Comparison of different internal fixation implants in the treatment of talar neck fractures: A finite element analysis

Abstract

Objectives This study aimed to analyze the biomechanics of cannulated screws (CS) with or without a lateral locking plate (LLP) in talar neck fractures through a finite element analysis. Patients and methods The computed tomography image of the talus from a healthy volunteer (adult male) was used to reconstruct a three-dimensional talar model. The method for fixing talar neck fractures with CS and an LLP was planned using computer-aided design software. Afterward, the three-dimensional models of comminuted talar neck fractures were used to simulate fixation with anteroposterior parallel dual CS, single CS+LLP, and dual CS+LLP. Finally, finite element analysis was carried out to compare the outcomes of dual CS+LLP to those of single CS+LLP and to those of using dual CS alone. The displacement and von Mises stress values of the three groups with different internal fixation were analyzed. Results For a simple talar neck fracture, the lowest amount of displacement was obtained with CS+LLP (0.407 mm), while dual CS (0.459 mm) showed the highest amount of total displacement; the lowest amount of peak stresses was obtained with CS+LLP (5.38 MPa), while dual CS (8.749 MPa) showed the highest amount of total peak stresses. For a comminuted talar neck fracture, the lowest amount of displacement was obtained with CS+LLP (0.398 mm), while dual CS (0.408 mm) showed the highest amount of total displacement; the lowest amount of peak stresses was obtained with CS+LLP (129.9 MPa), while dual CS (205.9 MPa) showed the highest amount of peak stresses. Conclusion Compared to the other two groups, the dual CS+LLP group had better biomechanics properties in the displacement and stress peak of the talus and implant. Thus, the use of dual CS+LLP fixation is recommended for the surgical treatment of comminuted talar neck fractures.

Treatment of Complex Central Talar Fractures with Lateral Plate Combination with Medial Screw Fixation

“…In managing complex central talar fractures, a strategy involving miniaturized plates combined with screws can be employed. A finite element analysis demonstrated that the dual medial cannulated screws (CS) with a lateral locking plate (LLP) in comminuted talar neck fractures had better biomechanics properties in the displacement and stress peak of the talus and implant compared to dual CS and single CS with LLP 28 . Biomechanical research suggests that plates offer superior resistance to rotation and shear compared to using screws alone 13 …”

“…A finite element analysis demonstrated that the dual medial cannulated screws (CS) with a lateral locking plate (LLP) in comminuted talar neck fractures had better biomechanics properties in the displacement and stress peak of the talus and implant compared to dual CS and single CS with LLP. 28 Biomechanical research suggests that plates offer superior resistance to rotation and shear compared to using screws alone. 13 Isolated talar neck fractures usually present with comminution of the dorsal and medial aspect of the neck of the talus, however, the comminution of complex central talar fracture may be on the medial and/or lateral.…”