The findings from the present study quantified percent changes in periprosthetic BMD as a function of fixation method, alloy, and stem design. While no one stem type was identified as ideal, we now have a clearer understanding of the influence of stem design on load transfer to the surrounding bone.

Suture-button devices provided torsional strength below that of screw fixation. However, all devices may provide failure torques well above 20 Nm, exceeding likely torques applied in casts during healing.(1,2,4) CLINICAL RELEVANCE: Suture-button devices appear to have provided adequate fixation strength for syndesmosis injuries.

Background Idiopathic clubfoot correction is commonly performed using the Ponseti method and is widely reported to provide reliable results. However, a relapsed deformity may occur and often is treated in children older than 2.5 years with repeat casting, followed by an anterior tibial tendon transfer. Several techniques have been described, including a whole tendon transfer using a two-incision technique or a three-incision technique, and a split transfer, but little is known regarding the biomechanical effects of these transfers on forefoot and hindfoot motion. Questions/purpose We used a cadaveric foot model to test the effects of three tibialis anterior tendon transfer techniques on forefoot positioning and production of hindfoot valgus. MethodsTen fresh-frozen cadaveric lower legs were used. We applied 150 N tension to the anterior tibial tendon, causing the ankle to dorsiflex. Three-dimensional motions of the first metatarsal, calcaneus, and talus relative to the tibia were measured in intact specimens, and then repeated after each of the three surgical techniques. Results Under maximum dorsiflexion, the intact specimens showed 6°(95% CI, 2.2°-9.4°) forefoot supination and less than 3°(95% CI, 0.4°-5.3°) hindfoot valgus motion. All three transfers provided increased forefoot pronation and hindfoot valgus motion compared with intact specimens: the three-incision whole transfer provided 38°( 95% CI, 33°-43°; p \ 0.01) forefoot pronation and 10°( 95% CI, 8.5°-12°; p \ 0.01) hindfoot valgus; the split transfer, 28°(95% CI, 24°-32°; p \ 0.01) pronation, 9°( 95% CI, 7.5°-11°; p \ 0.01) valgus; and the two-incision transfer, 25°(95% CI, 20°-31°; p \ 0.01) pronation, 6°( 95% CI, 4.2°-7.8°; p \ 0.01) valgus.