A comparison of absorbable screws and metallic plates in treating calcaneal fractures

Zhang, Jingwei; Ebraheim, Nabil A.; Lausé, Gregory E.; Xiao, Bai-ping; Xu, Rongming

doi:10.1097/ta.0b013e3182231811

Cited by 28 publications

(22 citation statements)

References 23 publications

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“…Recent literature on surgical treatment of displaced intraarticular calcaneal fractures without locked fracturedislocation using both the AOFAS and the FFI shows results similar to our study [11][12][13][14][15]. We identified one previous study that included a functional outcome scoring system to evaluate the results of locked fracture-dislocations [16].…”

Section: Discussionsupporting

confidence: 70%

Functional outcome following a locked fracture-dislocation of the calcaneus

Schepers

Backes

Schep

et al. 2013

International Orthopaedics (SICOT)

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Purpose Locked fracture-dislocations of the calcaneus are uncommon, and a substantial number of these injuries is not recognised or is misdiagnosed at first presentation. The primary aim of this study was to evaluate the long-term outcome in patients with this injury. Methods This is a retrospective cohort study of adult patients who sustained a uni-or bilateral calcaneal fracturedislocation. Outcome was measured using validated questionnaires, including the American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS), Foot Function Index (FFI) and a visual analogue scale (VAS). Results During the 12-year study period a total of 16 patients with 17 locked fracture-dislocations were identified. This represented 6 % of all surgically treated calcaneal fractures (17 of 279). The median follow-up was 48 months. All patients were treated using an extended lateral approach and plate fixation. In one patient with a delayed presentation a primary arthrodesis was performed. The functional outcome scores were available for 14 patients with 14 fractures. The median AOFAS was 74 [interquartile range (IQR) 47-86], the median FFI was 18 (IQR 6-37) and the median VAS for overall satisfaction was 8.2 (IQR 5.5-9.4). A secondary fusion was deemed necessary in three cases. Conclusions This study shows that, with surgical treatment via an extended lateral approach, the outcome in patients with a locked fracture-dislocation of the calcaneus is similar to the outcome of other displaced intra-articular calcaneal fracture types. However, a higher rate of secondary subtalar fusion can be expected.

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Section: Discussionsupporting

confidence: 70%

Functional outcome following a locked fracture-dislocation of the calcaneus

Schepers

Backes

Schep

et al. 2013

International Orthopaedics (SICOT)

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“…These potential benefits have been supported by reports demonstrating favourable results in treating fractures with these resorbable systems 4,[10][11][12][13][14][15] . However, conventional resorbable materials are associated with inflammatory reaction, can generate sterile sinus formation, result in incomplete remodelling of the bone and exhibit improper dynamics between device strength retention and wound healing 11,12,16 .…”

supporting

confidence: 58%

“…High-impact fractures have a mortality rate as high as 12% 3 . Currently, metal alloys are the gold standard for fracture-fixation devices, despite their numerous disadvantages, which include extreme stiffness causing stress shielding of the underlying bone, potentially poor wound healing and plate exposure, infection and in some cases the need for removal of metallic implants after fracture healing is complete as in the lower extremity 4,5 . Stress shielding may result in a reduction of the density of bone affecting bone remodelling and healing and impacting the mixed dentition when used for paediatric mandible fractures.…”

mentioning

confidence: 99%

The use of silk-based devices for fracture fixation

et al. 2014

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Metallic fixation systems are currently the gold standard for fracture fixation but have problems including stress shielding, palpability and temperature sensitivity. Recently, resorbable systems have gained interest because they avoid removal and may improve bone remodelling due to the lack of stress shielding. However, their use is limited to paediatric craniofacial procedures mainly due to the laborious implantation requirements. Here we prepare and characterize a new family of resorbable screws prepared from silk fibroin for craniofacial fracture repair. In vivo assessment in rat femurs shows the screws to be self-tapping, remain fixed in the bone for 4 and 8 weeks, exhibit biocompatibility and promote bone remodelling. The silk-based devices compare favourably with current poly-lactic-co-glycolic acid fixation systems, however, silk-based devices offer numerous advantages including ease of implantation, conformal fit to the repair site, sterilization by autoclaving and minimal inflammatory response.

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“…The absorbable materials poly-L-lactic acid (PLLA) and its copolymer have a long history of safe clinical use. PLLA screws have been shown to be sufficiently stable and perform clinically in treating intra-articular calcaneal fractures (Fu et al, 2013;Ni et al, 2015;Zhang et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures

Wong

Mei

et al. 2016

Sci. China Life Sci.

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The locking plate and percutaneous crossing metallic screws and crossing absorbable screws have been used clinically to treat intra-articular calcaneal fractures, but little is known about the biomechanical differences between them. This study compared the biomechanical stability of calcaneal fractures fixed using a locking plate and crossing screws. Three-dimensional finite-element models of intact and fractured calcanei were developed based on the CT images of a cadaveric sample. Surgeries were simulated on models of Sanders type III calcaneal fractures to produce accurate postoperative models fixed by the three implants. A vertical force was applied to the superior surface of the subtalar joint to simulate the stance phase of a walking gait. This model was validated by an in vitro experiment using the same calcaneal sample. The intact calcaneus showed greater stiffness than the fixation models. Of the three fixations, the locking plate produced the greatest stiffness and the highest von Mises stress peak. The micromotion of the fracture fixated with the locking plate was similar to that of the fracture fixated with the metallic screws but smaller than that fixated with the absorbable screws. Fixation with both plate and crossing screws can be used to treat intra-articular calcaneal fractures. In general, fixation with crossing metallic screws is preferable because it provides sufficient stability with less stress shielding.

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A comparison of absorbable screws and metallic plates in treating calcaneal fractures

Cited by 28 publications

References 23 publications

Functional outcome following a locked fracture-dislocation of the calcaneus

Functional outcome following a locked fracture-dislocation of the calcaneus

The use of silk-based devices for fracture fixation

Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures

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