The effects of tibia profile, distraction angle, and knee load on wedge instability and hinge fracture: A finite element study

Pei Wei Weng, Chia Hsien Chen, Chu An Luo, Jui Sheng Sun, Yang Hwei Tsuang, Cheng Kung Cheng, Shang Chih Lin

研究成果: 雜誌貢獻文章

9 引文 (Scopus)

摘要

Several plate systems for high tibial osteotomy (HTO) have been developed to stabilize the opening wedge of an osteotomized tibia. Among them, the TomoFix system, having a quasi-straight and T-shaped design, has been widely adopted in the literature. However, this system is implemented by inserting a lag (i.e., cortical) screw through the proximal combi-hole, to deform the plate and pull the distal tibia toward the plate. This process potentially induces plate springback and creates an elastic preload on the osteotomized tibia, especially at the lateral hinge of the distracted wedge. Using the finite-element method, this study aims to investigate the contoured effect of lag-screw application on the biomechanical behavior of the tibia-plate construct. Two tibial profiles (normal and more concave), three distraction angles (6°, 9°, and 12°), and three knee loads (intraoperative: contouring plate; postoperative: weight and nonweight bearing) are systematically varied in this study. The wedge instability and fracture risk at the lateral hinge are chosen as the comparison indices. The results show the necessity of preoperative planning for a precontoured procedure, rather than elastic deformation using a lag screw. Within the intraoperative period, a more concave tibial profile and/or reduced distraction angle (i.e., 6° or 9°) necessitate a higher compressive load to elastically deform the plate, thereby deteriorating the lateral-hinge fracture risk. A precontoured plate is recommended in the case that the proximal tibia is highly concave and the distraction angle is insufficient to stretch the tibial profile.
原文英語
頁(從 - 到)48-54
期刊Medical Engineering and Physics
42
DOIs
出版狀態已發佈 - 四月 1 2017

指紋

Hinges
Tibia
Knee
Bearings (structural)
Elastic deformation
Intraoperative Period
Weight-Bearing
Finite element method
Planning
Osteotomy

ASJC Scopus subject areas

  • Biophysics
  • Biomedical Engineering

引用此文

The effects of tibia profile, distraction angle, and knee load on wedge instability and hinge fracture : A finite element study. / Weng, Pei Wei; Chen, Chia Hsien; Luo, Chu An; Sun, Jui Sheng; Tsuang, Yang Hwei; Cheng, Cheng Kung; Lin, Shang Chih.

於: Medical Engineering and Physics, 卷 42, 01.04.2017, p. 48-54.

研究成果: 雜誌貢獻文章

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AB - Several plate systems for high tibial osteotomy (HTO) have been developed to stabilize the opening wedge of an osteotomized tibia. Among them, the TomoFix system, having a quasi-straight and T-shaped design, has been widely adopted in the literature. However, this system is implemented by inserting a lag (i.e., cortical) screw through the proximal combi-hole, to deform the plate and pull the distal tibia toward the plate. This process potentially induces plate springback and creates an elastic preload on the osteotomized tibia, especially at the lateral hinge of the distracted wedge. Using the finite-element method, this study aims to investigate the contoured effect of lag-screw application on the biomechanical behavior of the tibia-plate construct. Two tibial profiles (normal and more concave), three distraction angles (6°, 9°, and 12°), and three knee loads (intraoperative: contouring plate; postoperative: weight and nonweight bearing) are systematically varied in this study. The wedge instability and fracture risk at the lateral hinge are chosen as the comparison indices. The results show the necessity of preoperative planning for a precontoured procedure, rather than elastic deformation using a lag screw. Within the intraoperative period, a more concave tibial profile and/or reduced distraction angle (i.e., 6° or 9°) necessitate a higher compressive load to elastically deform the plate, thereby deteriorating the lateral-hinge fracture risk. A precontoured plate is recommended in the case that the proximal tibia is highly concave and the distraction angle is insufficient to stretch the tibial profile.

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