A biomechanical comparison of fixed angle locking compression plate osteosynthesis and cement augmented screw osteosynthesis in the management of intra articular calcaneal fractures

Rausch, Sascha; Klos, Kajetan; Wolf, Uwe; Gras, Marc; Simons, Paul; Brodt, Steffen; Windolf, Markus; Gueorguiev, Boyko

doi:10.1007/s00264-014-2334-x

Cited by 26 publications

(10 citation statements)

References 25 publications

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“…The loading protocol was adopted from previous studies performed by Rausch et al [ 12 ] and Marks et al [ 4 ]. It comprised initial quasi-static ramped compression loading from 20 N to 150 N at a rate of 13N/s, followed by cyclic axial compression at a rate of 2 Hz with progressively increasing loading and physiological profile of each cycle.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical investigation of two plating systems for medial column fusion in foot

et al. 2017

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BackgroundArthrodesis of the medial column (navicular, cuneiform I and metatarsal I) is performed for reasons such as Charcot arthropathy, arthritis, posttraumatic reconstruction or severe pes planus. However, the complication rate is still high and mainly resulting from inadequate fixation. Special plates, designed for medial column arthrodesis, seem to offer potential to reduce the complication rate. The aim of this study was to investigate biomechanically plantar and dorsomedial fusion of the medial column using two new plating systems.MethodsEight matched pairs of human cadaveric lower legs were randomized in two groups and medial column fusion was performed using either plantar or dorsomedial variable-angle locking compression plates. The specimens were biomechanically tested under cyclic progressively increasing axial loading with physiological profile of each cycle. In addition to the machine data, mediolateral x-rays were taken every 250 cycles and motion tracking was performed to determine movements at the arthrodesis site. Statistical analysis of the parameters of interest was performed at a level of significance p = 0.05.ResultsDisplacement of the talo-navicular joint after 1000, 2000 and 4000 cycles was significantly lower for plantar plating (p≤0.039) while there was significantly less movement in the naviculo-cuneiform I joint for dorsal plating post these cycle numbers (p<0.001). Displacements in all three joints of the medial column, as well as angular and torsional deformations between the navicular and metatarsal I increased significantly for each plating technique between 1000, 2000 and 4000 cycles (p≤0.021). The two plating systems did not differ significantly with regard to stiffness and cycles to failure (p≥0.171).ConclusionFrom biomechanical point of view, although dorsomedial plating showed less movement than plantar plating in the current setup under dynamic loading, there was no significant difference between the two plating systems with regard to stiffness and cycles to failure. Both tested techniques for dorsomedial and plantar plating appear to be applicable for arthrodesis of the medial column of the foot and other considerations, such as access morbidity, associated deformities or surgeon's preference, may also guide the choice of plating pattern. Further clinical studies are necessary before definitive recommendations can be given.

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Section: Methodsmentioning

confidence: 99%

Biomechanical investigation of two plating systems for medial column fusion in foot

et al. 2017

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“…Previous findings in biomechanical studies regarding bone substitutes in calcaneal fracture treatment were promising. No matter if bone substitutes were applied by injection through cannulated screws or as solid block, the stability always increased [ 11 , 13 , 18 , 19 ]. The calcanei treated with bone cement showed significantly less deformation in cyclic testing, and the authors reported a large increase in strength of the construct that possibly leads to more rapid rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Cement-augmented screw fixation for calcaneal fracture treatment: a biomechanical study comparing two injectable bone substitutes

et al. 2020

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Background The role of cement-augmented screw fixation for calcaneal fracture treatment remains unclear. Therefore, this study was performed to biomechanically analyze screw osteosynthesis by reinforcement with either a calcium phosphate (CP)-based or polymethylmethacrylate (PMMA)-based injectable bone cement. Methods A calcaneal fracture (Sanders type IIA) including a central cancellous bone defect was generated in 27 synthetic bones, and the specimens were assigned to 3 groups. The first group was fixed with four screws (3.5 mm and 6.5 mm), the second group with screws and CP-based cement (Graftys® QuickSet; Graftys, Aix-en-Provence, France), and the third group with screws and PMMA-based cement (Traumacem™ V+; DePuy Synthes, Warsaw, IN, USA). Biomechanical testing was conducted to analyze peak-to-peak displacement, total displacement, and stiffness in following a standardized protocol. Results The peak-to-peak displacement under a 200-N load was not significantly different among the groups; however, peak-to-peak displacement under a 600- and 1000-N load as well as total displacement exhibited better stability in PMMA-augmented screw osteosynthesis compared to screw fixation without augmentation. The stiffness of the construct was increased by both CP- and PMMA-based cements. Conclusion Addition of an injectable bone cement to screw osteosynthesis is able to increase fixation strength in a biomechanical calcaneal fracture model with synthetic bones. In such cases, PMMA-based cements are more effective than CP-based cements because of their inherently higher compressive strength. However, whether this high strength is required in the clinical setting for early weight-bearing remains controversial, and the non-degradable properties of PMMA might cause difficulties during subsequent interventions in younger patients.

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“…(17), it was emphasized that percutaneous screw fixation of calcaneus fractures may provide a strength similar to that of plate fixation. Different implants can be used for fracture synthesis and the goal is to achieve enough stability to promote early active range of motion, without weight bearing and redisplacement of the fragments (18,19).…”

Section: Discussionmentioning

confidence: 99%

Cannulated screw fixation for dislocated fractures of the calcaneus

Ivanov

2019

SSM

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INTRODUCTION: Fractures of the calcaneus still remain some of the most challenging injuries that an orthopedic surgeon should manage. The difficulties about these fractures arise from the specific anatomy of the region, from the unique shape and morphology of the bone, and from the mechanism of the injury (in most cases high energy trauma). Despite the progress of the medical implants that can be used for fracture fixation in the last decade there are a lot of controversies, regarding the best option. AIM: The aim of the study is to present our experience with the use of cannulated screws for fixation of dislocated fractures of os calcis. MATERIALS AND METHODS: Twenty patients with dislocated fractures of os calcis using cannulated screws for fixation were operated on for a period of two years (2017-2018). The classifications used in the study included: the Essex-Lopresti x-ray classification modified by Stulik and Stehlik and the CT classification of Sanders. Two of the patients were with dislocated extraarticular fractures of tuber calcanei, three patients with "extreme beak" type fractures, the remaining 15 patients were with intraarticular fractures with more than 2 mm step off in the subtalar joint: 9 patients with tongue type and 5 patients with joint depression type. Gender distribution: 18 men, 2 women. RESULTS: Evaluation of the results was made by using the Maryland Foot Score. Satisfaction from the treatment was graded using the Visual Analogue Scale (VAS) score (mean 7,5). The reduction is evaluated by measurement of the angle of Gissane, Bohler and Preis pre-and postoperatively. Assessment of the calcaneal height, length and width was initiated on lateral, axial and Broden views. CONCLUSION: Fixation of displaced calcaneal fractures by cannulated screw is effective and reliable method. These screws are introduced by stab incisions which leads to minimal soft tissue dissection in such complex area of the hindfoot. It is an enormous advantage for fracture healing and reduces the percentage of possible complications.

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A biomechanical comparison of fixed angle locking compression plate osteosynthesis and cement augmented screw osteosynthesis in the management of intra articular calcaneal fractures

Cited by 26 publications

References 25 publications

Biomechanical investigation of two plating systems for medial column fusion in foot

Biomechanical investigation of two plating systems for medial column fusion in foot

Cement-augmented screw fixation for calcaneal fracture treatment: a biomechanical study comparing two injectable bone substitutes

Cannulated screw fixation for dislocated fractures of the calcaneus

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