Biomechanical Comparison of Single‐, Double‐, and Triple‐Screw Fixation for Tibial Eminence Fractures: A Skeletally Immature Porcine Cadaveric Study

This study uses a porcine cadaveric model to biomechanically compare the single‐, double‐, and triple‐screw fixation techniques for tibial eminence fractures. Eighty porcine tibiae were divided into eight groups ( n = 10 each): intact control, pull‐out suture fixation, one 4.0‐mm half‐threaded screw, one 4.0‐mm full‐threaded screw, one 4.5‐mm screw, two 4.0‐mm parallel screws, two 4.0‐mm divergent screws, and three 4.0‐mm screws. Standardized fractures were created and fixed according to each protocol. The specimens underwent cyclic followed by load‐to‐failure testing. Maximum failure load and cyclic displacement were compared. The intact specimens demonstrated significantly higher ultimate load (1059.44 ± 311.84 N) than all fixation groups ( p < 0.001). Among the fixation methods, the three‐screw configuration withstood the highest load (442.10 ± 123.42 N), followed by the two‐screw divergent (392.26 ± 47.63 N) and two‐screw parallel (329.33 ± 56.30 N) configurations. The two‐screw divergent configuration provided significantly greater strength than the parallel orientation ( p < 0.050). Full‐threaded screws demonstrated significantly less cyclic displacement (1.05 ± 0.49 mm) than half‐threaded screws (2.21 ± 0.49 mm, p < 0.001). The pull‐out suture showed significantly greater displacement (3.25 ± 1.07 mm) than all screw fixations ( p < 0.050), yet achieved a comparable ultimate failure load (397.82 ± 126.35 N), indicating that the primary advantage of screw fixation lies in cyclic stability rather than ultimate strength. Although three‐screw fixation yielded the highest absolute failure load, the two‐screw divergent configuration offered comparable strength ( p = 0.571), representing a practical alternative. Screw number, orientation, and thread design significantly influence fixation stability in tibial eminence fractures.