The modified Lapidus Arthrodesis with a plantar locking plate and additional lag screw fixation

Background: Tarsometatarsal (TMT) arthrodesis is a common operative procedure for end-stage arthritis of the TMT joints. To date, there is no consensus on the best fixation technique for TMT arthrodesis and which joints should be included. Methods: Thirty fresh-frozen feet were divided into one group (15 feet) in which TMT joints I-III were fused with a lag screw and locking plate and a second group (15 feet) in which TMT joints I-III were fused with 2 crossing lag screws. The arthrodesis was performed stepwise with evaluation of mobility between the metatarsal and cuneiform bones after every application or removal of a lag screw or locking plate. Results: Isolated lag-screw arthrodesis of the TMT I-III joints led to significantly increased stability in every joint ( P < .05). Additional application of a locking plate caused further stability in every TMT joint ( P < .05). An additional crossed lag screw did not significantly increase rigidity of the TMT II and III joints ( P > .05). An IM screw did not influence the stability of the fused TMT joints. For TMT III arthrodesis, lag-screw and locking plate constructs were superior to crossed lag-screw fixation ( P < .05). TMT I fusion does not support stability after TMT II and III arthrodesis. Conclusion: Each fixation technique provided sufficient stabilization of the TMT joints. Use of a lag screw plus locking plate might be superior to crossed screw fixation. An additional TMT I and/or III arthrodesis did not increase stability of an isolated TMT II arthrodesis. Clinical Relevance: We report the first biomechanical evaluation of TMT I-III arthrodesis. Our results may help surgeons to choose among osteosynthesis techniques and which joints to include in performing arthrodesis of TMT I-III joints.

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Supplementary medial locking plate fixation of Ludloff osteotomy versus sole lag screw fixation: A biomechanical evaluation

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2017.06.003 ◽

2017 ◽

Vol 47 ◽

pp. 66-72

Author(s):

Panagiotis E. Chatzistergos ◽

George C. Karaoglanis ◽

Stavros K. Kourkoulis ◽

Minos Tyllianakis ◽

Emmanouil D. Stamatis

Keyword(s):

Locking Plate ◽

Screw Fixation ◽

Plate Fixation ◽

Locking Plate Fixation ◽

Lag Screw ◽

Biomechanical Evaluation

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The Fibular Intramedullary Nail Versus Locking Plate and Lag Screw Fixation in the Management of Unstable Elderly Ankle Fractures: A Cadaveric Biomechanical Comparison

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000001814 ◽

2020 ◽

Vol 34 (11) ◽

pp. e401-e406

Author(s):

Thomas H. Carter ◽

Robert Wallace ◽

Samuel A. Mackenzie ◽

William M. Oliver ◽

Andrew D. Duckworth ◽

...

Keyword(s):

Intramedullary Nail ◽

Locking Plate ◽

Screw Fixation ◽

Ankle Fractures ◽

Lag Screw ◽

Biomechanical Comparison

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Interfragmentary lag screw fixation in locking plate constructs increases stiffness in simple fracture patterns

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2015.06.008 ◽

2015 ◽

Vol 30 (8) ◽

pp. 814-819 ◽

Cited By ~ 8

Author(s):

Sven Märdian ◽

Werner Schmölz ◽

Klaus-Dieter Schaser ◽

Georg N. Duda ◽

Mark Heyland

Keyword(s):

Locking Plate ◽

Screw Fixation ◽

Lag Screw ◽

Fracture Patterns ◽

Simple Fracture

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First Metatarsalphalangeal Joint Arthrodesis: A Retrospective Comparison of Two Methods of Fixation

The Open Orthopaedics Journal ◽

10.2174/1874325001509010480 ◽

2015 ◽

Vol 9 (1) ◽

pp. 480-482 ◽

Cited By ~ 1

Author(s):

M.A Rashid ◽

M Parnell ◽

W.S Khan ◽

A Khan

Keyword(s):

Locking Plate ◽

Screw Fixation ◽

Fixation Method ◽

Compression Screw ◽

Clinical Criteria ◽

Non Union ◽

Lag Screw ◽

Retrospective Comparison ◽

Significant Difference ◽

Interfragmentary Compression

First metatarsalphalangeal joint arthrodesis is a well established and successful treatment; however there still remains controversy over the best choice of construct. We performed a retrospective study of patients undergoing first metatarsalphalangeal fusion over eighteen months (n=52) using either dorsal non-locking plate with additional compression lag screw fixation or dorsal non-locking plate alone. We found when assessing clinical criteria, patients with dorsal non-locking plates and additional compression lag screw fixation had a significantly higher rate of fusion (100% vs 77.8%), significantly higher rate of fusion within the first two months (55.6% vs 83.3%), significantly earlier time to fusion (52.2 days vs 75.6 days), and significantly lower rate of non-union (0% vs 22.2%). When blindly assessing radiographic criteria, the patients treated with the plate and compression screw had a significantly higher rate of fusion and lower rate of non-union (0% vs 33%). There was no statistically significant difference between the frequencies of complications in the groups. We believe that the interfragmentary compression is a crucial factor in achieving good union rates and recommend the use of non-locking pre-contoured plating with additional interfragmentary compression screw as the fixation method of choice for these procedures.

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Locking plate constructs benefit from interfragmentary lag screw fixation with decreased shear movements and more predictable fracture gap motion in simple fracture patterns

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2019.08.008 ◽

2019 ◽

Vol 70 ◽

pp. 89-96 ◽

Cited By ~ 2

Author(s):

Sven Märdian ◽

Werner Schmölz ◽

Klaus-Dieter Schaser ◽

Georg N. Duda ◽

Mark Heyland

Keyword(s):

Locking Plate ◽

Screw Fixation ◽

Lag Screw ◽

Fracture Patterns ◽

Simple Fracture

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Outcomes of First Metatarsophalangeal Joint Fusion in Patients with Greater Than Fifteen Percent Intermetatarsal Angle. Is Lag Screw Essential?

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000361 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Ashish Shah ◽

Parke Hudson ◽

Ibukunoluwa Araoye ◽

Zachariah Pinter ◽

Girish Motwani ◽

...

Keyword(s):

Locking Plate ◽

Screw Fixation ◽

Metatarsophalangeal Joint ◽

Dorsal Plate ◽

Chi Square ◽

First Metatarsophalangeal Joint ◽

Lag Screw ◽

Wide Range ◽

Significant Difference ◽

Student’S T

Category: Midfoot/Forefoot Introduction/Purpose: Metatarsophalangeal arthrodesis has usually been performed using a dorsal plate to immobilize the MTP joint with or without lag screw fixation. Data in the literature is sparse on outcomes of dorsal plate plus lag screw fixation, especially in patients with IMA greater than 15 percent. Our objective was to compare IMA correction outcomes and union rates between dorsal plate only fusions and dorsal plate plus lag screw fixation in patients with IMA greater than 15 percent. Methods: We retrospectively reviewed the charts of 36 patients (39 feet) who underwent first MTP joint arthrodesis for moderate to severe HV deformity between 2011 and 2015. Average age was 61 (range, 39 to 84) years. There were 24 females and 12 males. A single surgeon performed all operations. Joints were immobilized postoperatively using either dorsal locking plate alone or dorsal locking plate with a lag screw. Union (at least 3 bridging cortices) was determined radiographically at 6 weeks, 3 months, 6 months and yearly. All suspect nonunions were examined with CT. Other radiographic parameters examined included preoperative and postoperative hallux valgus, intermetatarsal, and dorsiflexion angles (HVA, IMA, and DFA respectively). Student’s t test was used to compare group means while Pearson’s Chi square test was used to compare group rates. Results: Overall union rate was 82.1% (32/39). There was no significant difference in union rates between the two groups (dorsal plate only = 81.5% (22/27), dorsal plate plus lag screw group = 83.3% (10/12)) (P > 0.05). Average follow-up was 9 (range 7 to 35) months. Overall, the average IMA correction was 4.7 (preoperative = 17.8, postoperative = 13.1) degrees. Average IMA corrections were 4.7 and 4.54 degrees in the dorsal plate only group and dorsal plate plus lag screw groups respectively. Overall, average HVA correction was 21 (preoperative = 39.5, postoperative = 18.5) degrees. Conclusion: Our findings indicate that there is no difference in the fusion rates between both patient groups with IMA greater than fifteen percent. Because other published studies have a wide range of IMAs preoperatively, our study represents more attainable goals in patients with severe (IMA greater than 15%) deformities. In addition, our findings suggest that in such patients, MTP arthrodesis may not be sufficient as a standalone procedure for correction of IMA. Additional proximal osteotomy may be required for correction of the IMA.

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Single column plate plus other column lag screw fixation vs. both column plate fixation for anterior column with posterior hemitransverse acetabular fractures – a biomechanical analysis using different loading protocols

Injury ◽

10.1016/j.injury.2020.12.041 ◽

2021 ◽

Author(s):

Huy Le Quang ◽

Werner Schmoelz ◽

Richard A. Lindtner ◽

Dietmar Dammerer ◽

Peter Schwendinger ◽

...

Keyword(s):

Screw Fixation ◽

Plate Fixation ◽

Biomechanical Analysis ◽

Anterior Column ◽

Acetabular Fractures ◽

Lag Screw ◽

Single Column

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Transverse Lag Screw Fixation in Midline Mandibulotomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940010900318 ◽

2000 ◽

Vol 109 (3) ◽

pp. 334-339 ◽

Cited By ~ 7

Author(s):

Joseph M. Serletti ◽

John U. Coniglio ◽

Salvatore J. Pacella ◽

John D. Norante

Keyword(s):

Reliable Method ◽

Screw Fixation ◽

Postoperative Radiotherapy ◽

Major Complication ◽

Recurrent Tumor ◽

Minor Complication ◽

Anterior Cortex ◽

Lag Screw ◽

The Mean

Vertical midline mandibulotomy has provided a relatively simple and efficient means of obtaining access to intraoral tumors that are too large or too posterior to be removed transorally. Midline mandibulotomy has had the advantage of nerve and muscle preservation and places the osteotomy outside the typical field of radiotherapy, in contrast to lateral and paramedian osteotomies. Plate and screw fixation has been the usual means of osteosynthesis for these mandibulotomies; however, plate contouring over the symphyseal surface has been a time-consuming process. Unless the plate was contoured exactly, mandibular malalignment and malocclusion in dentulous patients has occurred. Use of parallel transverse lag screws has become a popular method of osteosynthesis for parasymphyseal fractures, and we have extended their use for mandibulotomy fixation. This paper reports our clinical experience with transverse lag screw fixation of midline mandibulotomies in 9 patients from 1994 to 1997. There were 7 men and 2 women with a mean age of 56 (range 35 to 71 years). The pathological diagnosis in all patients was squamous cell carcinoma; 8 cases were primary, and 1 patient presented with recurrent tumor. No tumors involved the mandibular periosteum. One patient had had previous radiotherapy, and 3 patients underwent postoperative radiotherapy. The mean follow-up has been 17 months (range 9 to 27). There was 1 minor complication and 1 major complication related to our technique. The major complication was a delayed nonunion of the mandibulotomy. This occurred because the 2 parallel screws were placed too close to one another, and this placement resulted in a delayed sagittal fracture of the anterior cortex and subsequent nonunion. Transverse lag screw fixation has not affected occlusion in our dentulous patients. Speech and diet were normal in the majority of our patients. Transverse lag screw fixation of the midline mandibulotomy has been a relatively safe, rapid, and reliable method for tumor access and postextirpation mandibular stabilization and has significant advantages over other current methods of mandibulotomy and fixation.

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