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Effective combination of bone substitute and screws in the jail technique: a biomechanical study of tibial depression fractures

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Abstract

Purpose

The aim of this study was to investigate a new drillable calcium phosphate cement (Norian drillable Synthes GmbH) as a bone substitute either alone or in combination with screws in the jail technique (Petersen et al. Unfallchirurg Mar 109(3):219–234, 2006; Petersen et al. Unfallchirurg Mar 109(3):235–244, 2006) with regard to the primary stability in lateral tibial depression fractures.

Methods

Lateral depression fractures of the tibial plateau were created in a biomechanical fracture model. After reduction they were stabilised with bone substitute (group one), bone substitute with additional four screws in the jail technique (group two) or four screws only (group three). Displacement under cyclic loading, stiffness and maximum load in load-to-failure tests were determined.

Results

The groups with the bone substitute showed a lower displacement of the depressed articular fragment under cyclical loading and a higher stiffness. The maximum load was higher for the groups with screws.

Conclusions

Only the combination of bone substitute and screws prevented secondary loss of reduction and, at the same time, provided enough stability under maximum load.

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References

  1. Wiss, DA (2006) Master techniques in orthopaedic surgery fractures. Lippincott Williams & Wilking

  2. Kösters C, Schliemann B, Raschke MJ (2011) Tibial head fractures in the elderly. Unfallchirurg 114(3):251–260

    Article  PubMed  Google Scholar 

  3. Yetkinler DN, McClellan RT, Reindel ES, Carter D, Poser RD (2001) Biomechanical comparison of conventional open reduction and internal fixation versus calcium phosphate cement fixation of a central depressed tibial plateau fracture. J Orthop Trauma 15(3):197–206

    Article  PubMed  CAS  Google Scholar 

  4. Welch RD, Zhang H, Bronson DG (2003) Experimental tibial plateau fractures augmented with calcium phosphate cement or autologous bone graft. J Bone Joint Surg Am 85-A(2):222–231

    PubMed  Google Scholar 

  5. Zahn RK, Frey S, Jakubietz RG, Jakubietz MG, Doht S, Schneider P, Waschke J, Meffert RH (2012) A contoured locking plate for distal fibular fractures in osteoporotic bone: A biomechanical cadaver study. Injury 43(6):718–725

    Article  PubMed  Google Scholar 

  6. Braun MJ, Meta MD, Schneider P, Reiners C (1998) Clinical evaluation of a high-resolution new peripheral quantitative computerized tomography (pQCT) scanner for the bone densitometry at the lower limbs. Phys Med Biol 43(8):2279–2294

    Article  PubMed  CAS  Google Scholar 

  7. Guglielmi G, Schneider P, Lang TF, Giannatempo GM, Cammisa M, Genant HK (1997) Quantitative computed tomography at the axial and peripheral skeleton. Eur Radiol 7(Suppl 2):S32–S42

    Article  PubMed  Google Scholar 

  8. Karunakar MA, Egol KA, Peindl R, Harrow ME, Bosse MJ, Kellam JF (2002) Split depression tibial plateau fractures: a biomechanical study. J Orthop Trauma 16(3):172–177

    Article  PubMed  Google Scholar 

  9. Petersen W, Zantop T, Raschke M (2006) Fracture of the tibial head. Unfallchirurg Mar 109(3):219–234

    Google Scholar 

  10. Petersen W, Zantop T, Raschke M (2006) Tibial head fracture open reposition and osteosynthesis-arthroscopic reposition and osteosynthesis (ARIF). Unfallchirurg Mar 109(3):235–244

    Google Scholar 

  11. Wirth CJ, Mutschler W, Bischoff HP, Pueschmann H, Neu J (2010) Komplikationen in Orthopaedie und Unfallchirurgie. Thieme Verlag

  12. Raschke M, Stange R (2009) Alterstraumatologie, 1st ed. Urban & Fischer

  13. McDonald E, Chu T, Tufaga M, Marmor M, Singh R, Yetkinler D, Matityahu A, Buckley JM, McClellan RT (2011) Tibial plateau fracture repairs augmented with calcium phosphate cement have higher in situ fatigue strength than those with autograft. J Orthop Trauma 25(2):90–95

    Article  PubMed  Google Scholar 

  14. Ratcliff JR, Werner FW, Green JK, Harley BJ (2007) Medial buttress versus lateral locked plating in a cadaver medial tibial plateau fracture model. J Orthop Trauma 21(7):444–448

    Article  PubMed  Google Scholar 

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Acknowledgement

The authors would like to thank Dr. Maria Moritz and Prof. Dr. Peter Schneider for supporting the measurement of the bone mineral density. Furthermore, they would like to thank Jürgen Schmid from Synthes GmbH for providing the drillable calcium phosphate cement, Norian drillable. The authors would also like to thank Gabi Walter from Heraeus Medical GmbH for supplying the bone cement, Palacos.

Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to Stefanie Doht.

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Doht, S., Lehnert, T., Frey, S. et al. Effective combination of bone substitute and screws in the jail technique: a biomechanical study of tibial depression fractures. International Orthopaedics (SICOT) 36, 2121–2125 (2012). https://doi.org/10.1007/s00264-012-1604-8

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  • DOI: https://doi.org/10.1007/s00264-012-1604-8

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