title: Novel Spiked-Washer Repair Is Biomechanically Superior to Suture and Bone Tunnels for Arcuate Fracture Repair.
abstract: OBJECTIVE
  Injuries to the posterolateral corner of the knee can lead to chronic degenerative changes, external rotation instability, and varus instability if not repaired adequately. A proximal fibula avulsion fracture, referred to as an arcuate fracture, has been described in the literature, but a definitive repair technique has yet to be described. The objective of this study was to present a novel arcuate fracture repair technique, using a spiked-washer with an intramedullary screw, and to compare its biomechanical integrity to a previously described suture and bone tunnel method.
  
  
  METHODS
  Ten fresh-frozen cadaveric knees underwent a proximal fibula osteotomy to simulate a proximal fibula avulsion fracture. The lateral knee capsule and posterior cruciate ligament were also sectioned to create maximal varus instability. Five fibulas were repaired using a novel spiked-washer technique and the other 5 were repaired using the suture and bone tunnel method. The repaired knees were subjected to a monotonic varus load using a mechanical testing system instrument until failure of the repair or associated posterolateral corner structures.
  
  
  RESULTS
  Compared with the suture repair group, the spiked-washer repair group demonstrated a 100% increase in stiffness, 100% increase in yield, 110% increase in failure force, and 108% increase in energy to failure.
  
  
  CONCLUSIONS
  The spiked-washer technique offers superior quasi-static biomechanical performance compared with suture repair with bone tunnels for arcuate fractures of the proximal fibula. Further clinical investigation of this technique is warranted and the results of this testing may lead to improved outcomes and patient satisfaction for proximal fibula avulsion fractures.
authors.affiliation: *Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY; †School of Medicine, Stony Brook University Hospital, Stony Brook, NY; ‡Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY; and §Department of Orthopedics, Nassau University Medical Center, East Meadow, NY.
authors.forename: Saman
authors.initials: S
authors.lastname: Vojdani
authors.forename: Laviel
authors.initials: L
authors.lastname: Fernandez
authors.forename: Jian
authors.initials: J
authors.lastname: Jiao
authors.forename: Tyler
authors.initials: T
authors.lastname: Enders
authors.forename: Steven
authors.initials: S
authors.lastname: Ortiz
authors.forename: Liangjun
authors.initials: L
authors.lastname: Lin
authors.forename: Yi-Xian
authors.initials: YX
authors.lastname: Qin
authors.forename: David E
authors.initials: DE
authors.lastname: Komatsu
authors.forename: James
authors.initials: J
authors.lastname: Penna
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Ruotolo
mesh_terms: D000368:Aged; D001863:Bone Screws; D002102:Cadaver; D019245:Compressive Strength; D005360:Fibula / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing; D000071562:Fractures, Avulsion / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods; D013314:Stress, Mechanical; D016896:Treatment Outcome; D016474:Weight-Bearing