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. 2024 Jul 11;25(1):533.
doi: 10.1186/s12891-024-07660-2.

Biomechanical evaluation of different medial column fixation patterns for valgus pilon fractures

Bing-Hao Wang #  1 , Bin-Bin Zhang #  1 , Zi-Ling Gong  1 , Jiong Mei  1 , Cong-Feng Luo  2 , Yi Zhu  3
Affiliations

Biomechanical evaluation of different medial column fixation patterns for valgus pilon fractures

Bing-Hao Wang et al. BMC Musculoskelet Disord. .

Abstract

Background: The purpose of this study was to perform a biomechanical analysis to compare different medial column fixation patterns for valgus pilon fractures in a case-based model.

Methods: Based on the fracture mapping, 48 valgus pilon fracture models were produced and assigned into four groups with different medial column fixation patterns: no fixation (NF), K-wires (KW), intramedullary screws (IS), and locking compression plate (LCP). Each group contained wedge-in and wedge-out subgroups. After fixing each specimen on the machine, gradually increased axial compressive loads were applied with a load speed of one millimeter per minute. The maximum peak force was set at 1500 N. Load-displacement curves were generated and the axial stiffness was calculated. Five different loads of 200 N, 400 N, 600 N, 800 N, 1000 N were selected for analysis. The specimen failure was defined as resultant loading displacement over 3 mm.

Results: For the wedge-out models, Group-IS showed less displacement (p < 0.001), higher axial stiffness (p < 0.01), and higher load to failure (p < 0.001) than Group-NF. Group-KW showed comparable displacement under loads of 200 N, 400 N and 600 N with both Group-IS and Group-LCP. For the wedge-in models, no statistical differences in displacement, axial stiffness, or load to failure were observed among the four groups. Overall, wedge-out models exhibited less axial stiffness than wedge-in models (all p < 0.01).

Conclusions: Functional reduction with stable fixation of the medial column is essential for the biomechanical stability of valgus pilon fractures and medial column fixation provides the enough biomechanical stability for this kind of fracture in the combination of anterolateral fixation. In detail, the K-wires can provide a provisional stability at an early stage. Intramedullary screws are strong enough to provide the medial column stability as a definitive fixation. In future, this technique can be recommended for medial column fixation as a complement for holistic stability in high-energy valgus pilon fractures.

Keywords: Biomechanical study; Fixation stability; Internal fixation; Pilon fracture.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
3D heat mapping superimposed with all valgus pilon fracture lines (n = 45). The common comminuted area of the medial column is marked with the black circle
Fig. 2
Fig. 2
The polyamide cutting guide produced by the 3D printing technique
Fig. 3
Fig. 3
Illustration of the medial internal fixation patterns. Wedge-out models: (A) no fixation as a blank control (NF), (B) K-wires (KW), (C) intramedullary screws (IS), (D) locking compression plate (LCP); Wedge-in models: (E) no fixation as a blank control (NF), (F) K-wires (KW), (G) intramedullary screws (IS), (H) locking compression plate (LCP)
Fig. 4
Fig. 4
Schematic diagram of biomechanical test. (A) The load was applied to the distal end of the tibia through a metal ball. (B) Measurement of medial and posterior displacement
Fig. 5
Fig. 5
The displacement in wedge-in models
Fig. 6
Fig. 6
The displacement in wedge-out models
Fig. 7
Fig. 7
The stiffness of different fixation patterns
Fig. 8
Fig. 8
The load to failure of different fixation patterns
See this image and copyright information in PMC

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