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    Biomechanical comparison of three different surgical methods in the surgical treatment of distal tibial metaphyseal fractures. An animal model study
    (Turkish Assoc Trauma Emergency Surgery, 2023) Yildirim, Cem; Muratoglu, Osman Gorkem; Ordu, Samed; Ceylan, Hasan; Muslu, Duran Can; Atlihan, Dogan
    BACKGROUND: The aim of this study is to investigate mechanical properties of minimally invasive plate osteosynthesis (MIPO), supracutaneousplating (SP), and unilateral external fixators (UEF) which can be performed for open tibial fractures.METHODS: An unstable diaphysial tibia fracture was created in 60 fresh sheep tibia specimens by performing an osteotomy at the middle of bones. Specimens were divided into 3 groups. Specimens underwent fracture fixation with a standard MIPO technique, implanting the plate 15 mm from the bone for SP group. Unilateral uniplanar external fixators were achieved for UEF group. First, thirty specimens (10 specimen for each group) were loaded vertically along the tibial axis to 1800 N. Second, other 30 preperated bones were used for cyclical loading to avoid metal fatigue. For dynamic tests, a 350 N force was applied for 10,000 cycles.RESULTS: In compression testing (vertical loading up to 1800 N) of the three fixation instruments; construct stiffness was highest in MIPO group when compared with SP and UEF groups. While the stiffness of the MIPO group was similar to SP group, it was statistically higher than UEF group (P=0.08 and P=0.002, respectively). SP group was significantly stiffer than UEF group (P=0.0021). The mean peak load was highest in SP group and lowest in UEF group. The peak load in SP group was similar to the MIPO group, it was statistically higher than the UEF group (P=0.743 and P=0.002, respectively).CONCLUSION: Based on the biomechanical properties from this in vitro animal model study, SP technique was biomechanically stronger than UEF and has similar biomechanical properties with MIPO in terms of axial loading.
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    The Effect of Supplementary Staple Fixation on Biomechanical Properties of Soft Tissue Graft Tibial Fixation in Anterior Cruciate Ligament Reconstruction
    (Georg Thieme Verlag Kg, 2024) Yildirim, Cem; Demirel, Mehmet; Koraman, Emre; Muratoglu, Osman Gorkem; Yamak, Fatih; Bozdag, Sureyya Ergun; Kocabey, Yavuz
    This study aimed to test and compare the biomechanical properties of three tibial fixation methods of anterior cruciate ligament (ACL) tendon grafts under cyclic load and load-to-failure testing in the bovine proximal tibiae, comprising (1) staple fixation alone, (2) interference screw fixation alone, and (3) interference screw fixation with a supplementary staple. Twenty-four bovine tibiae used in the study were divided into three groups (eight proximal tibiae in each group) based on tibial fixation methods of ACL tendon grafts: group A (a spiked ligament staple alone), group B (a cannulated interference screw alone), and group C (a cannulated interference screw with a supplementary staple). Each graft fixation was exposed to cyclic loading conditions. Significant differences were determined in failure load among the three groups (p = 0.008). The mean failure load was significantly higher in group B (717.04 +/- 218.51 N) than in group A (308.03 +/- 17.22 N) (p = 0.006). No significant differences were observed among the groups regarding axial stiffness (p = 0.442). Cyclic displacement differed significantly among the three groups (p = 0.005). In pairwise comparisons, the mean cyclic displacement was significantly higher in group A (8.22 +/- 3.24 mm) compared with group C (1.49 +/- 0.41 mm) (p = 0.005). Failure displacement varied considerably among the groups (p = 0.037). Although group B (15.53 +/- 6.43 mm) exhibited a greater mean failure displacement than both group A (4.9 +/- 0.75 mm) and group C (8.84 +/- 4.65 mm), these differences did not reach statistical significance (p = 0.602 and p = 0.329, respectively). Interference screw fixation alone and supplementary staple fixation have biomechanically similar characteristics in terms of initial strength and stiffness of tibial ACL soft tissue graft fixation. Regardless of staple use, an interference screw with the same diameter as the tibial tunnel can ensure sufficient tensile strength in tibial ACL graft fixation.