Biomechanical Evaluation of Plate Osteosynthesis of Distal Fibula Fractures with Biodegradable Devices

BackgroundIn the last years intramedullary nailing has become the treatment of choice for most displaced diaphyseal tibia fractures. In contrast intramedullary nailing of distal tibia fractures is accompanied by problems like decreased biomechanical stability. Nevertheless the indications for intramedullary nailing have been extended to include even more distal fractures. The purpose of this study was to compare long-term mechanical characteristics of angle-stable versus conventional locked intramedullary nails in the treatment of unstable distal tibia fractures. Therefore, the effect of time on the mechanical properties of biodegradable sleeves was assessed.Methods8 pairs of fresh, frozen porcine tibiae were used. The expert tibial nail (Synthes) was equipped with either three conventional locking screws (CL) or the angle-stable locking system (AS), consisting of a special ASLS screw and a biodegradable sleeve. Biomechanical testing included torsional and axial loading at different time-points over 12 weeks.ResultsThe AS group showed a significantly higher torsional stiffness at all time-points (at least 60%) compared to the CL group (p < 0.001). The neutral zone was at least 5 times higher in the CL group (p < 0.001). The mean axial stiffness was maximum 10% higher (week 6) in the angle-stable locked group compared to the conventional group. There was no significant change of the torsional mechanical characteristics over the 12 weeks in both groups (p > 0.05). For axial stiffness and range of motion significant differences were found in the AS group.ConclusionsThe angle-stable locking system (ASLS) with the biodegradable sleeve provides significantly higher long-term stability. Especially the differences determined under torsional loading in this study may have clinical relevance. The ASLS permits the potential to decrease complications like secondary loss of reduction and mal-/non-union.

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“…The temperature (37 degrees C) and the pH (7.4) were kept constant throughout the period of immersion [18]. …”

Section: Methodsmentioning

confidence: 99%

Long-term stability of angle-stable versus conventional locked intramedullary nails in distal tibia fractures

Wähnert

Stolarczyk

Hoffmeier

et al. 2013

BMC Musculoskelet Disord

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“…It is generally agreed that displaced lateral malleolar fractures have improved outcomes with anatomic reduction and surgical stabilization. 7,8,10,12 However, controversy still exists regarding the best fixation method for these fractures. Posterior plating, which allows for bicortical distal fragment fixation without the risk of intra-articular penetration, has been shown to be biomechanically superior to lateral plating, especially in osteoporotic bone.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Comparison of 4 Different Lateral Plate Constructs for Distal Fibula Fractures

et al. 2013

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“…Nevertheless, operative treatment is usually associated with typical complications, such as mal- or nonunion, and especially skin problems ranging from delayed wound healing to severe skin defects [ 7 , 8 , 9 , 10 , 11 , 12 ]. Commonly known open reduction and internal fixation (ORIF) using various techniques is the standard of care for displaced ankle FX in adults [ 15 , 16 , 17 ]. Generally speaking, a recent advance in the treatment of fractures of different bones was the introduction of intramedullary nails [ 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

“…Open reduction and internal fixation (ORIF) has become the standard of care for displaced ankle FX in adults [ 13 , 14 ]. Several techniques for internal ankle fixation are commonly used, ranging from simple lag screw fixation to plate osteosynthesis with non-locking to locking screw systems up to biodegradable systems [ 15 , 16 , 17 , 18 , 19 , 20 ]. In this context, several studies in the common literature focus on intramedullary (IM) fixation of the distal fibula FX, fracture stabilization, and the appearance of soft tissue-related complications in the older population [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

A Prospective Randomized Study Comparing Functional Outcome in Distal Fibula Fractures between Conventional AO Semitubular Plating and Minimal Invasive Intramedullary “Photodynamic Bone Stabilisation”

Zyskowski

Wurm

Greve

et al. 2022

JCM

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(1) Background: As age in western populations is rising, so too are fractures, e.g., of the distal fibula. The aim of this study was to find out whether a novel, minimally invasive intramedullary osteosynthesis technique for the treatment of distal fibula fractures in elderly patients results in not only a reduction of postoperative complications, but also a shorter hospitalization time, an improved clinical outcome, and preserved autonomy in geriatric trauma patients. (2) Methods: In this prospective study, the results following surgical treatment for distal fibula fractures in geriatric patients after using DePuy Synthes® one-third semitubular plate (Group I) or a minimally invasive intramedullary photodynamic Bone StabilizationSystem (IlluminOss®) (Group II) were compared at 6 weeks, 12 weeks, 6 months, and 1 year after initial treatment. (3) Results: Significant improvement regarding clinical outcome was shown in Group II 6 and 12 weeks after surgery. (4) Conclusions: Our study results demonstrate that the use of this new intramedullary stabilization system in combination with an immediate postoperative weight bearing seems to be a safe and stable treatment option for ankle fractures in geriatric patients, especially in the early stages of recovery.

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Biomechanical Evaluation of Plate Osteosynthesis of Distal Fibula Fractures with Biodegradable Devices

Abstract: For the fixation of ankle fractures with a biodegradable plate of the type employed in this study, the use of fracture-gap-crossing screws is recommended.

Cited by 12 publications

References 27 publications

Long-term stability of angle-stable versus conventional locked intramedullary nails in distal tibia fractures

Long-term stability of angle-stable versus conventional locked intramedullary nails in distal tibia fractures

Biomechanical Comparison of 4 Different Lateral Plate Constructs for Distal Fibula Fractures

A Prospective Randomized Study Comparing Functional Outcome in Distal Fibula Fractures between Conventional AO Semitubular Plating and Minimal Invasive Intramedullary “Photodynamic Bone Stabilisation”

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