Role of the fibula in the stability of diaphyseal tibial fractures fixed by intramedullary nailing

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dc.contributor.author Galbraith, John G.
dc.contributor.author Daly, Charles J.
dc.contributor.author Harty, James A.
dc.contributor.author Dailey, Hannah L.
dc.date.accessioned 2016-09-27T10:56:32Z
dc.date.available 2016-09-27T10:56:32Z
dc.date.issued 2016-08-17
dc.identifier.citation GALBRAITH, J. G., DALY, C. J., HARTY, J. A. and DAILEY, H. L. (2016) ‘Role of the fibula in the stability of diaphyseal tibial fractures fixed by intramedullary nailing’, Clinical Biomechanics, 38, pp. 42-49. doi: 10.1016/j.clinbiomech.2016.08.007 en
dc.identifier.volume 38 en
dc.identifier.issued October 2016 en
dc.identifier.startpage 42 en
dc.identifier.endpage 49 en
dc.identifier.issn 0268-0033
dc.identifier.uri http://hdl.handle.net/10468/3119
dc.identifier.doi 10.1016/j.clinbiomech.2016.08.007
dc.description.abstract Background: For tibial fractures, the decision to fix a concomitant fibular fracture is undertaken on a case-by-case basis. To aid in this clinical decision-making process, we investigated whether loss of integrity of the fibula significantly destabilises midshaft tibial fractures, whether fixation of the fibula restores stability to the tibia, and whether removal of the fibula and interosseous membrane for expediency in biomechanical testing significantly influences tibial interfragmentary mechanics. Methods: Tibia/fibula pairs were harvested from six cadaveric donors with the interosseous membrane intact. A tibial osteotomy fracture was fixed by reamed intramedullary (IM) nailing. Axial, torsion, bending, and shear tests were completed for four models of fibular involvement: intact fibula, osteotomy fracture, fibular plating, and resected fibula and interosseous membrane. Findings: Overall construct stiffness decreased slightly with fibular osteotomy compared to intact bone, but this change was not statistically significant. Under low loads, the influence of the fibula on construct stability was only statistically significant in torsion (large effect size). Fibular plating stiffened the construct slightly, but this change was not statistically significant compared to the fibular osteotomy case. Complete resection of the fibula and interosseous membrane significantly decreased construct torsional stiffness only (large effect size). Interpretation: These results suggest that fixation of the fibula may not contribute significantly to the stability of diaphyseal tibial fractures and should not be undertaken unless otherwise clinically indicated. For testing purposes, load-sharing through the interosseous membrane contributes significantly to overall construct mechanics, especially in torsion, and we recommend preservation of these structures when possible. en
dc.description.sponsorship Health Research Board (HRA_POR/2011/44) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Elsevier Ltd en
dc.rights © 2016, Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license. en
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/ en
dc.subject Fracture fixation en
dc.subject Osteosynthesis en
dc.subject Cadaver en
dc.subject Biomechanics en
dc.title Role of the fibula in the stability of diaphyseal tibial fractures fixed by intramedullary nailing en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother James Harty, Surgery, University College Cork, Cork, Ireland. +353-21-490-3000 Email: james.harty@ucc.ie en
dc.internal.availability Full text available en
dc.check.info Access to this article is restricted until 12 months after publication by request of the publisher. en
dc.check.date 2017-08-17
dc.description.version Accepted Version en
dc.contributor.funder Health Research Board en
dc.description.status Peer reviewed en
dc.identifier.journaltitle Clinical Biomechanics en
dc.internal.IRISemailaddress james.harty@ucc.ie
dc.internal.IRISemailaddress james.harty@ucc.ie en


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© 2016, Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license. Except where otherwise noted, this item's license is described as © 2016, Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license.
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