PURPOSE:Proximal fibula avulsion fractures, or "arcuate fractures", are an often discussed but poorly defined injury pattern which represent a destabilizing injury to the posterolateral corner of the knee. Historical and recent literature discussing reconstruction and repair techniques exist, but there has been little biomechanical evaluation of repair techniques. The purpose of this study was to evaluate the strength of three type of fixation techniques for arcuate fractures: bone tunnels, a screw and washer, and a novel suture anchor technique. METHODS:A laboratory model of the arcuate fracture pattern was developed. This was used to create an arcuate fracture in 24 cadaveric specimens. Knees were randomized into fixation with either suture tunnel (ST), screw and washer (SW), or suture anchor (SA) repair. A previously published model for inducing varus stress was applied and a MTS testing system was used to assess fixation ultimate and yield strength. RESULTS:Fibular fracture occurred during the fixation of one specimen from the ST group and one from the SA group. Analysis of the remaining 22 specimens revealed a mean ultimate strength of 2422.48 N for the ST group, 2271.78 for SW, and 3041.66 for SA (p = 0.390). Yield strengths were 2065.28 for ST, 1882.43 for SW, and 2871.92 for SA (p = 0.224). Analyses of stiffness and total energy applied were not statistically different (p = 0.111 and 0.601, respectively). CONCLUSION:Biomechanical analysis of three types of arcuate fragment fixation revealed robust fixation among all methods, supporting surgeon preference for fixation. Fixation may depend on the size of bony fragment and whether or not the injury is a bony or soft tissue injury.

译文

目的:腓骨近端撕脱性骨折或“弓形骨折”,是一种经常讨论但定义不明确的损伤方式,代表了膝盖后外侧角的不稳定损伤。存在关于重建和修复技术的历史文献和最新文献,但是对修复技术的生物力学评估很少。这项研究的目的是评估弓形骨折的三种固定技术的强度:骨隧道,螺钉和垫圈以及新型缝合锚固技术。
方法:建立了弓形断裂模式的实验室模型。这被用来在24个尸体标本中产生弧形断裂。将膝关节随机分为缝合隧道(ST),螺钉和垫圈(SW)或缝合锚钉(SA)修复固定。应用了先前发表的诱发内翻应力的模型,并使用了MTS测试系统来评估固定极限和屈服强度。
结果:ST组1例和SA组1例在固定过程中发生腓骨骨折。对其余22个样品的分析显示,ST组的平均极限强度为2422.48N,SW的平均极限强度为2271.78,SA的平均极限强度为3041.66(p = 0.390)。 ST的屈服强度为2065.28,SW的屈服强度为1882.43,SA的屈服强度为2871.92(p = 0.224)。刚度和施加的总能量的分析无统计学差异(分别为p = 0.111和0.601)。
结论:对三种弓形碎片固定的生物力学分析显示,所有方法均具有牢固的固定方式,从而支持外科医生对固定方式的偏爱。固定可能取决于骨碎片的大小以及损伤是骨损伤还是软组织损伤。

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