Biomechanical guidance can improve accuracy of reduction for intra‐articular tibia plafond fractures and reduce joint contact stress

Michael C. Willey; Andrew M. Kern; Jessica E. Goetz; John Lawrence Marsh; Donald D. Anderson

doi:10.1002/jor.25393

$Biomechanical guidance can improve accuracy of reduction for intra‐articular tibia plafond fractures and reduce joint contact stress$

Journal article

Open access

Peer reviewed

Biomechanical guidance can improve accuracy of reduction for intra‐articular tibia plafond fractures and reduce joint contact stress

Michael C. Willey, Andrew M. Kern, Jessica E. Goetz, John Lawrence Marsh and Donald D. Anderson

Journal of orthopaedic research, Vol.41(3), pp.546-554

03/2023

DOI: 10.1002/jor.25393

PMCID: PMC9726992

PMID: 35672888

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Abstract

Articular fracture malreduction increases posttraumatic osteoarthritis (PTOA) risk by elevating joint contact stress. A new biomechanical guidance system (BGS) that provides intraoperative assessment of articular fracture reduction and joint contact stress based solely on a preoperative computed tomography (CT) and intraoperative fluoroscopy may facilitate better fracture reduction. The objective of this proof-of-concept cadaveric study was to test this premise while characterizing BGS performance. Articular tibia plafond fractures were created in five cadaveric ankles. CT scans were obtained to provide digital models. Indirect reduction was performed in a simulated operating room once with and once without BGS guidance. CT scans after fixation provided models of the reduced ankles for assessing reduction accuracy, joint contact stresses, and BGS accuracy. BGS was utilized 4.8 ± 1.3 (mean ± SD) times per procedure, increasing operative time by 10 min (39%), and the number of fluoroscopy images by 31 (17%). Errors in BGS reduction assessment compared to CT-derived models were 0.45 ± 0.57 mm in translation and 2.0 ± 2.5° in rotation. For the four ankles that were successfully reduced and fixed, associated absolute errors in computed mean and maximum contact stress were 0.40 ± 0.40 and 0.96 ± 1.12 MPa, respectively. BGS reduced mean and maximum contact stress by 1.1 and 2.6 MPa, respectively. BGS thus improved the accuracy of articular fracture reduction and significantly reduced contact stress. Statement of Clinical Significance: Malreduction of articular fractures is known to lead to PTOA. The BGS described in this work has potential to improve quality of articular fracture reduction and clinical outcomes for patients with a tibia plafond fracture.

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Details

Title: Subtitle: Biomechanical guidance can improve accuracy of reduction for intra‐articular tibia plafond fractures and reduce joint contact stress
Creators: Michael C. Willey - University of Iowa
Andrew M. Kern - University of Iowa
Jessica E. Goetz - University of Iowa
John Lawrence Marsh - University of Iowa
Donald D. Anderson - University of Iowa
Resource Type: Journal article
Publication Details: Journal of orthopaedic research, Vol.41(3), pp.546-554
DOI: 10.1002/jor.25393
PMID: 35672888
PMCID: PMC9726992
NLM abbreviation: J Orthop Res
ISSN: 0736-0266
eISSN: 1554-527X
Publisher: Wiley
Grant note: DOI: 10.13039/100000069, name: National Institute of Arthritis and Musculoskeletal and Skin Diseases, award: P50AR055533, R21AR054015
Language: English
Electronic publication date: 06/21/2022
Date published: 03/2023
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation; Industrial and Systems Engineering; Injury Prevention Research Center
Record Identifier: 9984303987402771

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