Tibial shaft fractures require surgical stabilization preferably by intramedullary nailing. However, patients often report functional limitations even years after the injury. This study investigates the influence of the surgical approach (transpatellar vs. parapatellar) on gait performance and patient reported outcome six months after surgery. Twenty-two patients with tibial shaft fractures treated by intramedullary nailing through a transpatellar approach (TP: n=15, age 41±15, BMI 24±3) or a parapatellar approach (PP: n=7, age 34±15, BMI 23±2) and healthy, matched controls (n=22, age 39±13, BMI 24±2) were assessed by instrumented motion analysis six months after intramedullary nailing. Short musculoskeletal function assessment questionnaire (SMFA) as well as kinematic and kinetic gait data were collected during level walking. Comparisons among approach methods and control group were performed by analysis of variance and Mann-Whitney test. Six months after surgery, knee kinetics in both groups differed significantly compared to controls (p <.04). The approach method affected gait speed (TP: p = .002; PP: p = .08) and knee kinematics in the early stance phase (TP: p = .011; PP: p = .082), with the parapatellar approach showing a more favorable outcome. However, the difference between patient groups was not significant for any of the assessed gait parameters (p > .2). Also, no differences could be found in the bother index (BI) or function index (FI) of SMFA between surgical approach methods (BI: TP: Mdn = 7.2, PP: Mdn = 9.4; FI: TP: Mdn = 10.3, PP: Mdn = 9.2, p > .7). Our study demonstrates, that six months after surgery for tibial shaft fractures functional limitations remain. These limitations appear not to be different for either a trans- or a parapatellar approach for the insertion of the intramedullary nail. The findings of this study are limited by the relatively short follow up time period and small number of patients. Future studies should investigate the source of the functional limitation after intramedullary nailing of tibial shaft fractures.
Bi-condylar tibia plateau fractures are one of challenging injuries due to multi-planar fracture lines. The risk of fixation failure is correlated with coronal splits observed in CT images, although established fracture classifications and previous studies disregarded this critical split. This study aimed to experimentally and numerically compare our innovative fracture model (Fracture C), developed based on clinically-observed morphology, with the traditional Horwitz model (Fracture H). Fractures C and H were realized using six samples of 4th generation tibia Sawbones and fixed with Stryker AxSOS locking plates. Loading was introduced through unilateral knee replacements and distributed 60% medially. Loading was initiated with six static ramps to 250 N and continued with incremental fatigue tests until failure. Corresponding FE models of Fractures C and H were developed in ANSYS using CT scans of Sawbones and CAD data of implants. Loading and boundary conditions similar to experimental situations were applied. All materials were assumed to be homogenous, isotropic, and linear elastic. Von-Mises stresses of implant components were compared between fractures.Abstract
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