Dimensional Optimization in Screw Fixation for Personalized Treatment of the Tibial Plateau Fracture

Background: Tibial plateau fractures represent 1% of all fractures in adults, and the aim of the fracture treatment is stable fixation. There is a lack of consensus regarding the optimal treatment method for complex fractures. Closed reduction and percutaneous screw fixation for tibial plateau fractures is minimally invasive and has many advantages. Objective: The aim of this study was to develop a method for the optimal sizing of cannulated cancellous screws for fixing bone fragments of tibial plateau fractures according to the patient's characteristics, followed by a calculation of the crushing strength of bone fragments. Method: The dimensional parameters of the cannulated cancellous screws for fixing fractured bone fragments in the basal bone are the length and diameter. These parameters are determined in the surgical planning stage using virtual models and resistance calculations. Bone fragments fixed with cannulated screws are checked for crushing and the number of screws required to meet the crushing strength condition is calculated. Results: Validation in practice of the methodology for fixing tibial plateau fractures with cannulated cancellous fixation screws was performed in a patient who had a Schatzker type IV fracture. The patient required the fixation of the tibial fracture fragment using a cannulated screw sized with 3 mm diameter and 54 mm length. The crushing verification of the fractured bone fragment was performed according to the methodology developed in this paper. Conclusion: The results indicate that the present methodology is recommended in the preoperative planning stage of the tibial plateau fractures reductions and screw fixations, offering the guarantee of a biomechanical quality fixation which ensures the good health of the patient. It opens new perspectives for fixing optimization and calculating the strength of other types of fractures.