Biomechanical analysis of operative methods in the treatment of extra-articular fracture of the proximal Tibia

Seong Man Lee, Chang Wug Oh, Jong Keon Oh, Joon Woo Kim, Hyun Joo Lee, Chang Soo Chon, Byoung Joo Lee, Hee Soo Kyung

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


Background: To determine relative fixation strengths of a single lateral locking plate, a double construct of a locking plate, and a tibial nail used in treatment of proximal tibial extra-articular fractures. Methods: Three groups of composite tibial synthetic bones consisting of 5 specimens per group were included: lateral plating (LP) using a locking compression plate-proximal lateral tibia (LCP-PLT), double plating (DP) using a LCP-PLT and a locking compression plate-medial proximal tibia, and intramedullary nailing (IN) using an expert tibial nail. To simulate a comminuted fracture model, a gap osteotomy measuring 1 cm was created 8 cm below the knee joint. For each tibia, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 25 mm/min until tibial failure. Results: Under axial loading, fixation strength of DP (14,387.3 N; standard deviation [SD], 1,852.1) was 17.5% greater than that of LP (12,249.3 N; SD, 1,371.6), and 60% less than that of IN (22,879.6 N; SD, 1,578.8;/? < 0.001, Kruskal-Wallis test). For ultimate displacement under axial loading, similar results were observed for LP (5.74 mm; SD, 1.01) and DP (4.45 mm; SD, 0.96), with a larger displacement for IN (5.84 mm; SD, 0.99). The median stiffness values were 2,308.7 N/mm (range, 2,147.5 to 2,521.4 N/mm; SD, 165.42) for the LP group, 4,128.2 N/mm (range, 3,028.1 to 4,831.0 N/mm; SD, 832.88) for the DP group, and 5,517.5 N/mm (range, 3,933.1 to 7,078.2 N/mm; SD, 1,296.19) for the IN group. Conclusions: During biomechanical testing of a simulated comminuted proximal tibial fracture model, the DP proved to be stronger than the LP in terms of ultimate strength. IN proved to be the strongest; however, for minimally invasive osteosynthesis, which may be technically difficult to perform using a nail, the performance of the DP construct may lend credence to the additional use of a medial locking plate.

Original languageEnglish
Pages (from-to)312-317
Number of pages6
JournalCiOS Clinics in Orthopedic Surgery
Issue number3
Publication statusPublished - 2014
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2014, by The Korean Orthopaedic Association. All rights reserved.


  • Biomechanical study
  • Locking plate
  • Nail
  • Proximal tibial fracture

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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