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

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 26; no. 3; pp. 756 - 761
• Main Authors: Carrera, Ion, Gelber, Pablo Eduardo, Chary, Gaetan, Gomez Masdeu, Mireia, González Ballester, Miguel A., Monllau, Juan Carlos, Noailly, Jerome
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2018; John Wiley & Sons, Inc
• Subjects: Body weight; Compression; Computed tomography; Computer simulation; Femur; Fibula; Finite element method; Fractures; Iron; Knee; Lateral stability; Locking; Mathematical models; Mathematical morphology; Medicine; Medicine & Public Health; Orthopedics; Radiographs; Radiography; Recovery of function; Screws; Skin & tissue grafts; Three dimensional models; Tibia; Weight reduction; Tibial plateau fracture; Fracture fixation; Interfragmentary motion; Fibula fracture; Weight bearing; Finite element; Bone fixation
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-017-4428-7

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.