Determination of distal fibula fracture for prediction of ankle injuries

Objective

This study quantified the local fracture tolerance of the distal fibula. The purpose of this data is to refine the understanding of ankle fracture tolerance in the population and enhance injury prediction by computational tools.

Methods

Fracture patterns of the fibula were obtained from the US National Highway Traffic Safety Administration (NHTSA) Crash Injury Research Engineering Network (CIREN). Of 143 cases of ankle injury, 120 included fibula fracture, many of which accompanied by radiology images. The most common fibula fracture type was a Weber C fracture, which was then used as the testing target to replicate with postmortem human surrogates. Isolated distal fibulae (male and female, across a wide anthropometric range) were subjected to quasi-static lateral-medial four-point bending superimposed on axial precompression.

Results

Of the 20 specimens tested, 17 fractured in compression and bending, two fractured in compression, bending, and shear, and one did not fracture upon the imposed displacement. Fractures occurring outside of the target testing span were treated as right-censored data points. Fracture patterns varied among specimens, with oblique fractures being most common, followed by segmental fractures. At failure, compressive force ranged from 77 N to 370 N and bending moment from 17 Nm to 47 Nm.

Conclusions

From the 19 fractured specimens, the variety of fracture patterns observed were generally consistent with the range of fibula fracture types and locations commonly observed in the field. While comparative studies with fibula specimens are largely absent from literature, comparison of this study to other long bones (radius and ulna) show that bending moment at fracture is similar. To the author’s knowledge, this is the first study to quantify the fracture tolerance of isolated distal fibulae under loading conditions representative of ankle injury mechanisms in motor vehicle collisions. By combining the results of this study with complementary results from parallel tibia-focused experiments (currently in-press), these results will aid development of tissue-level lower leg fracture prediction of human body models, thus enhancing prediction of ankle injury during safety assessment simulations. Specifically, the fracture tolerance information might generate an injury risk function to guide tissue-level injury prediction with human body models.