Treatment of C1.1 (AO-41) tibial plateau fracture: A finite element analysis of single medial, lateral and dual plating

Bicondylar tibial plateau fractures pose many challenges in surgical treatment. The aim of the present study was to analyze three methods of reduction, single medial, single lateral, and dual plating, for the treatment of a bicondylar tibial plateau fracture, through finite element analysis (FEA). A simple metaphyseal fracture, type C1.1 (AO-41) was modeled on a CT-derived 3D model of the knee. Lateral and medial proximal tibial polyaxial plates with screws were modeled and placed accordingly for the three methods of reduction. Simulation of physiological type loading corresponding to the maximal weight acceptance phase during a slow walking gait cycle was performed using FEA. Values of stress and strain were recorded near the fracture lines. Dual plating provided a decrease of stress and strain in the tibial plateau area. However, the differences in the values among the three cases were small. The stress concentration areas were located in the vicinity of the fracture, predominantly in the area of the tibial plateau. Considering the limitations of the present study, the results revealed that dual plating leads to smaller stress and strain values near the fracture lines in the tibial plateau area. However, values obtained for single lateral plating are close in range. Considering the complexity of the surgical approach for dual plating, single lateral plating may be a solution for good reduction with fewer surgical risks and complications. Further studies on the C1.1 fracture (AO-41) are needed to analyze the complex issue of reducing and stabilizing such a fracture and to characterize the postoperative state while providing predictable parameters for an optimal result.