Highlights
- •Fibular osteotomies increase load in tibial fractures and are used to promote/enhance healing in cases of delayed or hypertrophic non-union.
- •A novel protocol using a rig was designed to ascertain the ideal location for a fibular osteotomy, and explained by a beam model.
- •An osteotomy proximal to the fracture site produces most tibial fracture loading.
Abstract
Background
Tibial shaft fractures are the commonest long bone fracture, with early weight-bearing
improving the rate of bony union. However, an intact fibula can act as a strut that
splints the tibial segments and holds them apart. A fibular osteotomy, in which a
2.5 cm length of fibula is removed, has been used to treat delayed and hypertrophic
non-union by increasing axial tibial loading. However, there is no consensus on the
optimal site for the partial fibulectomy.
Methods
Nine leg specimens were obtained from formalin-embalmed cadavers. Transverse mid-shaft
tibial fractures were created using an oscillating saw. A rig was designed to compress
the legs with an adjustable axial load and measure the force within the fracture site
in order to ascertain load transmission through the tibia over a range of weights.
After 2.5cm-long fibulectomies were performed at one of three levels on each specimen,
load transmission through the tibia was re-assessed. A beam structure model of the
intact leg was designed to explain the findings.
Results
With an intact fibula, mean tibial loading at 34 kg was 15.52 ± 3.26 kg, increasing
to 17.42 ± 4.13 kg after fibular osteotomy. This increase was only significant where
the osteotomy was performed proximal to or at the level of the tibial fracture. Modelling
midshaft tibial loading using the Euler-Bernoulli beam theory showed that 80.5% of
the original force was transmitted through the tibia with an intact fibula, rising
to 81.1% after a distal fibulectomy, and 100% with a proximal fibulectomy.
Conclusion
This study describes a novel method of measuring axial tibial forces. We demonstrated
that a fibular osteotomy increases axial tibial loading regardless of location, with
the greatest increase after proximal fibular osteotomy. A contributing factor for
this can be explained by a simple beam model. We therefore recommend a proximal fibular
osteotomy when it is performed in the treatment of delayed and non-union of tibial
midshaft fractures.
Keywords
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Article info
Publication history
Published online: February 09, 2022
Accepted:
February 1,
2022
Identification
Copyright
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