Three internal fixation methods for Danis-Weber-B distal fibular fractures: A biomechanical comparison in an osteoporotic fibula model

Hollensteiner, Marianne; Sandriesser, Sabrina; Krauss, Hilmar; Greinwald, Markus; Stuby, Fabian; Augat, Peter

doi:10.1016/j.fas.2021.11.006

Cited by 4 publications

(6 citation statements)

References 26 publications

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“…As a consequence, the conventional clinical approach for lateral malleolar fractures entails utilising either a neutralisation plate or a locking plate in combination with lag screw fixation. Mechanical experiments conducted previously have illustrated that the technique of employing a locking plate in combination with lag screw fixation imparts superior stability in comparison to the application of a lateral neutralisation plate in tandem with a lag screw, as well as antiglide plating construct involving a lag screw for Weber-B distal fibular fractures [ 16 , 39 , 40 ]. Recent biomechanical investigations have suggested that the intrinsic stiffness of the locking plate construct is minimally affected by the addition of a lag screw.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical practice routinely involves the fixation of oblique distal fibula fractures with interfragmentary lag screws and plates. However, the potential advantages of combining a locking plate with an interfragmentary lag screw remain controversial in both biomechanical and clinical studies [ 15 , 16 ]. The current study aims to test the hypothesis that FMLP surpasses Conventional Locking Plate (CLP) in stabilising unstable fractures.…”

Section: Introductionmentioning

confidence: 99%

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Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fractures

Huang,

Zhu,

Xing

et al. 2023

BMC Musculoskelet Disord

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Background Displaced lateral malleolus fractures are typically stabilised through open reduction and internal fixation. The biomechanically and clinically efficacy of locking plates and lag screws, particularly in Weber A and B distal fibular fractures remains a subject of contention. This study examines two locking plate designs for lateral malleolus fractures, evaluating their performance with and without interfragmentary screws using finite element models. Methods Utilising CT images of a healthy adult male volunteer, a three-dimensional finite element model was constructed. The Fibula-specific Flank Multiaxial Locking Anatomic Plate (FMLP) and the Conventional Locking Plate (CLP) were subjected to stabilisation, both with and without an interfragmentary screw, mimicking the Danis-Weber A and B lateral malleolus oblique fracture fixation. Loads of 140 N and 70 N, equivalent to 20% of the body weight, were applied to simulate the single-leg and two-leg standing conditions in the axial direction. The von Mises stress (VMS) distributions and element displacements were subsequently analyzed. Results In the Danis-Weber A fracture model group, the FMLP with an interfragmentary screw fixation exhibited the lowest peak VMS values: 51.9 MPa in the fibula, 89.0 MPa in the plate, and 61.3 MPa in the screws for simulating single-leg conditions. Under two-leg standing conditions, these peak VMS values decreased to 25.9 MPa in the fibula, 44.5 MPa in the plate, and 30.6 MPa in the screws, respectively. Furthermore, the overall structural peak displacements during single-leg standing for both Weber-A and B fractures with different implants ranged from 1.61 to 2.54 mm. While standing on two feet, the ranged was from 0.80 to 1.27 mm. An interfragmentary screw at the oblique fracture site resulted in reduced the peak value of VMS in the fibula, plate, screws, consequently decreased the overall structural displacement for FMLP and CLP fixation in lateral malleolus fractures. Conclusions The current finite element analysis (FEA) demonstrates that FMLP exhibits superior mechanical characteristics in Danis-Weber A and B lateral malleolus fractures compared to CLP. The inclusion of an interfragmentary screw, combined with locking plate design, enhances stability for simple oblique distal fibular fractures. The FMLP presents itself as potential as an alternative for lateral malleolus fractures from a biomechanical perspective. Nevertheless, further verification of these results is imperative through subsequent clinical studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fractures

Huang,

Zhu,

Xing

et al. 2023

BMC Musculoskelet Disord

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“…In addition, the fibula bone is fixed by the elastic tightrope -damaged bone deflection; C i -bending stiffness factor of the i-th bone section; i-section number (i = 1 at 0 ≤ x ≤ t, i = 2 at t ≤ x ≤ a, i = 3 at a ≤ x ≤ s, i = 4 at s ≤ x ≤ l). Direct double integration of Equation (10) in four different sections leads to the appearance of eight integration constants. Their determining is quite a cumbersome task.…”

Section: Assessment Of Transverse Stiffness Of the Broken Fibula Fixe...mentioning

confidence: 99%

“…Their determining is quite a cumbersome task. Therefore, to find solutions to Equation (10), the method of initial parameters is used. To do this, a piecewise-homogeneous rod is represented by an imaginary equivalent beam of stable cross-section with a bending stiffness factor C eg = C. In order for such an imaginary equivalent beam to behave similar to a real object, the following steps are performed.…”

Section: Assessment Of Transverse Stiffness Of the Broken Fibula Fixe...mentioning

confidence: 99%

“…The consolidation periods of broken shin bones remain long and significantly depend on the choice of correct tactics and method of treatment [5][6][7]. The choice of the optimal surgical treatment method for a broken fibula has been debatable for decades [8][9][10]. At the same time, concomitant repair of unstable syndesmosis injuries does not have a unified approach.…”

Section: Introductionmentioning

confidence: 99%

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Determining the Tightrope Tightening Force for Effective Fixation of the Tibiofibular Syndesmosis during Osteomeatal Synthesis of Fibula Injuries

et al. 2022

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The issue of choosing the method for optimal surgical treatment of a broken fibula has been debatable for many years. At the same time, concomitant repair of tibiofibular syndesmosis injuries does not have a unified approach. It has been determined that osteosynthesis of broken shin bones with syndesmosis injury should combine stable fixation of the broken bone and should not limit the elastic properties of the syndesmosis. In case of a broken fibula, it is recommended to use a stable extracortical fixator and an elastic connection of the syndesmosis injury using a tightrope. An analytical model of the broken fibula, which is blocked with an extracortical fixator metal plate and elastically fixed with a tightrope, has been developed. The research object is the stress–strain state of the “broken fibula–extracortical titanium plate” composition under the action of tightrope tightening fixation. The main research result is an analytical dependence, which makes it possible to determine the permissible value of the tightrope tightening force for elastic fixation of the tibiofibular syndesmosis. The research results have been tested numerically, and the influence of the parameters of plate, bone and damage localization on the permissible value of the tightrope tightening force has been analyzed. By using the rational tightrope tightening force with stable–elastic fixation of the broken shin, it is possible to reduce the time before the start of loading on the injured extremity and accelerate the functional recovery of the patient.

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Bicortical Compression and Construct Stability With Variable Pitch Locking Screws in Cadaveric Specimens

Koroneos,

Alwine,

Tortora

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVES: A variable pitch locking screw is intended to provide interfragmentary compression combined with fixed angle stability of locking plate constructs. The objective of this study was to compare variable pitch locking screws (3.5 mm KreuLock Ti Locking Compression Screws, Arthrex Inc., Naples FL) with standard locking screws (from same manufacturer) in bicortical fixation scenarios in cadaver bone, by assessing: (1) interfragmentary compression and plate-bone compression; and (2) construct biomechanical stability. METHODS: Nine matched pairs of fresh-frozen cadaveric specimens with an average age of 67.2 years (range, 37-83) were used. Interfragmentary compression and plate-bone compression associated with insertion of single bicortical screws were compared between the variable pitch and standard locking screws at increasing levels of torque. The specimens tested were distal tibiae having a simulated longitudinal fracture. Fibulae were osteotomized to create a stable longitudinal fracture pattern and were fixed with a five-screw plate construct with either all variable pitch or all standard locking screws. One of the five screws was placed across the osteotomy without lagging. Fibulae were tested cyclically with axial with torsional loading to compare, displacements, rotation and loads at failure, or tested in four-point bending to compare construct stiffness and maximum force to failure. RESULTS: Interfragmentary and plate-bone compression forces in the distal tibia model varied across specimens but were significantly higher with variable pitch locking screws compared to standard locking screws [512 N (SD = 324 N) vs. 79 N (SD = 64 N), p = 0.002 & 242 N (SD = 119 N) vs. 104 N (SD = 123 N), p = 0.028, respectively]. In cyclic loading of fibula constructs, no significant differences were detected in construct axial displacement or angular displacement (p > 0.05). In four-point bending, no differences were detected in maximum force or bending stiffness (p > 0.05). CONCLUSIONS: Variable pitch locking screws produced interfragmentary compression between cortices and plate-bone compression that were greater than standard locking screws. In a stable bicortical fibula fixation scenario under external loading, the stability of variable pitch locking screw constructs was similar to constructs with standard locking screws.

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Three internal fixation methods for Danis-Weber-B distal fibular fractures: A biomechanical comparison in an osteoporotic fibula model

Cited by 4 publications

References 26 publications

Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fractures

Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fractures

Determining the Tightrope Tightening Force for Effective Fixation of the Tibiofibular Syndesmosis during Osteomeatal Synthesis of Fibula Injuries

Bicortical Compression and Construct Stability With Variable Pitch Locking Screws in Cadaveric Specimens

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