Biomechanical Comparison of Hook Plate vs Headless Compression Screw Fixation of Large Fifth Metatarsal Base Avulsion Fractures

2020 ◽  
pp. 107110072095308
Author(s):  
Bryan A. Bean ◽  
Niall A. Smyth ◽  
Pooyan Abbasi ◽  
Brent G. Parks ◽  
Walter C. Hembree
Keyword(s):  
Weight Bearing ◽  
Plantar Fascia ◽  
Hook Plate ◽  
Bony Union ◽  
Compression Screw ◽  
Avulsion Fractures ◽  
Headless Compression Screw ◽  
Plate Group ◽  
Headless Compression Screws ◽  
Fresh Frozen

Background: Debate exists on the optimum fixation construct for large avulsion fractures of the fifth metatarsal base. We compared the biomechanical strength of 2 headless compression screws vs a hook plate for fixation of these fractures. Methods: Large avulsion fractures were simulated on 10 matched pairs of fresh-frozen cadaveric specimens. Specimens were assigned to receive two 2.5-mm headless compression screws or an anatomic fifth metatarsal hook plate, then cyclically loaded through the plantar fascia and metatarsal base. Specimens underwent 100 cycles at 50%, 75%, and 100% physiological load for a total of 300 cycles. Results: The hook plate group demonstrated a significantly higher number of cycles to failure compared with the screw group (270.7 ± 66.0 [range 100-300] cycles vs 178.6 ± 95.7 [range 24-300] cycles, respectively; P = .039). Seven of 10 hook plate specimens remained intact at the maximum 300 cycles compared with 2 of 10 screw specimens. Nine of 10 plate specimens survived at least 1 cycle at 100% physiologic load compared with 5 of 10 screw specimens. Conclusion: A hook plate construct was biomechanically superior to a headless compression screw construct for fixation of large avulsion fractures of the fifth metatarsal base. Clinical Relevance: Whether using hook plates or headless compression screws, surgeons should consider protecting patient weight-bearing after fixation of fifth metatarsal base large avulsion fracture until bony union has occurred.

scholarly journals Biomechanical Comparison of Zone 1 5th Metatarsal Base Fracture Fixation

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0012
Author(s):  
Bryan Bean ◽  
Niall A. Smyth ◽  
Pooyan Abbasi ◽  
Brent Parks ◽  
Walter C. Hembree
Keyword(s):  
Small Sample Size ◽  
Plantar Fascia ◽  
Small Sample ◽  
Maximum Force ◽  
Hook Plate ◽  
Avulsion Fractures ◽  
Plate Group ◽  
Headless Compression Screws ◽  
Peroneus Brevis

Category: Basic Sciences/Biologics; Midfoot/Forefoot Introduction/Purpose: Zone 1 5th metatarsal base fractures are more common than zone 2 or 3 fractures, but significant debate still exists as to their optimum management, particularly for large fragments. The objective of this study was to compare the biomechanical strength of two headless compression screws versus a hook plate for fixation of large zone 1 5th metatarsal fractures. We hypothesized that hook plates would be biomechanically superior. Methods: Ten matched pairs of fresh-frozen 5th metatarsal cadaveric specimens were used. Large zone 1 avulsion fractures were simulated. Specimens were randomly assigned to fixation with two 2.5-mm headless compression screws or an anatomic 5th metatarsal hook plate. Specimens were mounted on a test frame and cyclically loaded through the plantar fascia, peroneus brevis tendon, and metatarsal base. Each specimen underwent 100 cycles at 50% physiological load (12 N on bone, 70 N on plantar fascia, 17.5 N on peroneus brevis), 100 cycles at 75% load (18 N on bone, 105 N on fascia, 26.25 N on peroneus brevis), and 100 cycles at 100% load (24 N on bone, 140 N on fascia, 35 N on peroneus brevis). Maximum cycles and maximum force were recorded. Results: The hook plate group had significantly higher cycles to completion of loading or failure compared with the screw group (270.7 +- 66.0 [range 100-300] cycles versus 178.6 +- 95.7 [range 24-300] cycles, respectively; P=0.011). Seven of 10 hook plate specimens and 2 of 10 screw specimens were intact at the maximum 300 cycles. Mean maximum force on the plantar fascia did not differ between the plate and screw groups (133.0 +- 22.1 [range 70-140]) N versus 119.0 +- 4.5 (range 70-140) N, respectively; P=0.098). Nine of 10 plate specimens and 5 of 10 screw specimens were intact at maximum force of 140 N. Conclusion: To our knowledge, this is the first biomechanical study comparing fixation constructs for 5th metatarsal avulsion fractures while loading the plantar fascia, which is the primary deforming force in vivo. These data suggest an anatomic hook plate is biomechanically superior to headless compression screw fixation of large zone 1 5th metatarsal avulsion fractures, which may prove pertinent in the setting of morbid obesity, fracture comminution, and/or fracture nonunion. Limitations include the relatively small sample size and the use of cadaveric bone which imperfectly mimics living tissue.

scholarly journals Headless Compression Screw Fixation of Jones Fractures

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0001
Author(s):  
David Ruta ◽  
Robert Ellis ◽  
Benjamin Grear ◽  
Susan Ishikawa ◽  
David Richardson ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Weight Bearing ◽  
Delayed Union ◽  
Compression Screw ◽  
Chi Square ◽  
Headless Compression Screw ◽  
Clinical Series ◽  
Headless Compression Screws ◽  
Intramedullary Screw ◽  
Radiographic Union

Category: Sports Introduction/Purpose: There remains controversy over the ideal implant for intramedullary screw fixation of fifth metatarsal Jones fractures. Promising results have separately been reported for both indication-specific partially threaded screws and headless compression screws. The purpose of this study was to compare clinical and radiographic results between Jones fracture patients treated with indication-specific partially threaded screws to variable-pitched headless compression screws. We also evaluated the association of various patient and fracture characteristics with surgical failure. Methods: We performed a retrospective review and comparative analyses of all Jones fractures treated with primary intramedullary screw fixation by 4 foot and ankle fellowship-trained orthopaedic surgeons at a single institution from 1995 through 2015. Exclusion criteria included concomitant foot or ankle procedures and revision surgery. Charts were reviewed for patient and injury characteristics, implant, and postoperative course. Serial radiographs were examined for fracture classification (Torg and anatomic zone) and radiographic union. Primary endpoint was number of surgical failures, defined as delayed union, nonunion, or refracture. Secondary endpoints included time to each of radiographic union, weight bearing, and pain resolution. Data were analyzed using independent T test, one-way ANOVA, chi-square, and correlation analyses with significance defined as p < 0.05. Results: Fifty-nine feet were reviewed with mean age 30 years and follow-up 9.6 months. Forty-seven received a partially threaded screw (PT) and 12 feet a headless compression screw (HC). The PT group had more failures (10/47, 21.3% vs. 1/12, 8.3%; p=0.31) and more weeks to full weight (4.2 vs. 3.3, p=0.06), without significant differences in time to radiographic union or pain resolution. Most failures were delayed unions. Pooled union rate was 96.6%. Correlated with failure were age (r=0.469, p < 0.001), diabetes (r=0.390, p=0.002), and BMI (r=0.281, p=0.03), without significant correlation for tobacco, gender, or weight. Compared to Torg 1 and 2, Torg 3 fractures had greater time to pain resolution and radiographic union, age, weight, and BMI. No differences were found between zone II and III fractures. Conclusion: To our knowledge, this is the first reported clinical comparison between indication-specific partially threaded screws (PT) and headless compression screws (HC) for treating Jones fractures. This is also one of the largest clinical series on the subject. The two groups had similar clinical and radiographic results, both with high union rates. While most failures were delayed unions that ultimately healed, the 21% failure rate in the PT group is concerning and may warrant further investigation. Increasing patient age, diabetes, and BMI were associated with worse outcomes. These data support headless compression screw fixation as a viable treatment for Jones fractures.

Single Versus Dual Headless Compression Screw Fixation of Scaphoid Nonunions: A Biomechanical Comparison

Hand ◽  
2021 ◽  
pp. 155894472097411
Author(s):  
Luke T. Nicholson ◽  
Kristen M. Sochol ◽  
Ali Azad ◽  
Ram Kiran Alluri ◽  
J. Ryan Hill ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Qualitative Assessment ◽  
Secondary Outcome ◽  
Scaphoid Nonunion ◽  
Compression Screw ◽  
Single Screw ◽  
Headless Compression Screw ◽  
Significant Difference ◽  
Load To Failure ◽  
Headless Compression Screws

Background: Management of scaphoid nonunions with bone loss varies substantially. Commonly, internal fixation consists of a single headless compression screw. Recently, some authors have reported on the theoretical benefits of dual-screw fixation. We hypothesized that using 2 headless compression screws would impart improved stiffness over a single-screw construct. Methods: Using a cadaveric model, we compared biomechanical characteristics of a single tapered 3.5- to 3.6-mm headless compression screw with 2 tapered 2.5- to 2.8-mm headless compression screws in a scaphoid waist nonunion model. The primary outcome measurement was construct stiffness. Secondary outcome measurements included load at 1 and 2 mm of displacement, load to failure for each specimen, and qualitative assessment of mode of failure. Results: Stiffness during load to failure was not significantly different between single- and double-screw configurations ( P = .8). Load to failure demonstrated no statistically significant difference between single- and double-screw configurations. Using a qualitative assessment, the double-screw construct maintained rotational stability more than the single-screw construct ( P = .029). Conclusions: Single- and double-screw fixation constructs in a cadaveric scaphoid nonunion model demonstrate similar construct stiffness, load to failure, and load to 1- and 2-mm displacement. Modes of failure may differ between constructs and represent an area for further study. The theoretical benefit of dual-screw fixation should be weighed against the morphologic limitations to placing 2 screws in a scaphoid nonunion.

scholarly journals Metacarpal Bony Dimensions Related to Headless Compression Screw Sizes

2019 ◽  
Vol 12 (S 01) ◽  
pp. S39-S44
Author(s):  
Michael Okoli ◽  
Kevin Lutsky ◽  
Michael Rivlin ◽  
Brian Katt ◽  
Pedro Beredjiklian
Keyword(s):  
Computed Tomography ◽  
Fracture Fixation ◽  
Ct Scans ◽  
Compression Screw ◽  
Metacarpal Head ◽  
Headless Compression Screw ◽  
Metacarpal Bones ◽  
Headless Compression Screws ◽  
The Mean ◽  
Distal Aspect

Abstract Introduction The purpose of this study is to determine the radiographic dimensions of the finger metacarpals and to compare these measurements with headless compression screws commonly used for fracture fixation. Materials and Methods We analyzed computed tomography (CT) scans of the index, long, ring, and small metacarpal bones and measured the metacarpal length, distance from the isthmus to the metacarpal head, and intramedullary diameter of the isthmus. Metacarpals with previous fractures or hardware were excluded. We compared these dimensions with the size of several commercially available headless screws used for intramedullary fixation. Results A total of 223 metacarpals from 57 patients were analyzed. The index metacarpal was the longest, averaging 67.6 mm in length. The mean distance from the most distal aspect of the metacarpal head to the isthmus was 40.3, 39.5, 34.4, and 31 mm for the index, long, ring, and small metacarpals, respectively. The narrowest diameter of the isthmus was a mean of 2.6, 2.7, 2.3, and 3 mm for the index, long, ring, and small metacarpals, respectively. Of 33 commercially available screws, only 27% percent reached the isthmus of the index metacarpal followed by 42, 48, and 58% in the long, ring, and small metacarpals, respectively. Conclusion The index and long metacarpals are at a particular risk of screw mismatch given their relatively long lengths and narrow isthmus diameters.

scholarly journals Low Rate of Complications Following Intramedullary Headless Compression Screw Fixation of Metacarpal Fractures

Hand ◽  
2019 ◽  
Vol 15 (6) ◽  
pp. 798-804 ◽  
Author(s):  
William J. Warrender ◽  
David E. Ruchelsman ◽  
Michael G. Livesey ◽  
Chaitanya S. Mudgal ◽  
Michael Rivlin
Keyword(s):  
Screw Fixation ◽  
Case Series ◽  
Compression Screw ◽  
Nickel Allergy ◽  
Hardware Failure ◽  
Metacarpal Fractures ◽  
Headless Compression Screw ◽  
Clinical Complications ◽  
Headless Compression Screws ◽  
Low Incidence

Background: There has been a recent increase in the use of headless compression screws for fixation of metacarpal neck and shaft fractures as they offer several advantages, and minimal complications have been reported. This study aimed to evaluate the clinical complications and their solutions following retrograde intramedullary headless compression screw fixation of metacarpal fractures. We describe complications and the approach to their management. Methods: We performed a multicenter case series through retrospective review of all patients treated with intramedullary headless screw fixation of metacarpal fractures by 3 fellowship-trained hand surgeons. Patient demographics, implant used, type of complication, pre- and postoperative radiographs, operative reports, and sequelae were reviewed for each case. We defined complications as infection, loss of fixation, hardware failure, malrotation, nonunion, malunion, metal allergy, and any repeat surgical intervention. Results: Four complications (2.5%) were identified through the review of 160 total metacarpal fractures. One complication was a nickel allergy, one was a broken screw after repeat trauma, and 2 patients had bent intramedullary screws. Screw removal in 3 patients was simple and without complications or persistent limitations. One bent screw with a refracture was left in place. No serious complications were seen. Conclusion: Intramedullary screw fixation of metacarpal fractures is safe with a low incidence of complications (2.5%) that can be safely and effectively managed.

Treatment of proximal phalangeal fractures with an antegrade intramedullary screw: a cadaver study

2016 ◽  
Vol 41 (7) ◽  
pp. 683-687 ◽  
Author(s):  
P. Borbas ◽  
M. Dreu ◽  
A. Poggetti ◽  
M. Calcagni ◽  
T. Giesen
Keyword(s):  
Articular Surface ◽  
Proximal Phalanx ◽  
Metacarpophalangeal Joint ◽  
Cadaver Study ◽  
Compression Screw ◽  
Headless Compression Screw ◽  
Headless Compression Screws ◽  
Average Defect ◽  
Phalangeal Fractures ◽  
Intramedullary Screw

The aim of this study was to quantify the articular cartilage defect created with two different antegrade techniques of intramedullary osteosynthesis with a headless compression screw inserted through the metacarpophalangeal joint. In 12 out of 24 fingers from six cadaveric hands, a trans-articular technique with cannulated headless compression screws (2.2 and 3.0 mm diameter) was used; whereas in the other 12 fingers, an intra-articular fixation technique was used. The areas of the articular surface and the defects created were measured with a digital image software program. All measurements were made twice by two observers. In the intra-articular technique, the average defect in the base of the articular surface of the proximal phalanx was 4.6% with the 2.2 mm headless compression screw and 8.5% with the 3.0 mm screw. In the trans-articular technique, the defect size was slightly smaller; 4.2% with the 2.2 mm screw and 8% with the 3.0 mm screw, but the differences were not statistically significant. The main advantage of the intra-articular technique was that it avoided damage to the articular surface of the metacarpal head.

scholarly journals The Radiologic Comparison of Operative Treatment Using a Hook Plate versus a Distal Clavicle Locking Plate of Distal Clavicle Fracture

2018 ◽  
Vol 21 (4) ◽  
pp. 227-233
Author(s):  
Byungil Yoon ◽  
Jae Yoon Kim ◽  
Jae Sung Lee ◽  
Hyoung Seok Jung
Keyword(s):  
Locking Plate ◽  
Metal Removal ◽  
Clavicle Fracture ◽  
Hook Plate ◽  
Plate Versus ◽  
Bony Union ◽  
Distal Clavicle ◽  
Distal Clavicle Fracture ◽  
Plate Group ◽  
Coracoclavicular Distance

BACKGROUND: The purpose of this study was to compare the radiologic results of patients who underwent surgery with a hook plate and a locking plate in distal clavicle fractures.METHODS: Sixty patients underwent surgical treatment for Neer type IIa, IIb, III, and V distal clavicle fracture. Twenty-eight patients underwent fracture fixation with a hook plate and 32 with a locking plate. Coracoclavicular distance was measured on standard anteroposterior radiographs before and after the surgery, and union was confirmed by radiograph or computed tomography taken at 6 months postoperatively. Other radiologic complications like osteolysis was also checked.RESULTS: Bony union was confirmed in 59 patients out of 60 patients, and 1 patient in the hook plate group showed delayed union. Coracoclavicular distance was decreased more in the hook plate group after surgery (p < 0.01). After 6 weeks of the hook plate removal, the coracoclavicular distance was increased a little compared to before metal removal, but there was no difference compared to the contralateral shoulder. Eleven out of 28 patients (39.3%) showed osteolysis on the acromial undersurface in the hook plate group.CONCLUSIONS: Both the hook plate group and the locking plate group showed satisfactory radiologic results in distal clavicle fractures. Both hook plate and locking plate could be a good treatment option if it is used in proper indication in distal clavicle fracture with acromioclavicular subluxation or dislocation.

scholarly journals Arthrodesis of the Distal Interphalangeal Joint and the Thumb Interphalangeal Joint: A Retrospective Comparison of Kirschner Wires and the Acutrak 2 Headless Compression Screw

2019 ◽  
Vol 13 (1) ◽  
pp. 166-169
Author(s):  
Jens-Christian Vedel ◽  
Rasmus Wejnold Jorgensen ◽  
Claus Hjorth Jensen
Keyword(s):  
Kirschner Wire ◽  
Fusion Rate ◽  
Interphalangeal Joint ◽  
Distal Interphalangeal Joint ◽  
Kirschner Wires ◽  
Compression Screw ◽  
Headless Compression Screw ◽  
Headless Compression Screws ◽  
Distal Interphalangeal ◽  
Total Fusion

Background: Headless compression screws have become first choice for achieving arthrodesis in the distal interphalangeal joint and thumb interphalangeal joint. Only few comparisons between headless compression screws and other methods have been published. Objective: To assess healing and complication rate after arthrodesis of the distal interphalangeal joint or the thumb interphalangeal joint using a headless compression screw or Kirschner wires. Methods: A retrospective analysis of 148 consecutive primary fusions performed with the Acutrak 2 headless compression screw (n=107) or K-wires (n=41) was conducted. Healing was assessed clinically and radiographically at 6 to 8 weeks postoperatively. Results: In 89% of cases fusion had been achieved at 6 to 8 weeks postoperatively using the headless compression screw. 7 cases healed after 8 weeks. Secondary surgery with screw removal was required in 11 cases due to screw prominence, infection or non-union. In 71% of cases fusion had been achieved at 6 to 8 weeks postoperatively using Kirschner wires showing a lower fusion rate at this stage as compared to the headless compression screw group (p<0.05). 9 joints in the Kirschner wire group fused at some point after 8 weeks of follow up yielding a total fusion rate of 93% which was similar to 96% in the headless compression screw group (p>0.05). One infection occurred in the Kirschner wire group. Conclusion: Arthrodesis can be achieved with either a headless compression screw or Kirschner wires both showing equivalent total fusion rates though fusion may occur earlier using a headless compression screw.

scholarly journals A Unique Presentation of Scaphocapitate Syndrome With Extrusion Into the Carpal Tunnel: A Case Report

Hand ◽  
2018 ◽  
Vol 13 (6) ◽  
pp. NP39-NP45
Author(s):  
Sheriff D. Akinleye ◽  
Eitan Melamed
Keyword(s):  
Carpal Tunnel ◽  
Scaphoid Fracture ◽  
Dorsal Approach ◽  
Compression Screw ◽  
Unique Case ◽  
Unique Challenge ◽  
Volar Approach ◽  
Headless Compression Screw ◽  
Headless Compression Screws ◽  
Capitate Fracture

Background: Scaphocapitate syndrome is a rare variety of perilunate instability, described as a trans-scaphoid, trans-capitate fracture, with rotation of the capitate head either 90° or 180°. Methods: We present a unique case of scaphocapitate syndrome in which the rotated proximal capitate fragment expelled into the carpal canal. Results: The capitate head was extricated from the carpal tunnel via the volar approach, and was anatomically aligned and fixed through the dorsal approach using two 2.0 mm headless compression screws. The scaphoid fracture was then also reduced through the dorsal approach and stabilized with a 2.5 mm headless compression screw. All intercarpal ligaments appeared intact. Conclusions: Volar dislocation of the proximal capitate into the carpal tunnel in scaphocapitate syndrome presents a unique challenge that can be addressed with a combined volar and dorsal approach.

Biomechanical Analysis of Conventional Partially Threaded Screws Versus Headless Compression Screws in Proximal Fifth Metatarsal (Jones) Fracture Fixation

2020 ◽  
pp. 193864002093166
Author(s):  
Kenrick Lam ◽  
Roger Bui ◽  
Randal Morris ◽  
Vinod Panchbhavi
Keyword(s):  
Biomechanical Analysis ◽  
Therapeutic Level ◽  
Compression Screw ◽  
Significant Difference ◽  
Headless Compression Screws ◽  
Fresh Frozen ◽  
Cantilever Bending ◽  
Fracture Stiffness ◽  
Intramedullary Screw ◽  
Cadaveric Model

Background. Intramedullary screw fixation of Jones fractures using partially threaded screws is a common method of fixation for these injuries, but refracture continues to be a problem. Various other fixation strategies, such as headless compression screws, plantar plating, and tension-band wiring. have been developed to mitigate these issues. Biomechanical studies with regard to these other fixation strategies are limited. Herein, we investigate the compression strength and angular stiffness of Jones fractures fixed with Herbert-style headless compression screws. Methods. Jones fractures were created in 10 fresh-frozen pairs of cadaveric fifth metatarsals. A bone from each pair was instrumented with either a conventional, partially threaded screw 5.0 or 6.5 mm in diameter, or a headless compression screw 5.0 or 7.0 mm in diameter. Sizes were determined via sequential tapping until a snug fit was obtained. Each metatarsal was stressed via cantilever bending over 1000 cycles. We monitored compression and displacement throughout. Results. Headless compression screws achieved a significantly higher amount of stiffness than conventional, partially threaded screws (P = 0.005). There was no statistically significant difference with respect to compression. Conclusion. In a cadaveric model, headless compression screws achieved a greater amount of fracture stiffness versus conventional, partially threaded screws. Levels of Evidence: Therapeutic, Level V: Biomechanical

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