Contribution of Minimally Invasive Bone Augmentation With PMMA Cement in Primary Fixation of Schatzker Type II Tibial Plateau Fractures

T Vendeuvre (1, 2) , C Koneazny (1) , C Brèque (3) , P Rigoard (1, 2) , M Severyns (2) , A Germaneau (2)

1 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
2 PEM - Photomécanique et analyse expérimentale en mécanique des solides [Institut Pprime]
3 COBRA - Cobotique, Bio-ing Robotique pour l'Assistance [Institut Pprime]

Background: The most common type of fracture of the lateral tibial plateau is the Schatzker type II split-depressed fracture. Minimally invasive surgery using balloon reduction appears to be very promising compared to the gold standard using a bone tamp. This surgery aims to have the best reduction and stabilization to benefit from an early passive and active rehabilitation to avoid stiffening and muscle wasting. Using a balloon for fracture reduction has allowed the use of semi-liquid Injectable Bone Cement (IBC) fillers. These fillers can be phosphocalcic or polymethyl methacrylate (PMMA). The latest recommendations on these IBCs in spinal surgery increasingly rule out phosphocalcic fillers because of their low mechanical strength. Questions/purposes: 1) What is the mechanical influence of IBC filling (PMMA) regarding the split and depression components of a Schatzker type II fracture? 2) What is the mechanical influence of osteosynthesis regarding the split and depression components of a Schatzker type II fracture with or without PMMA filing in three different kinds of percutaneous fixations? Methods: This biomechanical study was performed on 36 fresh frozen tibia/fibula specimens. Six groups were formed according to the type of percutaneous osteosynthesis or possible PMMA filling. Mechanical strength tests were carried out using a Unicompartmental Knee prosthesis and displacement components were measured on either side of the separation on the anterolateral facet by optical method. Results: We found a significant difference between cementless and cemented osteosynthesis for depression fracture stabilization (difference −507.56N with 95% confidence interval [−904.17; −110.94] (p-value = 0.026)). The differences between the different types of osteosynthesis were not significant (p-value = 0.58). There was a significant difference between osteosynthesis without cement and osteosynthesis with cement on separation (difference −477.72N [−878.52; −76.93] (p-value = 0.03)). The

Mots clés: tibial plateau fracture osteosynthesis; tuberoplasty; percutaneous osteosynthesis; injectable bone cement; optical methods; biomechanics

Domaines: Biomécanique [physics.med-ph]; Biomatériaux; Chirurgie; Rhumatologie et système ostéo-articulaire

T Vendeuvre, C Koneazny, C Brèque, P Rigoard, M Severyns, et al.. Contribution of Minimally Invasive Bone Augmentation With PMMA Cement in Primary Fixation of Schatzker Type II Tibial Plateau Fractures. Frontiers in Bioengineering and Biotechnology, 2022, 10, pp.840052. ⟨10.3389/fbioe.2022.840052⟩. ⟨hal-04052598⟩