title: Biomechanical analysis of the impact of fibular osteotomies at tibiotalar joint: A cadaveric study.
abstract: BACKGROUND
  Osteotomy of the fibula is a common orthopedic procedure performed for various indications, including harvesting fibula for grafting purposes. The effect of fibular osteotomy and need for tibiofibular syndesmotic fixation fusion at different levels on tibiotalar joint is matter of debate. We performed a biomechanical analysis of the impact of fibular osteotomies at different levels and whether the fixation of distal tibiofibular joint mitigates instability caused by the osteotomy.
  
  
  METHODS
  Six lower limb specimens from fresh adult cadavers were used to prepare leg-foot models. The specimens were assigned to six status according to the level of osteotomy and whether fixation of distal tibiofibular joint was performed or not. Each specimen was then loaded axially to 700 N by the material testing machine, and the tibiotalar joint contact area and peak pressure were measured using an electronic pressure sensor.
  
  
  RESULTS
  The contact area and the pressure of tibiotalar joint showed significant changes when compared to the normal specimen. All osteotomy specimens had a decreased tibiotalar contact area and an increased peak pressure. This positively correlated with proximity of level of osteotomy to the lateral malleolus.
  
  
  CONCLUSIONS
  Through this study, we found that fibular osteotomy had an adverse effect in terms of decreasing the contact surface of tibiotalar joint that led to increased peak pressure in the joint. However, bone fusion and screw fixation of the distal tibiofibular joint reduced these adverse effects.
authors.affiliation: Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Guangzhou, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Yang
authors.forename: Hong-Zhang
authors.initials: HZ
authors.lastname: Xu
authors.forename: Dong-Zhu
authors.initials: DZ
authors.lastname: Liang
authors.forename: Wei
authors.initials: W
authors.lastname: Lu
authors.forename: Shi-Zheng
authors.initials: SZ
authors.lastname: Zhong
authors.forename: Jun
authors.initials: J
authors.lastname: Ouyang