A Biomechanical Comparison of Intramedullary Nail and Crossed Lag Screw Fixation for Tibiotalocalcaneal Arthrodesis

1997 ◽  
Vol 18 (10) ◽  
pp. 639-643 ◽  
Author(s):  
Michael Edward Berend ◽  
Richard Robert Glisson ◽  
James Albert Nunley
Keyword(s):  
Intramedullary Nail ◽  
Screw Fixation ◽  
External Rotation ◽  
Fusion Rate ◽  
Tibiotalocalcaneal Arthrodesis ◽  
Lag Screw ◽  
Ankle Joints ◽  
Mechanical Bending ◽  
Cantilever Bending ◽  
Biomechanical Comparison

This study compared the mechanical bending and torsional properties of intramedullary nail fixation and lag screw fixation for tibiotalocalcaneal arthrodesis. Seven matched pairs of human cadaver lower extremities were studied, with one hindfoot in each pair stabilized with a 12 mm × 150 mm interlocked intramedullary nail inserted retrograde across the subtalar and ankle joints. The contralateral hindfoot was stabilized with two crossed 6.5 mm cannulated screws inserted across both the ankle and subtalar joints. Specimens were subjected to cantilever bending tests in plantarflexion, dorsiflexion, inversion, and eversion and to torsional tests in internal and external rotation. The intramedullary nail construct was significantly ( P < 0.05) stiffer than the crossed lag screw construct in all four bending directions and both rotational directions: plantarflexion (nail, 42.8 N/mm; screws, 16.4 N/mm; P = 0.0003), dorsiflexion (nail, 43.0 N/mm; screws, 10.3 N/mm; P = 0.0005), inversion (nail, 37.7 N/mm; screws, 12.3 N/mm; P = 0.0024), eversion (nail, 35.4 N/mm; screws, 10.8 N/mm; P = 0.0004), internal rotation (nail, 1.29 N-m/°; screws, 0.82 N-m/°; P = 0.01), external rotation (nail, 1.35 N-m/°; screws, 0.44 N-m/°; P = 0.0001). Intramedullary fixation is biomechanically stiffer than crossed lag screws in all bending and torsional directions tested and therefore this construct may aid in maintaining alignment of the hindfoot during union and may help increase fusion rate through increased stability of the internal fixation.

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

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

Screw fixation of radial head fractures: Compression screw versus lag screw—A biomechanical comparison

Injury ◽  
2010 ◽  
Vol 41 (10) ◽  
pp. 1015-1019 ◽  
Author(s):  
Klaus J. Burkhart ◽  
Tobias E. Nowak ◽  
Philipp Appelmann ◽  
Werner Sternstein ◽  
Pol M. Rommens ◽  
...  
Keyword(s):  
Radial Head ◽  
Screw Fixation ◽  
Compression Screw ◽  
Radial Head Fractures ◽  
Lag Screw ◽  
Biomechanical Comparison

scholarly journals Biomechanical Comparison of the Holding Strength of a PEEK Locking Dorsal Plate Versus Lag Screw Fixation for Triple Arthrodesis

2016 ◽  
Vol 1 (1) ◽  
pp. 2473011416S0013
Author(s):  
Jefferson Sabatini ◽  
Kenneth S. Smith ◽  
Alan Eberhardt ◽  
John S. Kirchner
Keyword(s):  
Screw Fixation ◽  
Plate Versus ◽  
Dorsal Plate ◽  
Triple Arthrodesis ◽  
Lag Screw ◽  
Biomechanical Comparison

Biomechanical Comparison of 3 Current Ankle Syndesmosis Repair Techniques

2016 ◽  
Vol 38 (2) ◽  
pp. 200-207 ◽  
Author(s):  
Thomas O. Clanton ◽  
Scott R. Whitlow ◽  
Brady T. Williams ◽  
Daniel J. Liechti ◽  
Jonathon D. Backus ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Screw Fixation ◽  
External Rotation ◽  
Three Dimensional ◽  
Compressive Load ◽  
Rotational Stability ◽  
Suture Button ◽  
Biomechanical Comparison ◽  
Single Suture ◽  
Repair Techniques

Background: Significant debate exists regarding optimal repair for unstable syndesmosis injuries. Techniques range from screw fixation, suture-button fixation, or a combination of the two. In this study, 3 common repairs were compared using a simulated weightbearing protocol with internal and external rotation of the foot. Methods: Twenty-four lower leg specimens with mean age 54 years (range, 38-68 years) were used for testing. Following creation of a complete syndesmotic injury (AITFL, ITFL, PITFL, interosseous membrane), specimens were repaired using 1 of 3 randomly assigned techniques: (1) one 3.5-mm syndesmotic screw, (2) 1 suture-button construct, and (3) 2 divergent suture-button constructs. Repairs were cycled for 500 cycles between 7.5 Nm of internal/external rotation torque under a constant 750 N axial compressive load in a neutral dorsiflexion position. At 0, 10, 100, and 500 cycles, torsional cyclic loading was interrupted to assess torsional resistance to rotation within a physiologic range of motion (15 degrees external rotation to 10 degrees internal rotation). Torque (Nm), rotational position (degrees), and 3-dimensional data were collected throughout the testing to characterize relative spatial relationships of the tibiofibular articulation. Results: There were no significant differences between repair techniques in resistance to internal and external rotation with respect to the intact syndesmosis. Three-dimensional analysis revealed significant differences between repair techniques for sagittal fibular translation with external rotation of the foot. Screw fixation had the smallest magnitude of posterior sagittal translation (2.5 mm), and a single suture-button construct demonstrated the largest magnitude of posterior sagittal translation (4.6 mm). Screw fixation also allowed for significantly less anterior sagittal translation with internal rotation of the foot (0.1 mm) when compared to both 1 (2.7 mm) and 2 (2.9 mm) suture-button constructs. Conclusion: All repairs provided comparable rotational stability to the syndesmosis; however, no repair technique completely restored rotational stability and tibiofibular anatomic relationships of the preinjury state. Clinical Relevance: Constructs were comparable across most conditions; however, when repairing injuries with a suture-button construct, a single suture-button construct may not provide sufficient resistance to sagittal translation of the fibula.

scholarly journals Anterior Transcervical Lag Screw Fixation of Type II Odontoid Fracture

2020 ◽  
Vol 17 (2) ◽  
pp. 73-76
Author(s):  
Dinuj Shrestha ◽  
Pratyush Shrestha
Keyword(s):  
Screw Fixation ◽  
Early Mobilization ◽  
Fusion Rate ◽  
Odontoid Fracture ◽  
Successful Outcome ◽  
Type Ii ◽  
Lag Screw ◽  
Recent Fracture ◽  
Cervical Spine Fractures ◽  
High Fusion Rate

Odontoid fracture comprises approximately 20% of all cervical spine fractures. Among them type II fracture accounts for about 65-74%. Presently, direct anterior screw fixation is considered to provide successful outcome with fracture healing of 80% and also preserve C1/C2 rotation movement with benefit of early mobilization and rapid return to normal life style. Recent fracture(<6months) have high fusion rate of 90% with this approach and for remote fracture(≥18months) it reduces to 25%. Here we present a case report of 18 years old female with type II odontoid fracture and underwent anterior transcervical lag screw fixation under C-arm guidance.

Effect of Ankle Position on Tibiotalar Motion With Screw Fixation of the Distal Tibiofibular Syndesmosis in a Fracture Model

2018 ◽  
Vol 39 (6) ◽  
pp. 746-750 ◽  
Author(s):  
Mark P. Pallis ◽  
David N. Pressman ◽  
Kenneth Heida ◽  
Tyler Nicholson ◽  
Susan Ishikawa
Keyword(s):  
Screw Fixation ◽  
External Rotation ◽  
Fracture Model ◽  
Tibiofibular Syndesmosis ◽  
Traumatic Injuries ◽  
Lag Screw ◽  
Syndesmotic Screw ◽  
Distal Tibiofibular Syndesmosis ◽  
Anatomic Reduction ◽  
Pronation External Rotation

Background: Anatomic reduction and fixation of the syndesmosis in traumatic injuries is paramount in restoring function of the tibiotalar joint. While overcompression is a potential error, recent work has called into question whether ankle position during fixation really matters in this regard. Our study aimed to corroborate more recent findings using a fracture model that, to our knowledge, has not been previously tested. Methods: Twenty cadaver leg specimens were obtained and prepared. Each was tested for tibiotalar motion under various conditions: intact syndesmosis, intact syndesmosis with lag screw compression, pronation external rotation type 4 (PER-4) ankle fracture with syndesmotic disruption, and single-screw syndesmotic fixation followed by plate and screw fracture and syndesmotic screw fixation. In each situation, the ankle was held in alternating plantarflexion and dorsiflexion when inserting the syndesmotic screw with the subsequent amount of maximal dorsiflexion being recorded following hand-tight lag screw fixation. Results: While ankle range of motion increased significantly with creation of the PER-4 injury, under no condition was there a statistically significant change in maximal dorsiflexion angle. Conclusion: Ankle position during distal tibiofibular syndesmosis fixation did not limit dorsiflexion of the ankle joint. Clinical Relevance: Our findings suggest that maximal dorsiflexion during syndesmotic screw fixation may not be necessary.

Biomechanical Comparison of Fixation Devices for First Metatarsocuneiform Joint Arthrodesis

2016 ◽  
Vol 10 (4) ◽  
pp. 322-328 ◽  
Author(s):  
Ashleen R. Knutsen ◽  
John F. Fleming ◽  
Edward Ebramzadeh ◽  
Nathan C. Ho ◽  
Tibor Warganich ◽  
...  
Keyword(s):  
Locking Plate ◽  
Failure Load ◽  
Screw Fixation ◽  
Plate Fixation ◽  
Joint Space ◽  
Medial Cuneiform ◽  
Space Angle ◽  
Failure Loads ◽  
Cantilever Bending ◽  
Biomechanical Comparison

Common surgical treatment of first tarsal-metatarsal arthritis is by first metatarsocuneiform joint arthrodesis. While crossed-screw and locking plate fixation are the most widely used methods, a novel construct was designed to alleviate soft tissue irritation while still providing stable fixation. Using anatomic first metatarsal and medial cuneiform composites, we compared 3 arthrodesis implants (crossed-screw, dorsal locking plate, and IO Fix) under 2 cyclic bending loading scenarios (cantilever and 4-point bending). Additionally, the optimal orientation (plantar-dorsal or dorsal-plantar) of the IO Fix construct was determined. Failure load, diastasis, joint space angle, and axial and angular stiffness were determined. Both crossed-screw fixation and the IO Fix constructs experienced significantly higher failure loads than the dorsal locking plate during both loading scenarios. Additionally, they had lower plantar diastasis and joint space angle at failure than the plate. Moreover, the plantar-dorsal IO Fix construct was significantly stiffer than the crossed-screw during cantilever bending. Finally, the plantar-dorsal orientation of the IO Fix device had higher failure load and lower diastasis and angle at failure than in the dorsal-plantar orientation. The results suggest that the IO Fix system can reduce motion at the interfragmentary site and ensure compression for healing comparable to that of the crossed-screw fixation. Levels of Evidence: Level V: Bench testing

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