A Biomechanical Evaluation of Three Forms of Internal Fixation Used in Ankle Arthrodesis

1994 ◽  
Vol 15 (6) ◽  
pp. 297-300 ◽  
Author(s):  
Michael P. Dohm ◽  
James B. Benjamin ◽  
Jeffrey Harrison ◽  
John A. Szivek
Keyword(s):  
Internal Fixation ◽  
Plate Fixation ◽  
Ankle Arthrodesis ◽  
Biomechanical Study ◽  
The Other ◽  
Fixation Failure ◽  
Plate Group ◽  
Biomechanical Evaluation ◽  
The Stability ◽  
Fibular Strut

A biomechanical study was undertaken to evaluate the relative stability of three types of internal fixation used for ankle arthrodesis. Crossed screw fixation, RAF fibular strut fixation, and T-plate fixation were tested in 30 cadaver ankles using an MTS machine. T-plate fixation consistantly provided the stiffest construct when compared with the other types of fixation. Failure occurred by distraction of bony surfaces, posterior to the plane of fixation, in the crossed screw and RAF groups. In contrast, failure in the T-plate group occurred through compression of bone anterior to the midcoronal plane of the tibia. Although the stability of fixation is only one factor in determining the success or failure of ankle arthrodesis, the results of this study would support T-plate fixation over the other forms tested.

scholarly journals A Biomechanical Evaluation of a Next-Generation Integrated and Modular ACDF Device Possessing Full-Plate, Half-Plate, and No-Profile Fixation Iterations

2019 ◽  
Vol 9 (8) ◽  
pp. 826-833
Author(s):  
Ripul Panchal ◽  
Anup Gandhi ◽  
Chris Ferry ◽  
Sam Farmer ◽  
Jeremy Hansmann ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Testing Machine ◽  
Axial Rotation ◽  
Biomechanical Study ◽  
The Novel ◽  
Novel Device ◽  
Plate Group ◽  
Flexion Extension ◽  
Group 2

Study Design: In vitro biomechanical study. Objectives: The objective of this in vitro biomechanical range-of-motion (ROM) study was to evaluate spinal segmental stability following fixation with a novel anterior cervical discectomy and fusion (ACDF) device (“novel device”) that possesses integrated and modular no-profile, half-plate, and full-plate fixation capabilities. Methods: Human cadaveric (n = 18, C3-T1) specimens were divided into 3 groups (n = 6/group). Each group would receive one novel device iteration. Specimen terminal ends were potted. Each specimen was first tested in an intact state, followed by anterior discectomy (C5/C6) and iterative instrumentation. Testing order: (1) novel device (group 1, no-profile; group 2, half-plate; group 3, full-plate); (2) novel device (all groups) with lateral mass screws (LMS); (3) traditional ACDF plate + cage; (4) traditional ACDF plate + cage + LMS. A 2 N·m moment was applied in flexion/extension (FE), lateral bending (LB), and axial rotation (AR) via a kinematic testing machine. Segmental ROM was tracked and normalized to intact conditions. Comparative statistical analyses were performed. Results: Key findings: (1) the novel half- and full-plate constructs provided comparable reduction in FE and LB ROM to that of traditional plated ACDF ( P ≥ .05); (2) the novel full-plate construct significantly exceeded all other anterior-only constructs ( P ≤ .05) in AR ROM reduction; and (3) the novel half-plate construct significantly exceeded the no-profile construct in FE ( P < .05). Conclusions: The novel ACDF device may be a versatile alternative to traditional no-profile and independent plating techniques, as it provides comparable ROM reduction in all principle motion directions, across all device iterations.

Application of the Titanium Plate Fixation System in Sternum Transverse Incisions

2011 ◽  
Vol 77 (11) ◽  
pp. 1477-1482
Author(s):  
Qin-Yun Ma ◽  
Yong-Jun Zhu ◽  
Lie-Wen Pang ◽  
Gang Chen ◽  
Ji Chen ◽  
...  
Keyword(s):  
Healing Rate ◽  
Steel Wire ◽  
Plate Fixation ◽  
Long Term Results ◽  
Titanium Plate ◽  
Plate Group ◽  
Wire Fixation ◽  
The Stability ◽  
Fixation System

The purpose of this study was to review the application of the titanium plate fixation system in sternum transverse incisions and assess its advantages over the conventional methods of steel wire fixation. Sternal healing of 249 patients who underwent a thymectomy and/or excision of the thymoma with a transverse sternal incision was compared between patients who underwent titanium plate fixation or steel wire fixation. Short-term results: The stability of the sternum was significantly superior in the titanium plate group compared with the steel wire group ( P < 0.01). Out-of-bed activities started earlier for patients in the titanium plate group compared with the steel wire group ( P < 0.01). Long-term results: The sternal healing rate in the titanium plate group was significantly higher than the steel wire group ( P < 0.05). Titanium plate fixation improves the postoperative sternal stability in patients with transverse sternal incisions for thymectomy and/or excision of a thymoma. Titanium plate fixation also reduces postoperative pain, enhances the patient's physical activity, and decreases the long-term nonunion rate of the sternum.

Calcaneal Tuberosity Fracture (Beak Fracture) Fixation Using a Pre-contoured “L-form” Hook Plate: A Retrospective Study

2021 ◽  
Author(s):  
Qiang Zhang ◽  
Chan Zhu ◽  
Zongde Wu
Keyword(s):  
Retrospective Study ◽  
Internal Fixation ◽  
Plate Fixation ◽  
Hook Plate ◽  
Fixation Technique ◽  
Fixation Failure ◽  
Clinical Healing ◽  
Ankle Function ◽  
Calcaneal Tuberosity

Abstract Background: The treatment of calcaneal tuberosity fracture (beak fracture) is very tricky. Patients’ ankle function may be badly affected by skin flap necrosis and internal fixation failure. This study presented a simple, and safe internal fixation technique which is to fix the fracture fragment with a pre-contoured “L-form” hook plate.Methods: A retrospective study was done to analyze patients with calcaneal tuberosity fracture who were treated with pre-contoured “L-form” hook plate fixation from January 2015 to February 2020. When the patients could complete single-legged heel raise tests, and when they achieved clinical healing criteria were reviewed. Functional assessment was performed according to the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS-AH) scores and the Visual Analogue Scale (VAS) was recommended for assessment of pain intensity (PI).Results: There were a total of 15 patients of calcaneal tuberosity fracture (beak fracture) treated with the pre-contoured “L-form” hook plate fixation technique, among which eight patients were female and the others were male, with the age ranging from 35 to 69 years (average of 55.3±9.0 years). And the mean duration of follow-up was 22.53±5.78 months (range: 12 to 36 months). 11 cases underwent emergency surgery. After the operation, there were no complications such as wound dehiscence, poor wound healing, infections, or plate exposure, no sural nerve injuries or venous thromboembolic events. Also, there was no loss of reduction or fixation failure in the follow-up. All 15 cases achieved clinical healing at 8-13 weeks (average 10.5±1.4 weeks) postoperatively. They were able to perform the test on their affected leg after 3.7±0.7 months (3-5 months) on average. The preoperative VAS and AOFAS-AH scores were 5.7±0.6 and 24.0±9.9 respectively, while the postoperative VAS and AOFAS-AH scores at the last follow-up were 1.3±0.5 and 93.8±5.2 (p<0.001).Conclusion: Emergency open reduction and internal fixation should be provided as soon as possible. For patients with Beavis type II beak fractures, the pre-contoured “L-form” hook plate fixation technique helps them restore normal ankle function. This simple, safe, and strong internal fixation technique can be one of the treatment options for avulsion fractures of the calcaneal tuberosity.

scholarly journals Does posterior configuration have similar strength as parallel configuration for treating comminuted distal humerus fractures? A cadaveric biomechanical study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Chien-An Shih ◽  
Fa-Chuan Kuan ◽  
Kai-Lan Hsu ◽  
Chih-Kai Hong ◽  
Cheng-Li Lin ◽  
...  
Keyword(s):  
Failure Modes ◽  
Sagittal Plane ◽  
Distal Humerus ◽  
Biomechanical Study ◽  
Posterior Fixation ◽  
Fixation Failure ◽  
Plate Group ◽  
Failure Loads ◽  
Humerus Fractures ◽  
Distal Humerus Fractures

Abstract Background The posterior plating technique could be used as a clinical alternative to parallel plating for treating comminuted distal humerus fractures (DHFs) successfully with good clinical results. However, the biomechanical characteristics for posterior fixation are still unclear. The purpose of this study is to evaluate the biomechanical properties of the posterior fixation and to make comparisons between the parallel and the posterior fixation systems. Materials and methods We performed a cadaveric biomechanical testing with two posterior plating systems (a posterior two plating and a single posterior pre-contoured Y plating system) and one parallel two plating system to treat AO/OTA type-C2.3 DHFs. Among three groups, we compared construct stiffness, failure strength, and intercondylar width changes after 5000-cycle fatigue loading and failure loads and failure modes after destructive tests in both the axial compression and (sagittal) posterior bending directions. The correlations between construct failure loads and bone marrow density (BMD) were also compared. Results In axial direction, there were no significant differences in the stiffness and failure load between the posterior and the parallel constructs. However, in sagittal direction, the two-plate groups (posterior two plating and parallel plating group) had significant higher stiffness and failure loads than the one-plate group (single posterior Y plating). There was no fixation failure after 5000-cyclic loading in both directions for all groups. Positive correlation was noted between BMD and failure loads on parallel fixation. Conclusions We found that when using two plates for treating comminuted DHFs, there were no significant differences in terms of most biomechanical measurements between posterior and parallel fixation. However, the single pre-contoured posterior Y plate construct was biomechanically weaker in the sagittal plane than the parallel and the posterior two-plate constructs, although there was no fixation failure after the fatigue test for all groups regardless of the fixation methods. Level of evidence Biomechanical study

Evaluation of the stability of a novel lateral plate internal fixation: an in vitro biomechanical study

2021 ◽  
Author(s):  
Zecheng Cai ◽  
Rong Ma ◽  
Jianqun Zhang ◽  
Xiaoyin Liu ◽  
Wei Yang ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Biomechanical Study ◽  
Lateral Plate ◽  
The Stability

scholarly journals A Biomechanical Comparison of Three 1.5-mm Plate and Screw Configurations and a Single 2.0-mm Plate for Internal Fixation of a Mandibular Condylar Fracture

2014 ◽  
Vol 7 (3) ◽  
pp. 218-223 ◽  
Author(s):  
Peter Aquilina ◽  
William C.H. Parr ◽  
Uphar Chamoli ◽  
Stephen Wroe ◽  
Philip Clausen
Keyword(s):  
Internal Fixation ◽  
Material Properties ◽  
Plate Fixation ◽  
Pure Titanium ◽  
Mandibular Condyle ◽  
Titanium Implants ◽  
Condylar Fracture ◽  
Square Plate ◽  
The Stability ◽  
Condyle Fracture

The most stable pattern of internal fixation for mandibular condyle fractures is an area of ongoing discussion. This study investigates the stability of three patterns of plate fixation using readily available, commercially pure titanium implants. Finite element models of a simulated mandibular condyle fracture were constructed. The completed models were heterogeneous in bone material properties, contained approximately 1.2 million elements and incorporated simulated jaw adducting musculature. Models were run assuming linear elasticity and isotropic material properties for bone. No human subjects were involved in this investigation. The stability of the simulated condylar fracture reduced with the different implant configurations, and the von Mises stresses of a 1.5-mm X-shaped plate, a 1.5-mm rectangular plate, and a 1.5-mm square plate (all Synthes (Synthes GmbH, Zuchwil, Switzerland) were compared. The 1.5-mm X plate was the most stable of the three 1.5-mm profile plate configurations examined and had comparable mechanical performance to a single 2.0-mm straight four-hole plate. This study does not support the use of rectangular or square plate patterns in the open reduction and internal fixation of mandibular condyle fractures. It does provide some support for the use of a 1.5-mm X plate to reduce condylar fractures in selected clinical cases.

Primary Union of Ankle Arthrodesis: Review of a Single Institution/Multiple Surgeon Experience

1994 ◽  
Vol 15 (6) ◽  
pp. 293-296 ◽  
Author(s):  
Micheal Dohm ◽  
Beth Ann Purdy ◽  
James Benjamin
Keyword(s):  
Surgical Technique ◽  
Success Rate ◽  
Plate Fixation ◽  
Ankle Arthrodesis ◽  
Single Institution ◽  
Index Procedure ◽  
Surgeon Experience ◽  
Primary Union ◽  
Fibular Strut ◽  
Initial Success Rate

A review of 37 ankle arthrodesis procedures done over a 12-year period by multiple surgeons at a single institution was performed. Six different techniques were used during the study period. The initial success rate, defined as cases achieving a solid union after the index procedure, was 65%. Seven additional patients went on to a solid arthrodesis after subsequent surgical procedures, for an ultimate success rate of 84%. The initial success rate varied considerably depending on the surgical technique used, and ranged from 29% with the RAF fibular strut technique to 100% with T-plate fixation. Although there are many variables that influence the success or failure of ankle arthrodesis, in our hands rigid internal fixation gave the most predictable rate of primary union.

scholarly journals Oblique Lateral Interbody Fusion Combined With Different Internal Fixations in The Treatment of Degenerative Lumbar Spine Disease: A Finite Element Analysis

2021 ◽  
Author(s):  
ShuYi Zhang ◽  
Zhengpeng Liu ◽  
Chenshui Lu ◽  
Li Zhao ◽  
Chao Feng ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Finite Element ◽  
Internal Fixation ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Three Dimensional ◽  
Fe Analysis ◽  
The Other ◽  
The Stability ◽  
Unilateral Pedicle Screw

Abstract Little is known about the biomechanical performance of various internal fixations in oblique lumbar interbody fusion (OLIF). In this study, finite element (FE) analysis was used to describe the biomechanical findings of various different internal fixations to compare and explore the stability of each fixation.METHODS: Six validated FE models of the L3-S1 segment were reconstructed from computed tomography images, including (1) an intact model, (2)a stand-alone (SA) model with no instrument (3) a unilateral pedicle screw model (UPS), (4) a unilateral pedicle screw contralateral translaminar facet screw model (UPS-CTLFS), (5) a bilateral pedicle screw (BPS) model, and (6) a cortical bone trajectory screw (CBT).Three-dimensional model was performed by computed tomography data, and 150N static force and 10N.m moments in different directions were applied to the models to analyze the validation of the models in comparison with previous studies. Models of the OLIF cage was created with three-dimensional scanning to improve the accuracy of the FE analysis. Range of motion (ROM) of the surgical segment stresses, stress of the cage, and stress of fixation were evaluated in the different models.RESULTS:ROM increased from least to greatest as follows: BPS, UPS-CTFS, CBT, UPS, SA. The SA group had the greatest ROM and the SA group had the greatest ROM and stresses on the CAGE. The ROM of the BPS and UPS-CTFS was not significantly different for all motion loadings. Compared with the other three models, the BPS model had lower stresses in internal fixation for all loading conditions and the CBT screw internal fixation had the highest stresses for different loads Compared with the other groups.CONCLUSIONSThe BPS model provided the best biomechanical stability for OLIF. The SA model was relatively less stable. The UPS-CFTS group reduced the ROM of the fusion segments, but the stresses on the internal fixation and CAGE were relatively higher in the UPS-CFTS Compared with the BPS group; and the CBT group had lower ROM in flexion and extension Compared with the BPS, but its ROM in rotation and lateral flexion was relatively higher. The stability of the CBT was poorer than that of the BPS and LPS-CTFS groups. The stress on the CAGE and internal fixation was greater in the CBT group.

scholarly journals Retrograde Tibial Nailing for Arthrodesis of Ankle and Subtalar Joints

2015 ◽  
Vol 2 (2) ◽  
pp. 60-70
Author(s):  
Govind Shivram Kulkarni ◽  
Milind Govind Kulkarni ◽  
Sunil Govind Kulkarni ◽  
Vidisha Sunil Kulkarni ◽  
Ruta Milind Kulkarni
Keyword(s):  
The Other ◽  
Asia Pacific ◽  
Joint Surfaces ◽  
Intramedullary Canal ◽  
Retrograde Nail ◽  
Principles Of Treatment ◽  
Post Traumatic ◽  
The Stability ◽  
Calcaneal Tuberosity ◽  
Fibular Strut

ABSTRACT Introduction When ankle and subtalar joints are arthritic and painful they both need fusion. Principles of treatment by fusion are removal of cartilage till bleeding of subchondral bone, keeping the joint surfaces congruous, proper positioning of the foot and ankle and stable fixation. Materials and methods During the last 10 years, 16 cases of retrograde nailing were done. Eight cases were post-traumatic, one was tuberculosis, three for Charcot joint and three for osteoarthritis of the ankle joint, and one case of rheumatoid arthritis. All patients had severe pain instability, varying degrees of deformities and antalgic gain. Two cases were treated with supracondylar femoral interlocking nail. Nine cases were treated with antegrade tibial nail as retrograde nail. Nine cases were treated with retrograde tibial nails with posteroanterior calcaneal screws. Two cases were treated with special nails newly designed by Smith and Nephew. Initially, older the calcaneus had two latero-medial screws. Newer designs of nail have two posteroanterior screws, passing from calcaneal tuberosity through the nail—one towards cuboid and the other towards talus. These two screws have increased the stability of the construct and improved the outcome. Mann's technique of ankle fusion was used. Fibular strut was used as bone graft and fixed by one screws into the tibia and the other into talus. Indian tibia is smaller in diameter with a narrow intramedullary canal. Indian tibia need to have a nail with a smaller diameter. Results When supracondylar femoral and antegrade tibial nails were used, 4 out of 5 failed. When newer design nails with posteroanterior calcaneal screws were used, outcome improved 2 out of 11 failed. Conclusion Newer design of retrograde tibial nails with two posteroanterior screws have greatly improved the outcome of pantalar arthrodesis. How to cite this article Kulkarni GS, Kulkarni MG, Kulkarni SG, Kulkarni VS, Kulkarni RM. Retrograde Tibial Nailing for Arthrodesis of Ankle and Subtalar Joints. J Foot Ankle Surg (Asia- Pacific) 2015;2(2):60-70.

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