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An intact fibula may contribute to allow early weight bearing in surgically treated tibial plateau fractures

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The role of the proximal tibiofibular joint (PTFJ) in tibial plateau fractures is unknown. The purpose of this study was to assess, with finite-element (FE) calculations, differences in interfragmentary movement (IFM) in a split fracture of lateral tibial plateau, with and without intact fibula. It was hypothesized that an intact fibula could positively contribute to the mechanical stabilization of surgically reduced lateral tibial plateau fractures.

Methods

A split fracture of the lateral tibial plateau was recreated in an FE model of a human tibia. A three-dimensional FE model geometry of a human femur–tibia system was obtained from the VAKHUM project database, and was built from CT images from a subject with normal bone morphologies and normal alignment. The mesh of the tibia was reconverted into a geometry of NURBS surfaces. The fracture was reproduced using geometrical data from patient radiographs, and two models were created: one with intact fibula and other without fibula. A locking screw plate and cannulated screw systems were modelled to virtually reduce the fracture, and 80 kg static body weight was simulated.

Results

Under mechanical loads, the maximum interfragmentary movement achieved with the fibula was about 30% lower than without fibula, with both the cannulated screws and the locking plate. When the locking plate model was loaded, intact fibula contributed to lateromedial forces on the fractured fragments, which would be clinically translated into increased normal compression forces in the fractured plane. The intact fibula also reduced the mediolateral forces with the cannulated screws, contributing to stability of the construct.

Conclusion

This FE model showed that an intact fibula contributes to the mechanical stability of the lateral tibial plateau. In combination with a locking plate fixation, early weight bearing may be allowed without significant IFM, contributing to an early clinical and functional recovery of the patient.

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References

  1. Blanchard R, Morin C, Malandrino A, Vella A, Zdenka S, Hellmich C (2016) Patient specific fracture risk assesment of vertebrae: a multiscale approach coupling X-ray physics and continuum micromechanics. Int J Numer Meth Biomed Eng. doi:10.1102/cnm.2760

    Google Scholar 

  2. Bozkurt M, Turanli S, Doral MN, Karaca S, Dogan M, Sesen H et al (2005) The impact of proximal fibula fractures in the prognosis of tibial plateau fractures: a novel classification. Knee Surg Sports Traumatol Arthrosc 13(4):323–328

    Article  PubMed  Google Scholar 

  3. Burdin G (2013) Arthroscopic management of tibial plateau fractures: surgical technique. Orthop Traumatol Surg Res Feb;99(1 Suppl):S208–S218

    Article  CAS  PubMed  Google Scholar 

  4. Carrera I, Gelber PE, Chary G, González-Ballester MA, Monllau JC, Noailly J (2016) Fixation of a split fracture of the lateral tibial plateau with a locking screw plate instead of cannulated screws would allow early weight bearing: a computational exploration. Int Orthop. doi:10.1007/s00264-015-3106-y

    PubMed  Google Scholar 

  5. Draganich LF, Nicholas RW, Shuster JK, Sathy MR, Chang AF, Simon MA (1991) The effects of resection of the proximal part of the fibular on stability of the knee and on gait. J Bone Joint Surg Am 73(4):575:583

    Google Scholar 

  6. Evans FG (1976) Mechanical properties and histology of cortical bone from younger and older men. Anat Rec 185

  7. Goldstein SA, Wilson DL, Sonstegard DA, Matthews LS (1983) The mechanical properties of human tibial trabecular bone as a function of metaphyseal location. J Biomech 16(12):965–969

    Article  CAS  PubMed  Google Scholar 

  8. Karunakar M, Egol KA, Peindl R, Harrow ME, Bosse MJ, Kellam JF (2002) Split depression tibial plateau fractures: a biomechanical study. J Orthop Trauma 16(3):172–177

    Article  PubMed  Google Scholar 

  9. Kozic N, Weber S, Bücher P, Lutz C, Reimers N, González-Ballester MA et al (2010) Optimisation of orthopaedic implant design using statistical shape space analysis based on level sets. Med Image Anal 14(3):265–275

    Article  PubMed  Google Scholar 

  10. Rho JY, Ashman RB, Turner CH (1993) Young´s modulus of trabecular and cortical bone material: Ultrasonic and microtensile measurements. J Biomechanics 26(2):111–119

    Article  CAS  Google Scholar 

  11. Sarma A, Borgohain B, Saikia B (2015) Proximal tibiofibular joint; Rendezvous with a forgotten articulation. Indian J Orthop 49(5):489–495

    Article  PubMed  PubMed Central  Google Scholar 

  12. Scott J, Lee H, Barsoum W, van den Bogert AJ (2007) The effect of tibiofemoral loading on proximal tibiofibular joint motion. J Anat 211(5):647–653

    Article  PubMed  PubMed Central  Google Scholar 

  13. Taylor WR, Roland E, Hertig D, Klabunda R, Warner MD, Hobatho MC et al (2002) Determination of orthotropic bone elastic constants using FEA and modal analysis. J Biomechanics 35:767–773

    Article  CAS  Google Scholar 

  14. Thorp LE, Wimmer MA, Block JA, Moisio KC, Shott S, Goker B et al (2006) Bone mineral density in the proximal tibia varies as a function of static alignment and knee adduction angular momentum in individuals with medial knee osteoarthritis. Bone 39(5):1116–1122

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08041, Barcelona, Spain

    Ion Carrera, Pablo Eduardo Gelber & Mireia Gomez Masdeu

  2. ICATME-Hospital Universitari Quirón-Dexeus, Universitat Autònoma de Barcelona, Sabino de Arana 5-19, 08028, Barcelona, Spain

    Pablo Eduardo Gelber & Juan Carlos Monllau

  3. Department of Communication and Information Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain

    Gaetan Chary, Miguel A. González Ballester & Jerome Noailly

  4. ICREA, Pg. Lluis Companys 23, 08010, Barcelona, Spain

    Miguel A. González Ballester

  5. Orthopaedic Surgery Department, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain

    Juan Carlos Monllau

Authors
  1. Ion Carrera
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  2. Pablo Eduardo Gelber
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  3. Gaetan Chary
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  4. Mireia Gomez Masdeu
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  5. Miguel A. González Ballester
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  6. Juan Carlos Monllau
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  7. Jerome Noailly
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Corresponding author

Correspondence to Ion Carrera.

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Carrera, I., Gelber, P.E., Chary, G. et al. An intact fibula may contribute to allow early weight bearing in surgically treated tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc 26, 756–761 (2018). https://doi.org/10.1007/s00167-017-4428-7

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  • DOI: https://doi.org/10.1007/s00167-017-4428-7

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