Plate Fixation Options

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3 Distal tibia extra-articular fractures can be difficult to treat Tenuous soft tissue Complex fracture patterns Plate Fixation Options Medial plating: Minimally invasive approach Technical ease Anterolateral plating Robust soft tissue coverage Better fracture visualization Fracture pattern should be considered when deciding between plate applications Objective: Compare biomechanical properties of both plate options to stabilize varus and valgus fractures

4 16 4 th generation tibia bone models with simulated oblique OTA 43-A1.2 distal tibia fractures Valgus Pattern Model 45 osteotomy proximal/lateral to distal/medial Varus Pattern Model 45 osteotomy proximal/medial to distal/lateral

5 Osteotomies plated using a medial or anterolateral distal tibial locking plate Specimens potted into a custom jig in polymethylmethacrylate cement Loading Protocol - Compressive Stiffness Body weight (standing) - Torsional Stiffness Internal / External Rotation - Cyclic Loading 2 x body weight (walking) - Load to Failure Statistical analysis was performed using Mann Whitney U tests.

6 Varus Fracture Pattern Medial plating stiffer in both compression and torsion Valgus Fracture Pattern No difference between medial and anterolateral plating

7 Medial plates had superior biomechanical performance compared to anterolateral plates when used to stabilize varus fracture patterns. In this application they functioned in anti-glide mode. For valgus fracture patterns, no biomechanical differences between anterolateral and medial plating were observed. In clinical practice, surgeons should take this biomechanical evidence into account and perform a plating that optimizes stability.

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