Arthrodesis of the First Metatarsophalangeal Joint: A Biomechanical Study Comparing Memory Compression Staples, Cannulated Screws, and a Dorsal Plate

Neufeld, Steven; Parks, Brent G.; Naseef, George S.; Melamed, Eyal; Schon, Lew C.

doi:10.1177/107110070202300203

Cited by 71 publications

(40 citation statements)

References 15 publications

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“…SMA staples are often utilized clinically as fixation-compression devices for osteotomies, arthrodeses and fracture repairs especially of short bones, facial bones and the distal extremities (Choudhary et al 2004; Laster et al 2001; Neufeld et al 2002; Rethnam et al 2009). Yang et al (1987) reviewed 51 cases where SMA staples were first used as an internal fixation device for a range of orthopaedic procedures and described good bone union and functional recovery in the 45 cases that were followed up.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of shape-memory alloy staples for internal fixation—an in vitro study

et al. 2016

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BackgroundThe field of orthopaedics is a constantly evolving discipline. Despite the historical success of plates, pins and screws in fracture reduction and stabilisation, there is a continuing search for more efficient and improved methods of fracture fixation. The aim of this study was to evaluate shape-memory staples and to compare them to a currently used implant for internal fracture fixation. Multi-plane bending stability and interfragmentary compression were assessed across a simulated osteotomy using single and double-staple fixation and compared to a bridging plate.MethodsTransverse osteotomies were made in polyurethane blocks (20 × 20 × 120 mm) and repairs were performed with one (n = 6), or two (n = 6) 20 mm nitinol staples, or an eight-hole 2.7 mm quarter-tubular plate (n = 6). A pressure film was placed between fragments to determine contact area and compressive forces before and after loading. Loading consisted of multi-planar four-point bending with an actuator displacement of 3 mm. Gapping between segments was recorded to determine loads corresponding to a 2 mm gap and residual post-load gap.ResultsStaple fixations showed statistically significant higher mean compressive loads and contact areas across the osteotomy compared to plate fixations. Double-staple constructs were superior to single-staple constructs for both parameters (p < 0.001). Double-staple constructs were significantly stiffer and endured significantly larger loads before 2 mm gap formation compared to other constructs in the dorsoventral plane (p < 0.001). However, both staple constructs were significantly less stiff and tolerated considerably lower loads before 2 mm gap formation when compared to plate constructs in the ventrodorsal and right-to-left lateral loading planes. Loading of staple constructs showed significantly reduced permanent gap formation in all planes except ventrodorsally when compared to plate constructs.ConclusionsAlthough staple fixations were not as stable as plate fixations in particular loading planes, double-staple constructs demonstrated the most consistent bending stiffness in all planes. Placing two perpendicular staples is suggested instead of single-staples whenever possible, with at least one staple applied on the compression side of the anticipated loading to improve construct stability.

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Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of shape-memory alloy staples for internal fixation—an in vitro study

et al. 2016

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“…A complex plantar dissection necessary to improve the stability by a plantar plate placement [26] was not necessary. Test models described in literature often use feet disarticulated in the ankle, arranged in an unphysiological position, measuring only translational forces or rely on synthetic bone [25, 27-29]. In some studies the locking plate lacked the possibility of interfragmentary compression and three - dimensional aspects were not taken into consideration in contrast to our study [30, 31].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical In Vitro - Stability Testing on Human Specimens of a Locking Plate System Against Conventional Screw Fixation of a Proximal First Metatarsal Lateral Displacement Osteotomy

Arnold

Stukenborg-Colsman²,

Hurschler³

et al. 2012

TOORTHJ

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Introduction: The aim of this study was to examine resistance to angulation and displacement of the internal fixation of a proximal first metatarsal lateral displacement osteotomy, using a locking plate system compared with a conventional crossed screw fixation.Materials and Methodology: Seven anatomical human specimens were tested. Each specimen was tested with a locking screw plate as well as a crossed cancellous srew fixation. The statistical analysis was performed by the Friedman test. The level of significance was p = 0.05.Results: We found larger stability about all three axes of movement analyzed for the PLATE than the crossed screws osteosynthesis (CSO). The Friedman test showed statistical significance at a level of p = 0.05 for all groups and both translational and rotational movements.Conclusion: The results of our study confirm that the fixation of the lateral proximal first metatarsal displacement osteotomy with a locking plate fixation is a technically simple procedure of superior stability.

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“…Artrodez tedavisi uygulanırken Kischner telinden plakvida birlikteliğine kadar birçok materyal tercih edilmiştir (13)(14)(15)(16)(17)(18)(19). Çoklu Kischner teli ile tespit sonrası implantın çıkarılması için ilave cerrahi gereksinimi ve yüksek kaynamama oranı gibi dezavantajlar bildirilmiştir (13).…”

Section: Discussionunclassified

“…Ayrıca gergi bandının vida uygulanmasına nispeten altı kez daha instabil olduğu gösterilmiştir (16). Staple kullanımı ile kabul edilebilir kaynama oranı bildirilmekle birlikte biyomekanik olarak diğer yöntemlere göre daha instabil olduğu gösterilmiştir (18). Birinci MTF eklem artrodezinde vida kullanımı sıklıkla tercih edilen tespit yöntemidir.…”

Section: Discussionunclassified

İleri Evre Halluks Rigidus Tedavisinde Tek Kortikal Vida ile Primer Artrodez

Yavuz¹,

Gül²,

Özer³

et al. 2014

Haseki

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ÖzetAmaç: Bu çalışmanın amacı halluks rigidus nedeniyle artrodez yapılırken tek kortikal vida kullanılmasının klinik ve radyolojik açıdan yeterliliğini değerlendirmektir.Yöntemler: İleri evre halluks rigidus tanısıyla tek kortikal vida kullanılarak artrodez uygulanan 18 hasta (16 kadın, 2 erkek) geriye dönük olarak değerlendirildi. Hastaların yaş ortalaması 58,1 yıl (dağılım 44-69 yıl) idi. Caughlin ve Shurnas'ın evreleme sistemine göre 5 ayak evre 3 ve 13 ayak evre 4 olarak değerlendirildi. Klinik değerlendirme American Orthopaedic Foot and Ankle Society (AOFAS) metatarsofalangeal-interfalengeal skalası ile yapıldı. Son takip grafileri üzerinden halluks valgus açısı, yere göre birinci parmak dorsifleksiyon açısı ölçüldü. Bulgular: Ortalama izlem süresi 32,4 ay (dağılım 14-69 ay) idi. Bir hastada radyolojik kaynamama mevcuttu. Hastaların preoperatif AOFAS skoru ortalama 56,1 (dağılım 38-72) idi. Hastaların son kontrolünde ortalama AOFAS skoru 81,1 bulundu. AOFAS skoruna göre iki hasta (% 11,1) orta, 11 hasta (% 61,1) iyi, beş hastada (% 27,8) Abs tractAim: The aim of this study was to evaluate the clinical and radiological results in patients with severe hallux rigidus who underwent arthrodesis using single cortical screw. Methods:We retrospectively evaluated 18 patients (16 females, 2 males) who underwent arthrodesis for severe hallux rigidus using single cortical screw. The mean age of the patients was 58.1 (range: 44-69) years. According to the Coughlin and Shurnas classification, 5 feet were rated as stage 3 and 13 feet were stage 4. 3 of the stage 3 patients had cheilectomy previously. The American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating scale for the metatarsophalangeal -interphalangeal joints was used for clinical evaluation. Hallux valgus angles and hallux dorsiflexion angles were measured on X-rays. Results:The mean follow-up period was 32.4 (range: 15-69) months. Radiological signs of non-union was found in one patient. The mean preoperative AOFAS score was 56.1 (range: 38-72). The mean final follow-up AOFAS score was found to be 81.1. Moderate results in 2 patients (11.1%), good results in 11 patients (61.1%) and excellent results in 5 patients (27.8%) were obtained. When the last X-rays were evaluated, 15.1° (7-24) valgus at the metatarsophalangeal joint and 11.9° (8-18) extension (to the floor) at the metatarsophalangeal joint were detected. Late surgical wound healing was observed in one patient. The screws were removed due to irritation in 8 (44%) patients. Conclusion:We assume that in the treatment of severe hallux rigidus, arthrodesis using a single cortical screw may be considered as a favorable surgical technique with its high union rates and increased functional results. (The Me di cal Bul le tin of Ha se ki 2014; 52:158-63)

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Arthrodesis of the First Metatarsophalangeal Joint: A Biomechanical Study Comparing Memory Compression Staples, Cannulated Screws, and a Dorsal Plate

Cited by 71 publications

References 15 publications

Biomechanical evaluation of shape-memory alloy staples for internal fixation—an in vitro study

Biomechanical evaluation of shape-memory alloy staples for internal fixation—an in vitro study

Biomechanical In Vitro - Stability Testing on Human Specimens of a Locking Plate System Against Conventional Screw Fixation of a Proximal First Metatarsal Lateral Displacement Osteotomy

İleri Evre Halluks Rigidus Tedavisinde Tek Kortikal Vida ile Primer Artrodez

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