Predicting the effect of individual weight-bearing on tibial load and fracture healing after tibial plateau fractures–introduction of a biomechanical simulation model

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Purpose: The prescribed amount of weight-bearing after tibial plateau fractures is controversial because it affects osteosynthetic construct stability and fracture healing. We aim to introduce a simulation model that adequately predicts the effects of different weight-bearing amounts on stability and healing, based on the patient's individual fracture pattern and treatment construct. Methods: To safely test different amounts of weight-bearing limits, we first extracted knee joint forces for different weight-bearing limits from musculoskeletal simulation based on monitoring data of 22 uninjured participants. Correct loading was ensured with a force-measuring insole. We then tested three patients after tibial plateau fracture with their current weight-bearing level and constructed a simulation model determining implant stress, knee joint force, and fracture gap interfragmentary strain. The patient-specific weight-bearing level was then substituted for weight-normalized uninjured participant data to test different weight-bearing levels in the simulation model. Results: The simulation model calculated individual construct stiffness and interfragmentary strain at different weight-bearing levels following the clinical course. When comparing the patient's individual weight-bearing input with the weight-normalized input of the uninjured participants at the same level, comparable knee joint forces were extracted, showing the feasibility of this approach. Conclusion: Using an adapted reference movement database, the model allows the determination of safe weight-bearing ranges concerning construct stability and fracture healing based on individual fracture morphology and treatment without exposing patients to excessive weight-bearing. Future studies can test this approach in more extensive patient-number studies and different treatment situations.

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