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World J Orthop. Nov 18, 2026; 17(11): 123916
Published online Nov 18, 2026. doi: 10.5312/wjo.123916
Influence of proximal cancellous bone void volume on the rigidity of tibial plateau fracture fixation: An observational study
Tosan Okoro, T Paavana, Sophie McDonald, Panagiotis Chatzistergos, Sophie Crooks, Thivagar Murugesan, Suresh Kondi, Robert Needham, Nachiappan Chockalingam
Tosan Okoro, Department of Trauma and Orthopedics, Royal Shrewsbury Hospital, Shrewsbury SY3 8XQ, United Kingdom
Tosan Okoro, T Paavana, Sophie Crooks, Department of Trauma and Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, United Kingdom
Tosan Okoro, Department of Trauma and Orthopaedics, North Wales Medical School at Bangor University, Bangor LL57 2DG, United Kingdom
Sophie McDonald, University Hospital North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, United Kingdom
Panagiotis Chatzistergos, School of Science and Engineering, University of Dundee, Dundee DD1 4HN, United Kingdom
Thivagar Murugesan, Department of Trauma and Orthopaedics, North Hampshire NHS Hospital, Basingstoke RG24 9NA, Hampshire, United Kingdom
Suresh Kondi, Department of Trauma and Orthopaedics, Salford Royal Hospital, Manchester M6 8HD, United Kingdom
Robert Needham, Nachiappan Chockalingam, Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST42DF, England
Nachiappan Chockalingam, Faculty of Health Sciences, University of Malta, Valletta MSD 2080, Malta
Co-first authors: Tosan Okoro and T Paavana.
Author contributions: Okoro T conceived study, supervised, revised manuscript; Paavana T contributed to specimen preparation, data collection; McDonald S contributed to biomechanical testing; Chatzistergos P contributed to statistics/methodology, biomechanical testing; Crooks S contributed to data collection; Murugesan T contributed to literature review, analysis, writing, manuscript revision; Kondi S contributed to manuscript revision; Needham R contributed to engineering support; Chockalingam N contributed to study conception, supervision, biomechanics.
AI contribution statement: No AI tools were used in the preparation, writing, editing, analysis, interpretation, or revision of this manuscript. All aspects of the study, including study design, data collection, data analysis, interpretation of results, manuscript preparation, and final review, were performed solely by the authors. The authors accept full responsibility for the integrity, accuracy, originality, and scientific validity of the manuscript.
Supported by AOUK & I Research Grants 2022.
Institutional review board statement: Ethical approval was not required for this study because it was a laboratory-based biomechanical investigation using commercially available fourth-generation composite tibial Sawbones models. No human participants, cadaveric specimens, animals, or identifiable patient data were involved.
Informed consent statement: Informed consent was not required because this study did not involve human participants or identifiable patient data.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this study.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Data sharing statement: The datasets generated and/or analysed during the current study are available from the corresponding author upon reasonable request.
Corresponding author: Tosan Okoro, Consultant, Department of Trauma and Orthopedics, Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury SY3 8XQ, United Kingdom.
tosan.okoro@nhs.net
Received: June 2, 2026
Revised: July 31, 2026
Accepted: November 5, 2026
Published online: November 18, 2026
Processing time: 162 Days and 10.5 Hours
BACKGROUND
Depressed tibial plateau (TP) fractures frequently result in metaphyseal cancellous bone voids following fracture reduction. The influence of cancellous bone void volume (CBVV) and location on the rigidity of fracture fixation constructs remains poorly understood despite potential implications for surgical decision-making.
AIM
To assess the effect of CBVV on the rigidity of TP fracture fixation.
METHODS
TP fractures with different levels of CBVV (Scenario 1: 10% distal, Scenario 2: 50% distal, and Scenario 3: 50% proximal) were created in fourth-generation Sawbones models and fixed according to standard surgical practice. The samples were loaded under controlled conditions, and rigidity was assessed. Descriptive statistics were used to test for normality, and statistical significance was determined using one-way analysis of variance.
RESULTS
All samples completed all loading sequences without failure. Loading to the capacity of the load frame (3 kN) did not result in fixation failure; therefore, no compressive load at failure was recorded. As expected, vertical displacement increased with increasing compressive load. The average fracture gap opening at the maximum applied load (2900 N) was 0.057 ± 0.056 mm, 0.066 ± 0.044 mm, and 0.124 ± 0.077 mm for scenarios 1-3, respectively. The average construct stiffness was 1469 ± 57 N/mm, 1484 ± 73 N/mm, and 1467 ± 23 N/mm for scenarios 1-3, respectively. No statistically significant differences were observed in vertical displacement, gap opening, or stiffness (P > 0.05).
CONCLUSION
No statistically significant differences in rigidity were found between constructs with varying CBVV. However, a trend was observed, with the 50% proximal deficit demonstrating the least rigidity. Further research is warranted to investigate if proximal cancellous bone voids may warrant adjunctive support during TP fracture fixation.
Core Tip: The biomechanical significance of metaphyseal cancellous bone loss in tibial plateau (TP) fractures remains poorly defined. Using standardized synthetic fracture models, this study demonstrated that increasing cancellous bone void volume did not significantly reduce fixation rigidity. Nevertheless, proximal bone defects exhibited greater fracture gap opening and a tendency toward reduced construct stability. Further research is required to investigate whether selective use of bone grafting or augmentation in TP fracture fixation is advisable.
