Articular fracture malreduction increases posttraumatic osteoarthritis (PTOA) risk by elevating joint contact stress. A new biomechanical guidance system (BGS) that provides intraoperative assessment of articular fracture reduction and joint contact stress based solely on a preoperative computed tomography (CT) and intraoperative fluoroscopy may facilitate better fracture reduction. The objective of this proof-of-concept cadaveric study was to test this premise while characterizing BGS performance. Articular tibia plafond fractures were created in five cadaveric ankles. CT scans were obtained to provide digital models. Indirect reduction was performed in a simulated operating room once with and once without BGS guidance. CT scans after fixation provided models of the reduced ankles for assessing reduction accuracy, joint contact stresses, and BGS accuracy. BGS was utilized 4.8 ± 1.3 (mean ± SD) times per procedure, increasing operative time by 10 min (39%), and the number of fluoroscopy images by 31 (17%). Errors in BGS reduction assessment compared to CT-derived models were 0.45 ± 0.57 mm in translation and 2.0 ± 2.5° in rotation. For the four ankles that were successfully reduced and fixed, associated absolute errors in computed mean and maximum contact stress were 0.40 ± 0.40 and 0.96 ± 1.12 MPa, respectively. BGS reduced mean and maximum contact stress by 1.1 and 2.6 MPa, respectively. BGS thus improved the accuracy of articular fracture reduction and significantly reduced contact stress. Statement of Clinical Significance: Malreduction of articular fractures is known to lead to PTOA. The BGS described in this work has potential to improve quality of articular fracture reduction and clinical outcomes for patients with a tibia plafond fracture.

中文翻译：

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生物力学引导可提高关节内胫骨平台骨折复位的准确性，降低关节接触应力

关节骨折复位不良会增加关节接触应力，从而增加创伤后骨关节炎 (PTOA) 的风险。一种新的生物力学引导系统 (BGS) 仅根据术前计算机断层扫描 (CT) 和术中透视提供关节骨折复位和关节接触应力的术中评估，可能有助于更好地复位骨折。这项概念验证尸体研究的目的是在描述 BGS 性能的同时测试这一前提。关节胫骨 plafond 骨折在五个尸体脚踝中产生。获得 CT 扫描以提供数字模型。在模拟手术室中进行一次间接复位，一次使用 BGS 引导，一次不使用 BGS 引导。固定后的 CT 扫描提供了减少脚踝的模型，用于评估减少准确性、关节接触应力、和 BGS 精度。每次手术使用 BGS 4.8 ± 1.3（平均值 ± SD）次，手术时间增加 10 分钟（39%），透视图像数量增加 31 张（17%）。与 CT 衍生模型相比，BGS 减少评估的误差在平移中为 0.45 ± 0.57 mm，在旋转中为 2.0 ± 2.5°。对于成功复位和固定的四个脚踝，计算的平均和最大接触应力的相关绝对误差分别为 0.40 ± 0.40 和 0.96 ± 1.12 MPa。BGS 将平均和最大接触应力分别降低了 1.1 和 2.6 MPa。因此，BGS 提高了关节骨折复位的准确性，并显着降低了接触应力。临床意义声明：已知关节骨折复位不良会导致 PTOA。