Frontiers in Bioengineering and Biotechnology

| 2023

Simulation-based prediction of bone healing and treatment recommendations for lower leg fractures: Effects of motion, weight-bearing and fibular mechanics

Marcel Orth, Bergita Ganse, Annchristin Andres, Kerstin Wickert, Elke Warmerdam, Max Müller, Stefan Diebels, Michael Roland and Tim Pohlemann

Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Saarbrücken


biomechanics, motion, gait analysis, prognosis of bone healing, tibial fracture, lower leg injury, fibula, finite element analysis


Despite recent experimental and clinical progress in the treatment of tibial and fibular fractures, in clinical practice rates of delayed bone healing and non-union remain high. The aim of this study was to simulate and compare different mechanical conditions after lower leg fractures to assess the effects of postoperative motion, weight-bearing restrictions and fibular mechanics on the strain distribution and the clinical course. Based on the computed tomography (CT) data set of a real clinical case with a distal diaphyseal tibial fracture, a proximal and a distal fibular fracture, finite element simulations were run. Early postoperative motion data, recorded via an inertial measuring unit system and pressure insoles were recorded and processed to study strain. The simulations were used to compute interfragmentary strain and the von Mises stress distribution of the intramedullary nail for different treatments of the fibula, as well as several walking velocities (1.0 km/h; 1.5 km/h; 2.0 km/h) and levels of weight-bearing restriction. The simulation of the real treatment was compared to the clinical course. The results show that a high postoperative walking speed was associated with higher loads in the fracture zone. In addition, a larger number of areas in the fracture gap with forces that exceeded beneficial mechanical properties longer was observed. Moreover, the simulations showed that surgical treatment of the distal fibular fracture had an impact on the healing course, whereas the proximal fibular fracture barely mattered. Weight-bearing restrictions were beneficial in reducing excessive mechanical conditions, while it is known that it is difficult for patients to adhere to partial weight-bearing recommendations. In conclusion, it is likely that motion, weight bearing and fibular mechanics influence the biomechanical milieu in the fracture gap. Simulations may improve decisions on the choice and location of surgical implants, as well as give recommendations for loading in the postoperative course of the individual patient.

Moticon's Summary

In this study the authors investigated different mechanical conditions in a patient with multiple lower limb fractures following surgery. Different mechanical conditions in the fracture gap were simulated using a previously introduced simulation workflow. The simulation workflow leverages postoperative CT scans as well as motion capture data to create a patient specific model. Motion capture data was recorded using Moticon sensor insoles as well as IMUs. Subsequently the simulation was used to compute strain at the fracture site for different treatments as well as for several walking speeds and levels of weightbearing restrictions in postoperative treatment. Regarding the results the authors emphasize the applicability of simulations to select appropriate treatments as well as to provide recommendations for loading. Furthermore the authors derived specific insights regarding postoperative walking speed, occurring forces in the fracture gap as well as surgical treatment of individual fracture sites.

Contact Us
Book a free online demo or use the contact form to get in touch
Subscribe to our newsletter for regular updates

Select your desired system

The cutting edge test based outcome assessment system for health professionals and trainers

The most versatile toolkit for free data acquisition and comprehensive analytics in research

Have a general inquiry?

Write us a message for general questions about products and solutions or if you’d like to discuss other topics.

The form was sent successfully.

You will be contacted shortly.


Stay one step ahead!

Subscribe to our newsletter for the latest information on case studies, webinars, product updates and company news

Get support

Check our FAQ database for answers to frequently asked questions

Describe your issue in as much detail as possible. Include screenshots or files if applicable.

Need help?
Want a live demo?
Interested in prices?
Want to say hello?
Always just a call away
+49 89 2000 301 60