Vojnosanitetski pregled 2011 Volume 68, Issue 10, Pages: 867-871
https://doi.org/10.2298/VSP1110867S
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High, open wedge tibial osteotomy: Finite element analysis of five internal fixation modalities
Stepanović Željko (Medicinski fakultet, Kragujevac + Klinički centar „Kragujevac“, Klinika za ortopediju, Kragujevac)
Živković Miroslav (Mašinski fakultet, Kragujevac)
Vulović Snežana (Univerzitet Metropolitan, Fakultet informacionih tehnologija, Beograd)
Aćimović Ljubiša (Medicinski fakultet, Kragujevac)
Ristić Branko (Medicinski fakultet, Kragujevac)
Matić Aleksandar (Medicinski fakultet, Kragujevac)
Grujović Zoran (Medicinski fakultet, Kragujevac)
Background/Aim. Medial open wedge tibial osteotomy is one of the most widely
accepted method of treatment for varus knee deformity in younger patient
population. Its success depends on the quality of fixation and preservation
of the outer cortex of the tibia. The aim of the study was to evaluate stress
distribution in five numerically designed plate configurations which can be
used in open wedge tibial osteotomy. Methods. The paper describes the 3D
numerical model of the tibia with 10° varus deformity correction obtained by
an optical scanner ATOS. The simulation anticipated axial compressive loads
of 700 N, 1 400 N and 2 100 N. We used a modification of the standard T-plate
in all of the five tested models. Modalities were tested with and without a
metal block, and with and without a stable angle fixation plates and screws.
Software PAK was used in the analysis of stress distribution. Results. With
exception for the standard T-plate configuration without the supporting
block, the loads up to 1400 N did not result in critical stresses on the
outer cortex of the tibia in the remaining four models. There is an objective
risk of possible failure of the outer cortex and loss of correction at a load
of 2100 N in all configurations. The plate model with the angle stable
fixation and the supporting metal block showed the most optimal distribution
of stresses on the plate-bone composite compared to other models. Conclusion.
The standard T-plate configuration without supporting metal block is not
sufficient to stabilize the open wedge osteotomy of the tibia. Numerical
models of the angle stable T-plate and the supporting metal block achieved a
favorable distribution of stresses on the bone and implant which require
further biomechanical testing.
Keywords: orthopedic procedures, tibia, osteotomy, internal fixators, bone screws
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