Buryanov O. A., Kvasha V. P., Gliba G. G., Karpinsky M. Yu., Yaresko O. V.

ANALYSIS OF STRESS DISTRIBUTION UNDER THE INFLUENCE OF TORSIONAL LOADING IN A MODEL OF A LOWER LEG WITH A MULTI-FRAGMENT FRACTURE OF THE PROXIMAL END OF THE TIBIA WITH DIFFERENT OSTEOSYNTHESIS OPTIONS

---

Show/Download

About the author:

Buryanov O. A., Kvasha V. P., Gliba G. G., Karpinsky M. Yu., Yaresko O. V.

Heading:

METHODS AND METHODOLOGIES

Type of article:

Scientific article

Annotation:

In cases of multi-fragment intra-articular fractures of the tibia with damage to the articular surface, the small size of the fragments does not always allow for stable osteosynthesis using standard intramedullary devices. The aim is to investigate the stress-strain state of a model of the lower leg with a multi-fragment fracture of the proximal end of the tibia under various options for its osteosynthesis with intramedullary plates under the influence of torsional loading. A finite element model of the lower leg was developed. A multi-fragment fracture was modelled at the proximal end of the tibia. Three options for osteosynthesis of the proximal end of the tibia with intramedullary plates were studied: a plate on the medial side, a plate on the lateral side, and two plates on both sides. The models were studied under torsional loading. The stress levels in the bone elements of the osteosynthesis model with two plates slightly exceed the minimum values for unilateral models, but differ significantly from the maximum values. The medially applied plate provides lower stress levels in the bone fragments around the screws in the metaphyseal zone. The plate applied on the lateral side provides a lower level of stress in all other areas of the tibia. Osteosynthesis with two plates ensures an even distribution of stress between the elements of the metal structure. With osteosynthesis using a plate on the medial side, torsional loading causes maximum stress on all elements of the structure. The lowest level of stress is determined with osteosynthesis using a plate on the lateral side. Under the influence of torsional load, the plate applied to the lateral side ensures a minimum level of stress both in the bone elements of the model and in the elements of the metal structure. Maximum stresses are determined during osteosynthesis with a plate on the medial side. The model of osteosynthesis with two plates allows obtaining stresses in the bone elements of the model, the level of which at all control points occupies an intermediate position between the maximum and minimum stress values at these same points on models with unilateral plate placement.

Tags:

Bibliography:

1. Bormann M, Neidlein C, Gassner C, Keppler A, Bogner-Flatz V, Ehrnthaller C, et al. Changing patterns in the epidemiology of tibial plateau fractures: a 10-year review at a level-I trauma center. Eur J Trauma Emerg Surg. 2023;49(1):401-409. DOI: 10.1007/s00068-022-02076-w.
2. Malik S, Herron T, Mabrouk A, Rosenberg N. Tibial Plateau Fractures. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470593.
3. Schatzker J, Kfuri M. Revisiting the management of tibial plateau fractures. Injury. 2022;53(6):2207-2218. DOI: 10.1016/j.injury.2022.04.006.
4. Khan K, Mushtaq M, Rashid M, Rather AA, Qureshi OAA. Management of tibial plateau fractures: a fresh review. Аcta orthopaedica Вelgica. 2023;89:265-273. DOI: 10.52628/89.2.11508.
5. Millar SC, Fraysse F, Arnold JB, Thewils D, Solomon LB. 3D modelling of tibial plateau fractures: Variability in fracture location and characteristics across Schatzker fracture types. Injury. 2021;52(8):2415-2424. DOI: 10.1016/j.injury.2021.01.019.
6. Pysarenko HS, Kvitka OL, Umanskyy ES. Opir materialiv. Kyyiv: Vyshcha shkola; 2004. 655 s. [in Ukrainian].
7. Mónico JL, Andrade R, Matos P. Tibial plateau fractures osteosynthesis - a case series of 88 patients evaluating surgical approaches, results and complications. Annals of Joint. 2021;6:26. DOI: 10.21037/aoj-20-95.
8. Gahr P, Mittlmeier T, Grau A, Herlyn P, Rahn A, Fischer D. Functional assessment and outcome following surgical treatment of displaced tibial plateau fractures: a retrospective analysis. Eur J Trauma Emerg Surg. 2023;49(6):2373-2379. DOI: 10.1007/s00068-023-02401-x.
9. Stroyev MYu, Berezka MI, Hryhoruk VV, Karpinskyy MYu, Yaresko OV. Efektyvnist protydiyi navantazhennyam na kruchennya riznykh variantiv osteosyntezu vidlamkiv homilky pry yiyi perelomi v verkhniy tretyni diafizu (za danymy matematychnoho modelyuvannya). Ortopedyya, travmatolohyya y protezyrovanye. 2022;3-4:45-51. DOI: 10.15674/0030-598720223-445-51. [in Ukrainian].
10. Stroyev MYU, Berezka MI, Vlasenko DV, Bitchuk MD, Karpinskyy MYU, Yaresko OV. Analiz napruzheno-deformovanoho stanu modeli velykohomilkovoyi kistky pry yiyi perelomi v verkhniy tretyni z riznymy variantamy osteosyntezu v umovakh zrostayuchoho z·hynalnoho navantazhennya. Travma. 2023;24(3):28-37. DOI: 10.22141/1608-1706.3. 24.2023.952. [in Ukrainian].
11. Gere JM, Timoshenko SP. Mechanics of Material. Boston: PWS Press; 1997. 912 s.
12. Rao SS. The Finite Element Method in Engineering. Oxford: Butterworth-Heinemann; 2017. 782 s.
13. Kurowski PM. Engineering Analysis with COSMOSWorks 2007. Albuquerque: SDC Publications; 2007. 263 s.
14. Chang H, Zhu Y, Zheng Z, Chen W, Zhao S, Zhang Y, et. al. Meta-analysis shows that highly comminuted bicondylar tibial plateau fractures treated by single lateral locking plate give similar outcomes as dual plate fixation. Int Orthop. 2016;40(10):2129-2141. DOI: 10.1007/s00264-016-3157-8.
15. Yan B, Huang X, Xu Y, Zou C. A Novel Locking Buttress Plate Designed for Simultaneous Medial and Posterolateral Tibial Plateau Fractures: Concept and Comparative Finite Element Analysis. Orthop Surg. 2023;15(4):1104-1116. DOI: 10.1111/os.13660.
16. Citak C, Kayali C, Ozan F, Altay T, Karahan HG, Yamak K. Lateral Locked Plating or Dual Plating: A Comparison of Two Methods in Simple Bicondylar Tibial Plateau Fractures. Clin Orthop Surg. 2019;11(2):151-158. DOI: 10.4055/cios.2019.11.2.151.
17. Wang Z, Wang Y, Tian S, Tan Z, Deng X, Zhao K, et al. Dual plating or dual plating combined with compression bolts for bicondylar tibial plateau fractures: a retrospective comparative study. Sci Rep. 2021;11:7768. DOI: 10.1038/s41598-021-87510-6.
18. Dehoust J, Münch M, Seide K, Barth T, Frosch KH. Biomechanical aspects of the posteromedial split in bicondylar tibial plateau fractures- a finite-element investigation. Eur J Trauma Emerg Surg. 2020;46:1257-1266. DOI: https://doi.org/10.1007/s00068-020-01538-3.
19. Tseng HP, Bartels H, Noppe N, Vancleef S, Herteleer M, Hoekstra H. 3D-validation of a simple tool to measure tibiofemoral axial rotation in tibial plateau fractures. Eur Radiol. 2023;33(12):8627-8636. DOI: 10.1007/s00330-023-09947-9.

Publication of the article:

«Bulletin of problems biology and medicine», 2025 Issue 3,178, 337-349 pages, index UDC 616.718.5-0001.5.-089.2-007.2:613.25]:00.942](045)

DOI:

10.29254/2077-4214-2025-3-178-337-349