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Contact stress aberrations following imprecise reduction of simple tibial plateau fractures
Author(s) -
Brown Thomas D.,
Anderson Donald D.,
Nepola James V.,
Singerman Robert J.,
Pedersen Douglas R.,
Brand Richard A.
Publication year - 1988
Publication title -
journal of orthopaedic research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1002/jor.1100060609
Subject(s) - cadaver , medicine , cartilage damage , fracture (geology) , reduction (mathematics) , plateau (mathematics) , cartilage , tibial plateau fracture , tibia , condyle , osteoarthritis , joint (building) , nuclear medicine , articular cartilage , anatomy , surgery , materials science , pathology , mathematics , internal fixation , architectural engineering , mathematical analysis , alternative medicine , geometry , engineering , composite material
Despite the well‐recognized association between poorly reduced intraarticular fractures and late degenerative changes, current guidelines regarding the reduction precision necessary to avoid excessive cartilage pressures are based largely on anecdotal clinical observations. To gain a quantitative appreciation of the relation between local pressure elevations and fracture reduction imprecision, a simplified laboratory cadaver model of minimally displaced tibial plateau fractures was developed. Cartilage contact stress distributions were measured as a function of depressed fragment malreduction in seven knees, using high‐resolution (100 pixels/mm 2 ) digital image scans of Fuji‐film stain patterns. The contact stress data showed a general trend of increases of peak local pressure with increasing fracture site incongruity, and in a few isolated instances the effect was very pronounced. Across the whole series, however, statistically significant departures from anatomic pressure levels did not occur until the fragment stepoff was >1.5 mm. Even at the 3‐mm stepoff level, for which the depressed fragment usually no longer made contact with the femoral condyle, the peak local pressure values on the intact side of the fracture line averaged only ∼75% greater than those prevailing anatomically. Given the successful clinical outcomes normally achieved for conservatively managed simple tibial plateau fractures having stepoff magnitudes (5–10 mm) clearly sufficient to insure fragment articular noncontact, the present laboratory results suggest that nominally factor‐of‐two peak local pressure elevations, provided that they occur over only small portions of the cartilage surface, are probably within the long‐term overall tolerance range of an articular joint.