National Clinical Research Centre for Kidney Disease, Chinese PLA General Hospital, Beijing, China, 100853;1. Peter Lougheed Center, Department of Surgery, University of Calgary, Canada;2. Maine General Medical Center, 35 Medical Center Pkwy, Augusta, ME 04330, USA;3. 0490 McCaig Tower, Foothills Medical Center 3134 Hospital Dr NW Calgary, Alberta T2N 5A1, Canada;1. Orthopedic Trauma Surgeon, Department of Orthopedic Trauma, Nottingham University Hospitals, Nottingham, UK;2. Chief of Orthopedic Trauma, Detroit Medical Center, Professor of Orthopedics, Wayne State University, 9B University Health Center, Detroit Receiving Hospital, 4201 St. Antoine Boulevard, Detroit, MI, 48201 United States;3. Professor of Orthopedics, 0490 McCaig Tower, Foothills Medical Center 3134 Hospital Dr NW Calgary, Alberta, T2N 5A1 Canada |
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| Abstract: | Aim3D-printed implants could improve the capture of fracture fragments for improved stability of tibial plateau fracture fixation. The aim of this study was to compare the biomechanical strength of fixation constructs using standard and customised 3D-printed proximal tibial locking plates for fixation of tibial plateau fractures.MethodsThis is a biomechanical study utilising six pairs of cadaveric tibiae. Fractures were created in an identical fashion using an osteotome and mallet, and fixed using either a standard, commercially-available proximal tibia locking plate or a customised 3D-printed plate. Design and production of the customised plates followed a “3D printing at point-of-care” model. Customised stainless steel 316 L plates were produced within a local additive manufacturing laboratory based upon pre-operative CT scans. Determination of implant choice within each cadaver pair was performed via simple randomisation. Following fracture fixation, the tibiae were skeletalised and biomechanically tested using a customised loading jig and a size-matched femoral knee prosthesis. The constructs were loaded cyclically from 100 N to approximately three times the cadaveric body-weight at 5 Hz for 10 000 cycles. Every 1000 cycles, the test was paused and the tibia was physically checked for failure. If failure had not occurred by the end of the testing cycle, the construct was loaded to failure and the load at which the construct failed was noted.ResultsFixation constructs using the 3D-printed plates performed comparably to those using the standard plates. There was no significant difference in the degree of fracture fragment displacement in both constructs. Overall longitudinal construct stiffness and load to failure was higher in the 3D-plates group but this did not reach statistical significance.ConclusionProduction of customised plates for proximal tibia fractures at point-of-care is feasible, however fixation constructs with these plates did not provide any biomechanical advantage over standard plates in terms of axial loading stiffness. |
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