Is double-strut fibula ankle arthrodesis a reliable reconstruction for bone defect after distal tibia tumor resection?-a finite element study based on promising clinical outcomes

• Published in: Journal of orthopaedic surgery and research Vol. 16; no. 1; p. 230
• Main Authors: Zhao, Zhiqing, Yan, Taiqiang, Guo, Wei, Yang, Rongli, Tang, Xiaodong
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.03.2021; BioMed Central; BMC
• Subjects: Ankle; Arthrodesis; Biomechanics; Bone cancer; Bone tumor; Bones; Clinical outcomes; Computer applications; Computer software industry; Distal tibia; Fibula; Fibular graft; Finite element analysis; Finite element method; Fractures; International economic relations; Load; Mathematical models; Orthopedics; Patient outcomes; Skin & tissue grafts; Software; Stress concentration; Talus; Tibia; Tumors; United States; United States > US; Distal tibia; Fibular graft; Finite element analysis; Bone tumor
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-021-02362-0

There are different surgical methods for primary malignant tumor located at distal tibia. Previous studies have reported that double-strut fibula ankle arthrodesis is an alternative option. The purpose of this study was to investigate the biomechanical effect of double-strut fibula ankle arthrodesis by finite element analysis (FEA). Computer-aided design software was used to establish three-dimension models. Three different models were constructed: normal tibia-fibula-talus complex (model A), double-strut fibula ankle arthrodesis (model B), and reconstruction by ipsilateral fibula (model C). We used FEA to evaluate and compare the biomechanical characteristics of these constructs. Simulated load of 600 N was applied to the tibial plateau to simulate balanced single-foot standing. Output results representing the model von Mises stress and displacement of the components were analyzed. Construct stiffness was increased when the internal plate fixation was used. For axial load, model B (1460.5 N/mm) was stiffer than the construct of model A (524.8 N/mm), and model C (636.6 N/mm), indicating model B was more stable. Maximum stress on the fibular graft occurred on the proximal end. The von Mises stress and stress distribution of fibular graft in model B (71.4 MPa) and model C (67.8 MPa) were similar. In model B, the ipsilateral fibula in model B has a higher value of stress (16.1 MPa) than that in model A (0.5 MPa), indicating the ipsilateral fibula shared load after fusion with talus. Our computational findings suggest that double-strut fibula ankle arthrodesis is an acceptable construct for distal tibia defect and the ipsilateral fibula shares load after fusion with talus.