Biomechanical Comparison of Two Double Plating Methods in a Coronal Fracture Model of Bi-condylar Tibial Plateau Fractures.

OBJECTIVES Since management of bi-condylar tibial plateau fractures are complicated even for expert surgeons, with using a coronal fracture model we aimed to compare two kinds of double locked plating techniques which were consisted of the lateral locking plate and the medial locking plate inserted medial-anteriorly (MA) or medial-posteriorly (MP). METHODS Fourteen fresh-frozen tibias stabilized with the MA or MP methods were allocated into two groups with similar BMD values. Implanted samples were tested under incremental fatigue loading conditions utilizing a customized load applicator. An optical motion tracking system was employed to assess relative displacements and rotations of fracture fragments during loading. Static and dynamic global stiffness, failure load, failure cycles, a well as movements of fracture fragments were measured. RESULTS There were no significant differences between the two fixation methods regarding global stiffness, failure load, or failure cycles (p= 0.67-0.98, depending on the parameter). The kinematic evaluations, however, revealed that different positions of the medial locking plates altered the directions of movements for the medial-anterior or medial-posterior fracture segments. CONCLUSIONS The mechanical stability of tibia-implant constructs fixed with the double plating methods was not remarkably affected by the location of the medial locking plate. Depending on clinical conditions and surgeons' preferences, bi-condylar tibial plateau fractures can be managed with either MA or MP methods.