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

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dc.check.date2017-08-17
dc.check.infoAccess to this article is restricted until 12 months after publication by request of the publisher.en
dc.contributor.authorGalbraith, John G.
dc.contributor.authorDaly, Charles J.
dc.contributor.authorHarty, James A.
dc.contributor.authorDailey, Hannah L.
dc.contributor.funderHealth Research Boarden
dc.date.accessioned2016-09-27T10:56:32Z
dc.date.available2016-09-27T10:56:32Z
dc.date.issued2016-08-17
dc.description.abstractBackground: 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.sponsorshipHealth Research Board (HRA_POR/2011/44)en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationGALBRAITH, 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.2016.08.007en
dc.identifier.doi10.1016/j.clinbiomech.2016.08.007
dc.identifier.endpage49en
dc.identifier.issn0268-0033
dc.identifier.issuedOctober 2016en
dc.identifier.journaltitleClinical Biomechanicsen
dc.identifier.startpage42en
dc.identifier.urihttps://hdl.handle.net/10468/3119
dc.identifier.volume38en
dc.language.isoenen
dc.publisherElsevier Ltden
dc.rights© 2016, Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license.en
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subjectFracture fixationen
dc.subjectOsteosynthesisen
dc.subjectCadaveren
dc.subjectBiomechanicsen
dc.titleRole of the fibula in the stability of diaphyseal tibial fractures fixed by intramedullary nailingen
dc.typeArticle (peer-reviewed)en
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