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

Abstract

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.

First Tarsometatarsal Joint Fusion in Foot—A Biomechanical Human Anatomical Specimen Analysis with Use of Low-Profile Nitinol Staples Acting as Continuous Compression Implants

“…In the current study, nitinol devices were placed at the dorsal compression site of the foot to allow continuous compression across the joint while unloading the foot. From this perspective and in alignment with other studies investigating plating of the medial column [33], although a plantar nitinol device placement would be located on the tension site and provide enhanced resistance against plantar gapping, it would conflict with the dogma of superelasticity provided by the nitinol devices and risk injury and irritation to the anterior tibialis.…”

“…Medicina 2023, 59, x FOR PEER REVIEW Biomechanical testing commenced with initial quasi-static axial ra from 20 N to 150 N at a rate of 13 N/s, followed by progressively increasi loading at 2 Hz with a physiologic profile of each cycle [33]. Whereas the va was held at a constant level of 20 N, the peak load, starting from 150 N, incr of 0.08 N/cycle until 100 mm axial displacement of the machine actuator, w sidered large enough to provoke catastrophic failure of the tested construc Biomechanical testing commenced with initial quasi-static axial ramped loading from 20 N to 150 N at a rate of 13 N/s, followed by progressively increasing cyclic axial loading at 2 Hz with a physiologic profile of each cycle [33]. Whereas the valley cyclic load was held at a constant level of 20 N, the peak load, starting from 150 N, increased at a rate of 0.08 N/cycle until 100 mm axial displacement of the machine actuator, which was considered large enough to provoke catastrophic failure of the tested constructs.…”

Canine ex vivo tarsal arthrodesis: fixation by using a new bone tissue glue

“…most glues are weakest in shear), in addition to being a force that arises during normal locomotion, besides compression, bending and torsion. While tarsal loading has been evaluated in general by using: 1-, 2-and 3-point bending [25,[38][39][40]; pure torsion [23]; compression [41]; shear [26] and multi-modal loading using intact (cadaver) ankles [42] there is no clear consensus on which type(s) of loading are su cient to accurately model forces that arise during locomotion. No other studies have evaluated adhesives for joint xation, and the magnitude of force(s) that arise during joint movement are poorly characterized in canines.…”

Plantar Plating for Medial Naviculocuneiform Arthrodesis in Progressive Collapsing Foot Deformity

“… 37 A cadaver biomechanical study comparing dorsal vs plantar plating for extended midfoot arthrodesis (TMT and NC combined) demonstrated no difference in construct stiffness and number of loads to failure. 36 …”

“…37 A cadaver biomechanical study comparing dorsal vs plantar plating for extended midfoot arthrodesis (TMT and NC combined) demonstrated no difference in construct stiffness and number of loads to failure. 36 The authors propose that application of a plantar neutralization plate during NC arthrodesis should function like a tension-band construct to resist plantar-sided gapping and reduce the risk of deformity recurrence. This concept has been used in other areas of foot and ankle surgery with successful clinical outcomes.…”