OPTIMISING A PERIARTICULAR FRACTURE FIXATION PLATE: DOES ONE SHAPE FIT ALL?

Abstract

With the development and popularisation of minimally invasive surgical methods and implants for fracture fixation, it is increasingly important that available implants are pre-contoured to the specific anatomical location for which they are designed. Due to differences in the bone morphology it is impossible to design single implants that are universally applicable for the entire human population. A recent study on the fit of a distal periarticular medial tibia plate to Japanese bones supported the need for shape optimisation [1]. The present study aimed to quantify and optimise the fit of the same plate for an extended dataset of Japanese tibiae. Forty-five 3D models of the outer bone contour of Japanese tibiae were used. The average age of the specimens was 67 years with an average height of 156 cm. All bone models were considered to be within a normal range without any bony pathology. An anatomical fit of the plate was defined with four criteria [1]. The current plate shape was optimised based on the quantitative results of the plate fitting. Two different optimised plate shapes were generated. The current plate shape achieved an anatomical fit on 13% of tibias from the dataset. Plate 1 achieved an anatomical fit for 42% and Plate 2 a fit for 67% of the bone models. If either Plate 1 or Plate 2 is used, then the anatomical fit can be increased from 13% to 82% for the same dataset. For 12 (27%) of the 45 bones both modified plate shapes were fitting. The results for the fit of the current plate shape are comparable to findings of a similar study on the anatomical fitting of proximal tibia plates [2]. The obtained results indicate that for the available dataset no further modification is warranted for the shaft region of the modified plates. Further optimization of the distal regions of Plate 1 and Plate 2 will be possible. This study shows that in order to achieve an anatomical fit of the plate to the medial Malleolus at least two different plate shapes will be required.

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