Influence of reduction accuracy in lateral tibial plateau fractures on intra-articular friction – a biomechanical study
Background Lateral tibial split fractures (LTSF) usually require surgical therapy with screw or plate osteosynthesis. Excellent anatomical reduction of the fracture is thereby essential to avoid post-traumatic osteoarthritis. In clinical practice, a gap and step of 2 mm have been propagated as maxim...
Ausführliche Beschreibung
Autor*in: |
Walter, Christian [verfasserIn] |
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Englisch |
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2020 |
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© The Author(s). 2020 |
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Übergeordnetes Werk: |
Enthalten in: BMC musculoskeletal disorders - London : BioMed Central, 2000, 21(2020), 1 vom: 11. Jan. |
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Übergeordnetes Werk: |
volume:21 ; year:2020 ; number:1 ; day:11 ; month:01 |
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DOI / URN: |
10.1186/s12891-019-3020-3 |
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SPR028059840 |
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520 | |a Background Lateral tibial split fractures (LTSF) usually require surgical therapy with screw or plate osteosynthesis. Excellent anatomical reduction of the fracture is thereby essential to avoid post-traumatic osteoarthritis. In clinical practice, a gap and step of 2 mm have been propagated as maximum tolerable limit. To date, biomechanical studies regarding tibial fractures have been limited to pressure measurement, but the relationship between dissipated energy (DE) as a friction parameter and reduction accuracy in LTSF has not been investigated. In past experiments, we developed a new method to measure DE in ovine knee joints. To determine weather non-anatomical fracture reduction with lateral gap or vertical step condition leads to relevant changes in DE in the human knee joint, we tested the applicability of the new method on human LTSFs and investigated whether the current limit of 2 mm gap and step is durable from a biomechanical point of view. Methods Seven right human, native knee joint specimens were cyclically moved under 400 N axial load using a robotic system. During the cyclic motion, the flexion angle and the respective torque were recorded and the DE was calculated. First, DE was measured after an anterolateral approach had been performed (condition “native”). Then a LTSF was set with a chisel, reduced anatomically, fixed with two set screws and DE was measured (“even”). DE of further reductions was then measured with gaps of 1 mm and 2 mm, and a 2 mm step down or a 2 mm step up was measured. Results We successfully established a measurement protocol for DE in human knee joints with LTSF. While gaps led to small though statistically significant increase (1 mm gap:ΔDE compared with native = 0.030 J/cycle, (+ 21%), p = 0.02; 2 mm gap:ΔDE = 0.032 J/cycle, (+ 22%), p = 0.009), this increase almost doubled when reducing in a step-down condition (ΔDE = 0.058 J/cycle, (+ 56%), p = 0.042) and even tripled in the step-up condition (ΔDE = 0.097 J/cycle, (+ 94%), p = 0.004). Conclusions Based on our biomechanical findings, we suggest avoiding step conditions in the daily work in the operating theatre. Gap conditions can be handled a bit more generously. | ||
650 | 4 | |a Tibial head fracture |7 (dpeaa)DE-He213 | |
650 | 4 | |a Trauma surgery |7 (dpeaa)DE-He213 | |
650 | 4 | |a Friction |7 (dpeaa)DE-He213 | |
650 | 4 | |a Knee joint |7 (dpeaa)DE-He213 | |
650 | 4 | |a Dissipated energy |7 (dpeaa)DE-He213 | |
650 | 4 | |a Biomechanics |7 (dpeaa)DE-He213 | |
650 | 4 | |a Reduction |7 (dpeaa)DE-He213 | |
700 | 1 | |a Beck, Alexander |4 aut | |
700 | 1 | |a Jacob, Christopher |4 aut | |
700 | 1 | |a Hofmann, Ulf Krister |4 aut | |
700 | 1 | |a Stöckle, Ulrich |4 aut | |
700 | 1 | |a Stuby, Fabian |4 aut | |
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10.1186/s12891-019-3020-3 doi (DE-627)SPR028059840 (SPR)s12891-019-3020-3-e DE-627 ger DE-627 rakwb eng Walter, Christian verfasserin (orcid)0000-0003-3724-6533 aut Influence of reduction accuracy in lateral tibial plateau fractures on intra-articular friction – a biomechanical study 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2020 Background Lateral tibial split fractures (LTSF) usually require surgical therapy with screw or plate osteosynthesis. Excellent anatomical reduction of the fracture is thereby essential to avoid post-traumatic osteoarthritis. In clinical practice, a gap and step of 2 mm have been propagated as maximum tolerable limit. To date, biomechanical studies regarding tibial fractures have been limited to pressure measurement, but the relationship between dissipated energy (DE) as a friction parameter and reduction accuracy in LTSF has not been investigated. In past experiments, we developed a new method to measure DE in ovine knee joints. To determine weather non-anatomical fracture reduction with lateral gap or vertical step condition leads to relevant changes in DE in the human knee joint, we tested the applicability of the new method on human LTSFs and investigated whether the current limit of 2 mm gap and step is durable from a biomechanical point of view. Methods Seven right human, native knee joint specimens were cyclically moved under 400 N axial load using a robotic system. During the cyclic motion, the flexion angle and the respective torque were recorded and the DE was calculated. First, DE was measured after an anterolateral approach had been performed (condition “native”). Then a LTSF was set with a chisel, reduced anatomically, fixed with two set screws and DE was measured (“even”). DE of further reductions was then measured with gaps of 1 mm and 2 mm, and a 2 mm step down or a 2 mm step up was measured. Results We successfully established a measurement protocol for DE in human knee joints with LTSF. While gaps led to small though statistically significant increase (1 mm gap:ΔDE compared with native = 0.030 J/cycle, (+ 21%), p = 0.02; 2 mm gap:ΔDE = 0.032 J/cycle, (+ 22%), p = 0.009), this increase almost doubled when reducing in a step-down condition (ΔDE = 0.058 J/cycle, (+ 56%), p = 0.042) and even tripled in the step-up condition (ΔDE = 0.097 J/cycle, (+ 94%), p = 0.004). Conclusions Based on our biomechanical findings, we suggest avoiding step conditions in the daily work in the operating theatre. Gap conditions can be handled a bit more generously. Tibial head fracture (dpeaa)DE-He213 Trauma surgery (dpeaa)DE-He213 Friction (dpeaa)DE-He213 Knee joint (dpeaa)DE-He213 Dissipated energy (dpeaa)DE-He213 Biomechanics (dpeaa)DE-He213 Reduction (dpeaa)DE-He213 Beck, Alexander aut Jacob, Christopher aut Hofmann, Ulf Krister aut Stöckle, Ulrich aut Stuby, Fabian aut Enthalten in BMC musculoskeletal disorders London : BioMed Central, 2000 21(2020), 1 vom: 11. Jan. (DE-627)326643745 (DE-600)2041355-5 1471-2474 nnns volume:21 year:2020 number:1 day:11 month:01 https://dx.doi.org/10.1186/s12891-019-3020-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 21 2020 1 11 01 |
spelling |
10.1186/s12891-019-3020-3 doi (DE-627)SPR028059840 (SPR)s12891-019-3020-3-e DE-627 ger DE-627 rakwb eng Walter, Christian verfasserin (orcid)0000-0003-3724-6533 aut Influence of reduction accuracy in lateral tibial plateau fractures on intra-articular friction – a biomechanical study 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2020 Background Lateral tibial split fractures (LTSF) usually require surgical therapy with screw or plate osteosynthesis. Excellent anatomical reduction of the fracture is thereby essential to avoid post-traumatic osteoarthritis. In clinical practice, a gap and step of 2 mm have been propagated as maximum tolerable limit. To date, biomechanical studies regarding tibial fractures have been limited to pressure measurement, but the relationship between dissipated energy (DE) as a friction parameter and reduction accuracy in LTSF has not been investigated. In past experiments, we developed a new method to measure DE in ovine knee joints. To determine weather non-anatomical fracture reduction with lateral gap or vertical step condition leads to relevant changes in DE in the human knee joint, we tested the applicability of the new method on human LTSFs and investigated whether the current limit of 2 mm gap and step is durable from a biomechanical point of view. Methods Seven right human, native knee joint specimens were cyclically moved under 400 N axial load using a robotic system. During the cyclic motion, the flexion angle and the respective torque were recorded and the DE was calculated. First, DE was measured after an anterolateral approach had been performed (condition “native”). Then a LTSF was set with a chisel, reduced anatomically, fixed with two set screws and DE was measured (“even”). DE of further reductions was then measured with gaps of 1 mm and 2 mm, and a 2 mm step down or a 2 mm step up was measured. Results We successfully established a measurement protocol for DE in human knee joints with LTSF. While gaps led to small though statistically significant increase (1 mm gap:ΔDE compared with native = 0.030 J/cycle, (+ 21%), p = 0.02; 2 mm gap:ΔDE = 0.032 J/cycle, (+ 22%), p = 0.009), this increase almost doubled when reducing in a step-down condition (ΔDE = 0.058 J/cycle, (+ 56%), p = 0.042) and even tripled in the step-up condition (ΔDE = 0.097 J/cycle, (+ 94%), p = 0.004). Conclusions Based on our biomechanical findings, we suggest avoiding step conditions in the daily work in the operating theatre. Gap conditions can be handled a bit more generously. Tibial head fracture (dpeaa)DE-He213 Trauma surgery (dpeaa)DE-He213 Friction (dpeaa)DE-He213 Knee joint (dpeaa)DE-He213 Dissipated energy (dpeaa)DE-He213 Biomechanics (dpeaa)DE-He213 Reduction (dpeaa)DE-He213 Beck, Alexander aut Jacob, Christopher aut Hofmann, Ulf Krister aut Stöckle, Ulrich aut Stuby, Fabian aut Enthalten in BMC musculoskeletal disorders London : BioMed Central, 2000 21(2020), 1 vom: 11. Jan. (DE-627)326643745 (DE-600)2041355-5 1471-2474 nnns volume:21 year:2020 number:1 day:11 month:01 https://dx.doi.org/10.1186/s12891-019-3020-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 21 2020 1 11 01 |
allfields_unstemmed |
10.1186/s12891-019-3020-3 doi (DE-627)SPR028059840 (SPR)s12891-019-3020-3-e DE-627 ger DE-627 rakwb eng Walter, Christian verfasserin (orcid)0000-0003-3724-6533 aut Influence of reduction accuracy in lateral tibial plateau fractures on intra-articular friction – a biomechanical study 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2020 Background Lateral tibial split fractures (LTSF) usually require surgical therapy with screw or plate osteosynthesis. Excellent anatomical reduction of the fracture is thereby essential to avoid post-traumatic osteoarthritis. In clinical practice, a gap and step of 2 mm have been propagated as maximum tolerable limit. To date, biomechanical studies regarding tibial fractures have been limited to pressure measurement, but the relationship between dissipated energy (DE) as a friction parameter and reduction accuracy in LTSF has not been investigated. In past experiments, we developed a new method to measure DE in ovine knee joints. To determine weather non-anatomical fracture reduction with lateral gap or vertical step condition leads to relevant changes in DE in the human knee joint, we tested the applicability of the new method on human LTSFs and investigated whether the current limit of 2 mm gap and step is durable from a biomechanical point of view. Methods Seven right human, native knee joint specimens were cyclically moved under 400 N axial load using a robotic system. During the cyclic motion, the flexion angle and the respective torque were recorded and the DE was calculated. First, DE was measured after an anterolateral approach had been performed (condition “native”). Then a LTSF was set with a chisel, reduced anatomically, fixed with two set screws and DE was measured (“even”). DE of further reductions was then measured with gaps of 1 mm and 2 mm, and a 2 mm step down or a 2 mm step up was measured. Results We successfully established a measurement protocol for DE in human knee joints with LTSF. While gaps led to small though statistically significant increase (1 mm gap:ΔDE compared with native = 0.030 J/cycle, (+ 21%), p = 0.02; 2 mm gap:ΔDE = 0.032 J/cycle, (+ 22%), p = 0.009), this increase almost doubled when reducing in a step-down condition (ΔDE = 0.058 J/cycle, (+ 56%), p = 0.042) and even tripled in the step-up condition (ΔDE = 0.097 J/cycle, (+ 94%), p = 0.004). Conclusions Based on our biomechanical findings, we suggest avoiding step conditions in the daily work in the operating theatre. Gap conditions can be handled a bit more generously. Tibial head fracture (dpeaa)DE-He213 Trauma surgery (dpeaa)DE-He213 Friction (dpeaa)DE-He213 Knee joint (dpeaa)DE-He213 Dissipated energy (dpeaa)DE-He213 Biomechanics (dpeaa)DE-He213 Reduction (dpeaa)DE-He213 Beck, Alexander aut Jacob, Christopher aut Hofmann, Ulf Krister aut Stöckle, Ulrich aut Stuby, Fabian aut Enthalten in BMC musculoskeletal disorders London : BioMed Central, 2000 21(2020), 1 vom: 11. Jan. (DE-627)326643745 (DE-600)2041355-5 1471-2474 nnns volume:21 year:2020 number:1 day:11 month:01 https://dx.doi.org/10.1186/s12891-019-3020-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 21 2020 1 11 01 |
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10.1186/s12891-019-3020-3 doi (DE-627)SPR028059840 (SPR)s12891-019-3020-3-e DE-627 ger DE-627 rakwb eng Walter, Christian verfasserin (orcid)0000-0003-3724-6533 aut Influence of reduction accuracy in lateral tibial plateau fractures on intra-articular friction – a biomechanical study 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2020 Background Lateral tibial split fractures (LTSF) usually require surgical therapy with screw or plate osteosynthesis. Excellent anatomical reduction of the fracture is thereby essential to avoid post-traumatic osteoarthritis. In clinical practice, a gap and step of 2 mm have been propagated as maximum tolerable limit. To date, biomechanical studies regarding tibial fractures have been limited to pressure measurement, but the relationship between dissipated energy (DE) as a friction parameter and reduction accuracy in LTSF has not been investigated. In past experiments, we developed a new method to measure DE in ovine knee joints. To determine weather non-anatomical fracture reduction with lateral gap or vertical step condition leads to relevant changes in DE in the human knee joint, we tested the applicability of the new method on human LTSFs and investigated whether the current limit of 2 mm gap and step is durable from a biomechanical point of view. Methods Seven right human, native knee joint specimens were cyclically moved under 400 N axial load using a robotic system. During the cyclic motion, the flexion angle and the respective torque were recorded and the DE was calculated. First, DE was measured after an anterolateral approach had been performed (condition “native”). Then a LTSF was set with a chisel, reduced anatomically, fixed with two set screws and DE was measured (“even”). DE of further reductions was then measured with gaps of 1 mm and 2 mm, and a 2 mm step down or a 2 mm step up was measured. Results We successfully established a measurement protocol for DE in human knee joints with LTSF. While gaps led to small though statistically significant increase (1 mm gap:ΔDE compared with native = 0.030 J/cycle, (+ 21%), p = 0.02; 2 mm gap:ΔDE = 0.032 J/cycle, (+ 22%), p = 0.009), this increase almost doubled when reducing in a step-down condition (ΔDE = 0.058 J/cycle, (+ 56%), p = 0.042) and even tripled in the step-up condition (ΔDE = 0.097 J/cycle, (+ 94%), p = 0.004). Conclusions Based on our biomechanical findings, we suggest avoiding step conditions in the daily work in the operating theatre. Gap conditions can be handled a bit more generously. Tibial head fracture (dpeaa)DE-He213 Trauma surgery (dpeaa)DE-He213 Friction (dpeaa)DE-He213 Knee joint (dpeaa)DE-He213 Dissipated energy (dpeaa)DE-He213 Biomechanics (dpeaa)DE-He213 Reduction (dpeaa)DE-He213 Beck, Alexander aut Jacob, Christopher aut Hofmann, Ulf Krister aut Stöckle, Ulrich aut Stuby, Fabian aut Enthalten in BMC musculoskeletal disorders London : BioMed Central, 2000 21(2020), 1 vom: 11. Jan. (DE-627)326643745 (DE-600)2041355-5 1471-2474 nnns volume:21 year:2020 number:1 day:11 month:01 https://dx.doi.org/10.1186/s12891-019-3020-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 21 2020 1 11 01 |
allfieldsSound |
10.1186/s12891-019-3020-3 doi (DE-627)SPR028059840 (SPR)s12891-019-3020-3-e DE-627 ger DE-627 rakwb eng Walter, Christian verfasserin (orcid)0000-0003-3724-6533 aut Influence of reduction accuracy in lateral tibial plateau fractures on intra-articular friction – a biomechanical study 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2020 Background Lateral tibial split fractures (LTSF) usually require surgical therapy with screw or plate osteosynthesis. Excellent anatomical reduction of the fracture is thereby essential to avoid post-traumatic osteoarthritis. In clinical practice, a gap and step of 2 mm have been propagated as maximum tolerable limit. To date, biomechanical studies regarding tibial fractures have been limited to pressure measurement, but the relationship between dissipated energy (DE) as a friction parameter and reduction accuracy in LTSF has not been investigated. In past experiments, we developed a new method to measure DE in ovine knee joints. To determine weather non-anatomical fracture reduction with lateral gap or vertical step condition leads to relevant changes in DE in the human knee joint, we tested the applicability of the new method on human LTSFs and investigated whether the current limit of 2 mm gap and step is durable from a biomechanical point of view. Methods Seven right human, native knee joint specimens were cyclically moved under 400 N axial load using a robotic system. During the cyclic motion, the flexion angle and the respective torque were recorded and the DE was calculated. First, DE was measured after an anterolateral approach had been performed (condition “native”). Then a LTSF was set with a chisel, reduced anatomically, fixed with two set screws and DE was measured (“even”). DE of further reductions was then measured with gaps of 1 mm and 2 mm, and a 2 mm step down or a 2 mm step up was measured. Results We successfully established a measurement protocol for DE in human knee joints with LTSF. While gaps led to small though statistically significant increase (1 mm gap:ΔDE compared with native = 0.030 J/cycle, (+ 21%), p = 0.02; 2 mm gap:ΔDE = 0.032 J/cycle, (+ 22%), p = 0.009), this increase almost doubled when reducing in a step-down condition (ΔDE = 0.058 J/cycle, (+ 56%), p = 0.042) and even tripled in the step-up condition (ΔDE = 0.097 J/cycle, (+ 94%), p = 0.004). Conclusions Based on our biomechanical findings, we suggest avoiding step conditions in the daily work in the operating theatre. Gap conditions can be handled a bit more generously. Tibial head fracture (dpeaa)DE-He213 Trauma surgery (dpeaa)DE-He213 Friction (dpeaa)DE-He213 Knee joint (dpeaa)DE-He213 Dissipated energy (dpeaa)DE-He213 Biomechanics (dpeaa)DE-He213 Reduction (dpeaa)DE-He213 Beck, Alexander aut Jacob, Christopher aut Hofmann, Ulf Krister aut Stöckle, Ulrich aut Stuby, Fabian aut Enthalten in BMC musculoskeletal disorders London : BioMed Central, 2000 21(2020), 1 vom: 11. Jan. (DE-627)326643745 (DE-600)2041355-5 1471-2474 nnns volume:21 year:2020 number:1 day:11 month:01 https://dx.doi.org/10.1186/s12891-019-3020-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 21 2020 1 11 01 |
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Enthalten in BMC musculoskeletal disorders 21(2020), 1 vom: 11. Jan. volume:21 year:2020 number:1 day:11 month:01 |
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Tibial head fracture Trauma surgery Friction Knee joint Dissipated energy Biomechanics Reduction |
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Walter, Christian @@aut@@ Beck, Alexander @@aut@@ Jacob, Christopher @@aut@@ Hofmann, Ulf Krister @@aut@@ Stöckle, Ulrich @@aut@@ Stuby, Fabian @@aut@@ |
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Excellent anatomical reduction of the fracture is thereby essential to avoid post-traumatic osteoarthritis. In clinical practice, a gap and step of 2 mm have been propagated as maximum tolerable limit. To date, biomechanical studies regarding tibial fractures have been limited to pressure measurement, but the relationship between dissipated energy (DE) as a friction parameter and reduction accuracy in LTSF has not been investigated. In past experiments, we developed a new method to measure DE in ovine knee joints. To determine weather non-anatomical fracture reduction with lateral gap or vertical step condition leads to relevant changes in DE in the human knee joint, we tested the applicability of the new method on human LTSFs and investigated whether the current limit of 2 mm gap and step is durable from a biomechanical point of view. Methods Seven right human, native knee joint specimens were cyclically moved under 400 N axial load using a robotic system. During the cyclic motion, the flexion angle and the respective torque were recorded and the DE was calculated. First, DE was measured after an anterolateral approach had been performed (condition “native”). Then a LTSF was set with a chisel, reduced anatomically, fixed with two set screws and DE was measured (“even”). DE of further reductions was then measured with gaps of 1 mm and 2 mm, and a 2 mm step down or a 2 mm step up was measured. Results We successfully established a measurement protocol for DE in human knee joints with LTSF. While gaps led to small though statistically significant increase (1 mm gap:ΔDE compared with native = 0.030 J/cycle, (+ 21%), p = 0.02; 2 mm gap:ΔDE = 0.032 J/cycle, (+ 22%), p = 0.009), this increase almost doubled when reducing in a step-down condition (ΔDE = 0.058 J/cycle, (+ 56%), p = 0.042) and even tripled in the step-up condition (ΔDE = 0.097 J/cycle, (+ 94%), p = 0.004). 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Walter, Christian misc Tibial head fracture misc Trauma surgery misc Friction misc Knee joint misc Dissipated energy misc Biomechanics misc Reduction Influence of reduction accuracy in lateral tibial plateau fractures on intra-articular friction – a biomechanical study |
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Influence of reduction accuracy in lateral tibial plateau fractures on intra-articular friction – a biomechanical study Tibial head fracture (dpeaa)DE-He213 Trauma surgery (dpeaa)DE-He213 Friction (dpeaa)DE-He213 Knee joint (dpeaa)DE-He213 Dissipated energy (dpeaa)DE-He213 Biomechanics (dpeaa)DE-He213 Reduction (dpeaa)DE-He213 |
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influence of reduction accuracy in lateral tibial plateau fractures on intra-articular friction – a biomechanical study |
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Influence of reduction accuracy in lateral tibial plateau fractures on intra-articular friction – a biomechanical study |
abstract |
Background Lateral tibial split fractures (LTSF) usually require surgical therapy with screw or plate osteosynthesis. Excellent anatomical reduction of the fracture is thereby essential to avoid post-traumatic osteoarthritis. In clinical practice, a gap and step of 2 mm have been propagated as maximum tolerable limit. To date, biomechanical studies regarding tibial fractures have been limited to pressure measurement, but the relationship between dissipated energy (DE) as a friction parameter and reduction accuracy in LTSF has not been investigated. In past experiments, we developed a new method to measure DE in ovine knee joints. To determine weather non-anatomical fracture reduction with lateral gap or vertical step condition leads to relevant changes in DE in the human knee joint, we tested the applicability of the new method on human LTSFs and investigated whether the current limit of 2 mm gap and step is durable from a biomechanical point of view. Methods Seven right human, native knee joint specimens were cyclically moved under 400 N axial load using a robotic system. During the cyclic motion, the flexion angle and the respective torque were recorded and the DE was calculated. First, DE was measured after an anterolateral approach had been performed (condition “native”). Then a LTSF was set with a chisel, reduced anatomically, fixed with two set screws and DE was measured (“even”). DE of further reductions was then measured with gaps of 1 mm and 2 mm, and a 2 mm step down or a 2 mm step up was measured. Results We successfully established a measurement protocol for DE in human knee joints with LTSF. While gaps led to small though statistically significant increase (1 mm gap:ΔDE compared with native = 0.030 J/cycle, (+ 21%), p = 0.02; 2 mm gap:ΔDE = 0.032 J/cycle, (+ 22%), p = 0.009), this increase almost doubled when reducing in a step-down condition (ΔDE = 0.058 J/cycle, (+ 56%), p = 0.042) and even tripled in the step-up condition (ΔDE = 0.097 J/cycle, (+ 94%), p = 0.004). Conclusions Based on our biomechanical findings, we suggest avoiding step conditions in the daily work in the operating theatre. Gap conditions can be handled a bit more generously. © The Author(s). 2020 |
abstractGer |
Background Lateral tibial split fractures (LTSF) usually require surgical therapy with screw or plate osteosynthesis. Excellent anatomical reduction of the fracture is thereby essential to avoid post-traumatic osteoarthritis. In clinical practice, a gap and step of 2 mm have been propagated as maximum tolerable limit. To date, biomechanical studies regarding tibial fractures have been limited to pressure measurement, but the relationship between dissipated energy (DE) as a friction parameter and reduction accuracy in LTSF has not been investigated. In past experiments, we developed a new method to measure DE in ovine knee joints. To determine weather non-anatomical fracture reduction with lateral gap or vertical step condition leads to relevant changes in DE in the human knee joint, we tested the applicability of the new method on human LTSFs and investigated whether the current limit of 2 mm gap and step is durable from a biomechanical point of view. Methods Seven right human, native knee joint specimens were cyclically moved under 400 N axial load using a robotic system. During the cyclic motion, the flexion angle and the respective torque were recorded and the DE was calculated. First, DE was measured after an anterolateral approach had been performed (condition “native”). Then a LTSF was set with a chisel, reduced anatomically, fixed with two set screws and DE was measured (“even”). DE of further reductions was then measured with gaps of 1 mm and 2 mm, and a 2 mm step down or a 2 mm step up was measured. Results We successfully established a measurement protocol for DE in human knee joints with LTSF. While gaps led to small though statistically significant increase (1 mm gap:ΔDE compared with native = 0.030 J/cycle, (+ 21%), p = 0.02; 2 mm gap:ΔDE = 0.032 J/cycle, (+ 22%), p = 0.009), this increase almost doubled when reducing in a step-down condition (ΔDE = 0.058 J/cycle, (+ 56%), p = 0.042) and even tripled in the step-up condition (ΔDE = 0.097 J/cycle, (+ 94%), p = 0.004). Conclusions Based on our biomechanical findings, we suggest avoiding step conditions in the daily work in the operating theatre. Gap conditions can be handled a bit more generously. © The Author(s). 2020 |
abstract_unstemmed |
Background Lateral tibial split fractures (LTSF) usually require surgical therapy with screw or plate osteosynthesis. Excellent anatomical reduction of the fracture is thereby essential to avoid post-traumatic osteoarthritis. In clinical practice, a gap and step of 2 mm have been propagated as maximum tolerable limit. To date, biomechanical studies regarding tibial fractures have been limited to pressure measurement, but the relationship between dissipated energy (DE) as a friction parameter and reduction accuracy in LTSF has not been investigated. In past experiments, we developed a new method to measure DE in ovine knee joints. To determine weather non-anatomical fracture reduction with lateral gap or vertical step condition leads to relevant changes in DE in the human knee joint, we tested the applicability of the new method on human LTSFs and investigated whether the current limit of 2 mm gap and step is durable from a biomechanical point of view. Methods Seven right human, native knee joint specimens were cyclically moved under 400 N axial load using a robotic system. During the cyclic motion, the flexion angle and the respective torque were recorded and the DE was calculated. First, DE was measured after an anterolateral approach had been performed (condition “native”). Then a LTSF was set with a chisel, reduced anatomically, fixed with two set screws and DE was measured (“even”). DE of further reductions was then measured with gaps of 1 mm and 2 mm, and a 2 mm step down or a 2 mm step up was measured. Results We successfully established a measurement protocol for DE in human knee joints with LTSF. While gaps led to small though statistically significant increase (1 mm gap:ΔDE compared with native = 0.030 J/cycle, (+ 21%), p = 0.02; 2 mm gap:ΔDE = 0.032 J/cycle, (+ 22%), p = 0.009), this increase almost doubled when reducing in a step-down condition (ΔDE = 0.058 J/cycle, (+ 56%), p = 0.042) and even tripled in the step-up condition (ΔDE = 0.097 J/cycle, (+ 94%), p = 0.004). Conclusions Based on our biomechanical findings, we suggest avoiding step conditions in the daily work in the operating theatre. Gap conditions can be handled a bit more generously. © The Author(s). 2020 |
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score |
7.3972692 |