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Published on: April 11, 2012
Biomechanical evaluation of physeal-sparing fixation methods in tibial eminence fractures
Christian N Anderson1, Jeffry S Nyman, Kirk A McCullough
1Tennessee Orthopaedic Alliance/The Lipscomb Clinic, St Thomas Medical Plaza, Suite 1000, 4230 Harding Road, Nashville, TN 37205, USA. canders6@comcast.net
Insights
Ultra-high molecular weight polyethylene suture-button fixation offers superior biomechanical strength and consistency for tibial eminence fractures in children compared to other physeal-sparing methods. This technique provides more reliable fixation, reducing displacement risks.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Biomedical engineering
Background:
- Tibial eminence fractures are common in skeletally immature children.
- Existing physeal-sparing fixation techniques lack structural property evaluation.
- This study addresses the need for biomechanical assessment of these techniques.
Purpose of the Study:
- To evaluate the biomechanical strength and resistance to displacement of various physeal-sparing fixation methods for tibial eminence fractures.
- To compare the performance of ultra-high molecular weight polyethylene suture-button (UHMWPE/SB), suture anchor, polydioxanone suture-button (PDS/SB), and screw fixation.
Main Methods:
- A controlled laboratory study using skeletally immature porcine knees.
- Four fixation groups were tested: UHMWPE/SB, suture anchor, PDS/SB, and screw fixation.
- Biomechanical testing included cyclical and load-to-failure protocols under anterior shear force.
Main Results:
- UHMWPE/SB fixation demonstrated significantly higher peak failure and yield loads compared to screw fixation and PDS/SB.
- Screw fixation showed the lowest survival rate (0%) during cyclical testing.
- PDS/SB fixation exhibited the most creep and lowest stiffness, while suture anchors showed inconsistent fixation.
Conclusions:
- Physeal-sparing fixation with UHMWPE suture-button is biomechanically superior for tibial eminence fractures.
- This technique offers more consistent fixation than suture anchors and better strength than PDS/SB and screw fixation.
- UHMWPE/SB fixation is a reliable option for pediatric tibial eminence fracture treatment.
Background:
Tibial eminence fractures occur most commonly in skeletally immature children. Several techniques using physeal-sparing fracture fixation have been described, but their structural properties have not been evaluated.
Purpose:
To determine the strength and resistance to displacement of physeal-sparing techniques used to fix tibial eminence fractures.
Study Design:
Controlled laboratory study.
Methods:
Skeletally immature porcine knees were randomized into 4 treatment groups: (1) ultra-high molecular weight polyethylene suture-suture button (UHMWPE/SB), (2) suture anchor, (3) polydioxanone suture-suture button (PDS/SB), and (4) screw fixation. A prospective analysis of bone mineral density using dual-energy x-ray absorptiometry was performed on all specimens. Fracture fragments were created in a standardized manner and measured for size comparison. After fracture fixation, biomechanical testing was performed with cyclical and load-to-failure protocols by loading the tibia with an anterior shear force.
Results:
In load-to-failure testing, screw fixation had a significantly lower median peak failure load (186.4 N; lower quartile [LQ], 158.4 N; upper quartile [UQ], 232.6 N) than did UHMWPE/SB (465.8 N; LQ, 397.8 N; UQ, 527.8 N), suture anchors (440.5 N; LQ, 323.0 N; UQ, 562.3 N), and PDS/SB (404.3 N; LQ, 385.9 N; UQ, 415.6 N). UHMWPE/SB demonstrated a significantly higher median yield load (465.8 N; LQ, 397.8 N; UQ, 527.8 N) than did PDS/SB (306.7 N; LQ, 271.4, N; UQ, 405.7 N) and screw fixation (179.0 N; LQ, 120.2 N; UQ, 232.5 N). During cyclical testing, screw fixation demonstrated significantly lower percentage survival of specimens (0%) compared with the other groups (UHMWPE/SB, 100%; suture anchor, 78%; PDS/SB, 78%). After 1000 cycles of loading, PDS/SB fixation had significantly more median creep (6.76 mm; LQ, 6.34 mm; UQ, 8.28 mm) than did UHMWPE/SB (4.43 mm; LQ, 3.80 mm; UQ, 4.73 mm) and suture anchor fixation (3.06 mm; LQ, 2.59 mm; UQ, 4.28 mm). The lowest median stiffness was observed in the PDS/SB group (48.6 N/mm; LQ, 45.3 N/mm; UQ, 54.2 N/mm). UHMWPE/SB fixation demonstrated a significantly higher median peak failure load after cyclic testing (469.0 N; LQ, 380.6 N; UQ, 507.2 N) than did PDS/SB (237.7 N; LQ, 197.3 N; UQ, 298.3 N) and screw fixation (132.4 N; LQ, 123.7 N; UQ, 180.9 N). Suture anchor fixation had significantly more variance, as demonstrated by width of interquartile range, in peak failure load, yield load, and creep than did other techniques.
Conclusion:
Physeal-sparing fixation of tibial eminence fractures with UHMWPE suture-suture button is biomechanically superior to both PDS suture-suture button and a single screw at the time of surgery and provides more consistent fixation than do suture anchors.
Clinical Relevance:
Suture anchors provide inconsistent fixation for tibial eminence fractures.
