The biomechanical study of the influence to the forefoot plantar pressure of the first tarsometatarsal joint fracture-dislocation fixed by three different implants

Abstract

Objectives:To study the influence of forefoot plantar pressure of the first tarsometatarsal joint fracture-dislocation by three different implants to provide experimental reference in selecting implants.Methods:Eight fresh foot specimens were made into the models of the first tarsometatarsal joint fracture-dislocation, which were fixed with 3.5 mm cortical screw, 1/4 tubular plate and compressive staple in turn. After the loading of 600N, the changes of the plantar pressure in forefoot were measured by the method of the F-scan plantar pressure system.Results:After first tarsometatarsal joint fracture-dislocation, the peak pressure under the first metatarsal head would decrease, while the pressure under the second metatarsal head would increase(P<0.05). When the first tarsometatarsal joint was fixed with screw or plate respectively; the peak pressure under the two metatarsal heads would tend to be normal. However, the staple fixation would show the statistical significant difference, although the peak pressure under the first and second metatarsal heads were recovered in some extent(P<0.05).Conclusions:After the first tarsometatarsal joint fracture-dislocation, the plantar pressure might be compensated partly by the adjacent metatarsal heads. While the first tarsometatarsal joint fracture-dislocation was fixed by screw or plate, the plantar pressure of the forefoot would return to the normal state. However, if the joint was fixed by the staple, it would still be difficult to return the plantar pressure to be normal.

Finite element analysis of locking plate and 1/4 tubular plate for first tarsometatarsal joint fracture-dislocation

“… 15 Staples are more suitable for fixation of TMT joint subluxation. 16 Occasionally, in some cases of comminuted TMT joint fracture-dislocation, the use of cannulated screws will eventually lead to failure of the fixation because the guide pin cannot be drilled though the articular surface. Therefore, a plate might be the most suitable implant in this situation.…”

Management of Midfoot Fractures and Dislocations

“…2 a-c AP, oblique, lateral radiographs showing an ORIF of the cuboid stabilizing the lateral column and medial column bride plate including screws traversing the lisfranc joint to stabilize the TMT complex ability to obtain compression, but Yu et al have shown the staple is inferior in restoring forefoot plantar pressure after a simulated first tarsometatarsal joint fracture dislocation in a cadaver specimen. This is in contrast to fixation with a quarter tubular plate or screws alone which was able to return the forefoot pressure distribution to normal [25]. Lau et al reported on their findings of 62 patients comparing screw fixation, dorsal spanning plate fixation, or a combination of these techniques in a retrospective fashion.…”

Análisis biomecánico de dos constructos de osteosíntesis en fracturas oblicuas largas de primer metatarsiano

“…Al encontrar los valores correctos de momento y desplazamiento necesarios para ejercer la fuerza requerida, así como la posición ideal de colocación, se procedió a fijar cada constructo de la misma forma, después fueron sometidos a la carga previamente determinada de forma cíclica hasta la fatiga o hasta los 300,000 ciclos, que son las cargas a las que está sometido el metatarsiano durante seis semanas, es decir, hasta la consolidación del trazo de fractura (Figura 3). 3,4,[13][14][15][16][17][18][19][20][21][22][23][29][30][31][32][33][34][35][36][37][38][39][40][41][42]…”

“…[2][3][4][5][6][7][8][9] En cuanto al tratamiento quirúrgico, existe un gran número de constructos de osteosíntesis propuestos para el tratamiento de este tipo de fracturas, de los cuales son aceptados el uso de clavillos cruzados e intramedulares, tornillos de compresión, un tornillo de compresión asociado a una placa de protección y placas bloqueadas de bajo perfil, considerando todos, salvo el caso de los clavillos, como equivalentes. [2][3][4][5][6][7][8][9][10] Se realizó una búsqueda en la literatura considerando como criterios de inclusión el ser artículos que utilizarán pruebas biomecánicas con sometimiento de los constructos a fuerzas simulando la marcha, que utilizaran implantes de osteosíntesis y que fueran realizadas en modelos de primer metatarsiano, sin encontrarse estudios biomecánicos que comparen estos implantes en dicha región del organismo con las cargas específicas a las que está sometido el primer metatarsiano y que permitan definir si alguno es superior a los demás; [11][12][13][14][15][16][17][18][19][20][21][22][23] es por esto que decidimos realizar cargas cíclicas, simulando la marcha humana en metatarsianos con fractura en laboratorio y que fueron fijados con las dos técnicas de osteosíntesis previamente mencionadas para definir la equiparabilidad biomecánica de las mismas.…”