Anterolateral Versus Medial Plating for Comminuted Intra Articular Distal Tibia Fractures: A Biomechanical Assessment

Abstract

Pilon fractures are a result of high energy impacts to the ankle joint causing comminution to the tibia. Open reduction and internal fixation is the current method of treatment, which involves reducing the fracture and placing an anterolateral or medial plate along the tibia to secure the bone fragments during the bone healing process, but these have frequent complications for patients. No previous studies have investigated the biomechanical performance of these plates using a model that consists of the tibia, fibula and the syndesmotic tissue. The purpose of this study was to evaluate the biomechanical effectiveness of these plates using cadaveric specimens. Eight pairs of cadaveric specimens were anatomically aligned and potted proximally. A typical fracture pattern was created in each specimen and then one from each pair treated with an anterolateral and the other with a medial plate. A materials testing machine applied an axial load to the specimen to determine the construct stiffness, followed by a ramp load to failure. An optical tracking system was configured to track the motion of the bone fragments in 3D space. The medial plates tended to provide superior results when compared to the anterolateral plate; however, no statistical difference was found. This represents the most complex fracture and comprehensive evaluation of the plating options available for this type of injury and may inform surgeons to help reduce the poor outcomes for patients.