Periarticular raft constructs and fracture stability in split-depression tibial plateau fractures [presentation] Presentation uri icon
  • The optimal fixation for split depression tibial plateau fractures has been debated in the literature with various implant configurations being recommended. The 'raft-construct,' has been proposed as an effective way to maintain elevation of the articular cartilage after reduction of depressed fragments. Osteoporosis likely increases the likelihood for fixation failure, and demands that the optimal raft construct be understood in order to accomplish the goals of fixation. This method is characterized by multiple screws typically placed from lateral to medial direction in a single plane along the subchondral bone. The purpose of our study was to evaluate the relative fracture stability yielded by screws placed above a lateral plate, as well as locking and non-locking screws used through the plate. Cadaver tibia specimens (mean age 72 years) were randomized across 3 groups: Group I: Raft-construct outside the plate, II: Non-locking raft-construct through the plate, and III: Locking raft-construct through the plate. Specimens were subjected to cyclic displacement stresses at increasing loads (400N, 800N, 1200N, 1600N) immediately followed by load-to-failure (0.5 cm, 1.0 cm,1.5 cm 2.0 cm) evaluating the force required for fixation failure. ANOVA testing showed groups 1 and 2&3 combined were significantly different (p=0.0042) favoring increased stability in raft constructs placed through the plate. The data was log transformed evaluated with Tukey-Kramer comparisons showing differences between Group 1 and 3 (p=0.0066). Differences between Groups 1 and 2 demonstrated a trend (p=0.1044). Groups 2 and 3 were not different (p=0.5038). Periarticular subchondral raft constructs in the treatment of unicondylar tibial plateau fractures are most stable when placed through a plate. There does not appear to be a significant benefit of locked screws over nonlocked screws in this model.

  • participant
  • Armitage, B. M.   Presenter  
  • Cole, Peter A., MD   Presenter  
  • Cross, W. W.   Presenter  
  • Levy, B. A.   Presenter  
  • Research
  • Fractures
  • Orthopedics
  • Surgery