scholarly journals Effect of Skeletal Maturity on Fixation Techniques for Tibial Eminence Fractures

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110494
Author(s):  
Andrew P. Thome ◽  
Ryan O’Donnell ◽  
Steven F. DeFroda ◽  
Brian H. Cohen ◽  
Aristides I. Cruz ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Screw Fixation ◽  
Skeletal Maturity ◽  
Suture Technique ◽  
Fixation Method ◽  
Suture Fixation ◽  
Skeletally Immature ◽  
Tibial Eminence ◽  
Fixation Group ◽  
Load To Failure

Background: Several fixation methods have been reported for the operative treatment of tibial eminence fractures. Previous biomechanical studies have demonstrated that suture fixation may be a stronger construct; however, the maturity status of these specimens was not scrutinized. Purpose: To examine if suture fixation remains a biomechanically superior fixation method to screw fixation in both skeletally mature and immature specimens. Study Design: Controlled laboratory study. Methods: Sixteen total matched porcine (Yorkshire) knees (8 skeletally immature knees and 8 skeletally mature knees) were procured, and a standardized tibial eminence fracture was created. In each age-matched group of knees, 4 knees underwent randomization to fixation with 2 screws while 4 knees were randomized to fixation using a dual-suture technique. Once fixation was complete, the specimens underwent cyclic loading (200 cycles) in the anteroposterior plane of the tibia and load-to-failure testing, both with the knee positioned at 30° of flexion. Relevant measurements were recorded, and data were analyzed. Results: Among mature specimens, load to failure was 1.9 times higher in the suture fixation group compared with the screw fixation group (1318.84 ± 305.55 vs 711.66 ± 279.95 N, respectively; P = .03). The load to failure was not significantly different between the groups in immature specimens (suture: 470.00 ± 161.91 N vs screw: 348.79 ± 102.46; P = .08). Conclusion: These findings suggest that suture fixation may represent a better construct choice for fixation of tibial eminence fractures in the skeletally mature population. However, in the skeletally immature population, fixation with screws or suture may be equivalent. Displacement after cyclic loading did not appear to differ by fixation method, nor did stiffness. Clinical Relevance: A stronger fixation construct may be beneficial and allow for earlier range of motion to help potentially decrease postoperative stiffness. Clinical studies are warranted to see if these results may be replicated in humans.

scholarly journals Comparison of Time-dependent Changes in Syndesmotic Reduction Between Suture-button and Screw Fixation for Ankle Malleolar Fractures with Tibiofibular Diastasis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0029
Author(s):  
Seiji Kimura ◽  
Satoshi Yamaguchi
Keyword(s):  
Fracture Fixation ◽  
Screw Fixation ◽  
Time Dependent ◽  
Fixation Method ◽  
Suture Button ◽  
Malleolar Fractures ◽  
Fixation Group ◽  
Postoperative Changes ◽  
Group B ◽  
Over Time

Category: Trauma Introduction/Purpose: Reduction of the tibiofibular syndesmosis is one of the most important factors that affect the clinical outcome after ankle malleolar fractures with syndesmotic diastasis. Recent studies have shown that suture-button fixation can yield better syndesmotic reduction than screw fixation immediately after surgery. However, the time-dependent change in the reduction for each fixation method has not been well studied. The purpose of this study was to compare the postoperative changes in the syndesmotic reduction after surgical treatment of ankle malleolar fractures between suture-button fixation and screw fixation using bilateral computed tomography. Methods: Patients who sustained ankle malleolar fractures with tibiofibular diastasis and underwent tibiofibular fixation were included. Suture-button fixation (Group B; n=14; age, 39 years) was used between 2015 and 2016, and syndesmotic screw fixation (Group S; n=20; age, 35 years) was used between 2012 and 2014. The syndesmotic screws were routinely removed. Patients underwent CT scanning of the bilateral ankles at 2 time points: at 2 weeks and 1 year after fracture fixation. Side-to-side differences in the anterior and posterior tibiofibular distances, and anteroposterior fibular translation were measured. Syndesmotic melreduction was defined as a side-to-side difference?2 mm in either of the measurements. The changes in each measurement and incidence of malreduction for each group were assessed using the Wilcoxon signed-ranks test and McNemar’s test. Differences between the two groups at each time point were also compared. Results: At 2 weeks after fracture fixation, the side-to-side difference in anterior tibiofibular distance was significantly wider in Group B (1.9 mm) than in Group S (0.7 mm) (p=0.03). Additionally, the fibulas were more translated posteriorly in Group B (1.5 mm) than in Group S (0.2 mm). At 1 year, the anterior tibiofibular distance decreased to 0.8 mm in Group B (p=0.09). On the contrary, it significantly increased to 1.9 mm in Group S (p=0.002). In Group B, the incidences of malreduction were 4/14 and 2/14 at 2 weeks and 1 year, respectively (p=0.74). Two ankles, which were malreduced at 2 weeks, changed to a reduced syndesmosis at 1 year. In Group S, the incidences were 8/20 and 9/20 at 2 weeks and 1 year, respectively (p=0.35). Conclusion: Syndesmotic alignment changed over time in both fixation methods, however, the patterns of change were different. Using suture-button fixation, the anterior tibiofibular distance decreased over time. As a result, the widened syndesmoses at 2 weeks changed to reduced syndesmoses at 1 year. On the contrary, using tibiofibular screw fixation, the anterior tibiofibular distance widened after screw removal. Our result suggests that the flexible suture-button fixation allows the fibula to move to the optimal location over time.

scholarly journals Biomechanical Analysis of the Efficacy of Locking Plates during Cyclic Loading in Metacarpal Fractures

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Stefanie Doht ◽  
Rainer H. Meffert ◽  
Michael J. Raschke ◽  
Torsten Blunk ◽  
Sabine Ochman
Keyword(s):  
Cyclic Loading ◽  
Locking Plate ◽  
Screw Fixation ◽  
Maximum Load ◽  
Biomechanical Analysis ◽  
Locking Plates ◽  
Functional Rehabilitation ◽  
Metacarpal Bones ◽  
Load To Failure ◽  
Bicortical Screw

Purpose.To analyse the biomechanical characteristics of locking plates under cyclic loading compared to a nonlocking plate in a diaphyseal metacarpal fracture.Methods.Oblique diaphyseal shaft fractures in porcine metacarpal bones were created in a biomechanical fracture model. An anatomical reduction and stabilization with a nonlocking and a comparable locking plate in mono- or bicortical screw fixation followed. Under cyclic loading, the displacement, and in subsequent load-to-failure tests, the maximum load and stiffness were measured.Results.For the monocortical screw fixation of the locking plate, a similar displacement, maximum load, and stiffness could be demonstrated compared to the bicortical screw fixation of the nonlocking plate.Conclusions.Locking plates in monocortical configuration may function as a useful alternative to the currently common treatment with bicortical fixations. Thereby, irritation of the flexor tendons would be avoided without compromising the stability, thus enabling the necessary early functional rehabilitation.

scholarly journals Radial Tears of the Lateral Meniscus—Two Novel Repair Techniques: A Biomechanical Study

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876808 ◽  
Author(s):  
Zachary C. Stender ◽  
Allison M. Cracchiolo ◽  
Michael P. Walsh ◽  
David P. Patterson ◽  
Matthew J. Wilusz ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Lateral Meniscus ◽  
Suture Technique ◽  
Biomechanical Study ◽  
Partial Meniscectomy ◽  
Suture Repair ◽  
Load To Failure ◽  
The Cross ◽  
Inside Out ◽  
Repair Techniques

Background: A common treatment for radial tears of the meniscus has historically been partial meniscectomy. Owing to the poor outcomes associated with partial meniscectomy, repair of the meniscus is an important treatment option. It is important to evaluate different repair techniques for radial tears of the meniscus. Purpose/Hypothesis: The purpose of this study was to evaluate 2 novel techniques to repair radial tears of the lateral meniscus. The 2 techniques were compared biomechanically with the cross-suture method with an inside-out technique. The authors hypothesized that novel repair techniques would result in less displacement after cyclic loading, increased load required to displace the repair 3 mm, greater load to failure, decreased displacement at load to failure, and increased stiffness of the repair, resulting in a construct that more closely re-creates the function of the intact meniscus. Study Design: Controlled laboratory study. Methods: A total of 36 fresh-frozen cadaveric tibial plateaus containing intact menisci were obtained. The menisci were divided into 3 groups (n = 12 in each group), and each meniscus was repaired simulating an inside-out technique. The 3 repairs completed were the hashtag, crosstag, and cross-suture techniques. Radial tears were created at the midbody of the lateral meniscus and repaired via the 3 techniques. The repaired menisci were attached to an axial loading machine and tested for cyclic and failure loading. Results: After cyclic loading, the cross-suture repair displaced 4.78 ± 1.65 mm; the hashtag, 2.42 ± 1.13 mm; and the crosstag, 3.13 ± 1.77 mm. The hashtag and cross-tag repairs both resulted in significantly less displacement ( P = .003 and .024, respectively) as compared with the cross-suture repair. The cross-suture technique had a load to failure of 81.43 ± 14.31 N; the hashtag, 86.08 ± 23.58 N; and the crosstag, 62.50 ± 12.15 N. The cross-suture and hashtag repairs both resulted in a greater load to failure when compared with the crosstag ( P = .009 and .009, respectively). There was no difference comparing the load required to displace the cross-suture technique 3 mm versus the hashtag or crosstag technique ( P = .564 and .094, respectively). However, when compared with the crosstag technique, the hashtag technique required a significantly greater load to displace the repair 3 mm ( P = .015). Conclusion: This study introduced 2 novel repair techniques—hashtag and crosstag—that did not demonstrate superiority in terms of load to failure or stiffness, but both repairs were statistically superior to the cross-suture repair in terms of displacement after cyclic loading. Considerations that may influence the validity of these techniques include cost, surgical time, and increased technical demand. Clinical Relevance: Radial tears of the meniscus are difficult to repair. Further research into more stable constructs is necessary.

Plantar-to-Dorsal Compared to Dorsal-to-Plantar Screw Fixation for Proximal Chevron Osteotomy: A Biomechanical Analysis

2005 ◽  
Vol 26 (10) ◽  
pp. 854-858 ◽  
Author(s):  
Krishn M. Sharma ◽  
Brent G. Parks ◽  
Augustine Nguyen ◽  
Lew C. Schon
Keyword(s):  
Screw Fixation ◽  
Biomechanical Analysis ◽  
Fixation Method ◽  
Materials Testing ◽  
Metatarsal Osteotomy ◽  
First Metatarsal ◽  
Lag Screw ◽  
Chevron Osteotomy ◽  
Plantar Aspect ◽  
Load To Failure

Background: A change in screw orientation in fixing the chevron proximal first metatarsal osteotomy was noted anecdotally to improve fixation strength. The authors hypothesized that plantar-to-dorsal screw orientation would be more stable than the conventional dorsal-to-plantar screw orientation for fixation of the chevron osteotomy. The purpose of this study was to determine if the load-to-failure and stiffness of the chevron type proximal first metatarsal osteotomy stabilized using plantar-to-dorsal screw fixation were greater than with the more conventional dorsal-to-plantar screw fixation method. Methods: One foot from each of eight matched cadaver pairs was randomly assigned to one of two groups: 1) fixation with a dorsal-to-plantar lag screw or 2) fixation with a plantar-to-dorsal lag screw. A proximal chevron osteotomy was then created using standard technique and the metatarsal was fixed according to previously established method. The bone was potted in polyester resin, and the construct was fitted into a materials testing system machine in which load was applied to the plantar aspect of the metatarsal until failure. The two groups were compared using a two-tailed Student t test. Results: The average load-to-failure and stiffness of the chevron osteotomy fixed with the plantar-to-dorsal lag screw were significantly greater ( p < 0.05) than the group fixed with more conventional dorsal-to-plantar lag screws. Conclusion: Plantar-to-dorsal screw orientation was more stable than the conventional dorsal-to-plantar screw orientation for fixation of the proximal chevron osteotomy. Plantar-to-dorsal screw orientation should be considered when using the chevron proximal first metatarsal osteotomy.

scholarly journals Arthroscopic pull-through suture for tibial eminence avulsion fracture: a case series

2020 ◽  
Vol 8 (12) ◽  
pp. 4471
Author(s):  
Mario D. Simatupang ◽  
I. G. N. Wien Aryana ◽  
Hans K. Nugraha
Keyword(s):  
Knee Pain ◽  
Traffic Accident ◽  
Avulsion Fracture ◽  
Case Series ◽  
International Knee Documentation Committee ◽  
Suture Technique ◽  
Fixation Method ◽  
Long Distance ◽  
Tibial Eminence ◽  
Pull Through

Fractures of the tibial eminence is commonly reported in adolescents and adults, due to traffic accident, sports injury, or any other mechanism. Case 1: a 12-year-old male complained knee pain after a traffic accident 2 months prior to visit. Case 2: a 31-year-old female complained knee pain which worsened with long-distance walking and sitting, after falling on her knees one month prior to visit. Case 3: a 27-year-old female complained a worsening knee pain after traffic accident 12 years ago. Although it has been extensively studied, controversies regarding the best fixation method still exist. Open technique was once popular, but some morbidity has been associated with this method. Therefore, a new approach using arthroscopic pull-through suture technique, albeit technically challenging, is currently being advocated as a treatment option for such fractures. The result in our series confirm that all of 3 patients have a good result based on international knee documentation committee (IKDC) scoring for evaluation the treatment, hence support the use of this novel technique for the patients with tibial eminence avulsion fracture.

scholarly journals Braided tape is equivalent to modified Mason-Allen multi-strand #2 suture in subscapularis muscle repair: results of a biomechanical study

2016 ◽  
Vol 9 (2) ◽  
pp. 85-91
Author(s):  
Benjamin Léger-St-Jean ◽  
Jérémie Ménard ◽  
Stéphanie Hinse ◽  
Frédéric Balg ◽  
Dominique M Rouleau
Keyword(s):  
Cyclic Loading ◽  
Ultimate Load ◽  
Tendon Repair ◽  
Biomechanical Study ◽  
Fixation Method ◽  
Subscapularis Tendon ◽  
Mineral Density ◽  
Significant Difference ◽  
Load To Failure ◽  
The Mean

Background To help determine the optimal fixation method for subscapularis tendon repair in arthroplasty, the present study compares single-passage transosseous tape (BT) and modified Mason-Allen #2 suture (MA). Methods Eighteen human cadaveric shoulders were randomized to two repair constructs after arthroplasty preparation. Both techniques included two transosseous passages through the bicipital groove and then through the tendon at the level of the anatomical neck. Construct was tested using a traction machine, measuring cyclic loading and ultimate load to failure. Results The mean age of our specimens was 71 years. No significant difference was observed between the repair techniques in both mean ultimate load and cyclic loading. The mean (SD) ultimate load (UL) for BT was 293 (84) N and 342 (117) N for MA, which was not statistically significant ( p = 0.374). The majority of repairs failed in the tendon. Bone cut-out was observed with the MA but not for the BT repair. No correlation was found between bone density and UL for BT ( r = −0.09) but there was strong correlation for MA ( r = 0.63). Conclusions The MA repair appears to be more dependant on bone mineral density for ultimate load, indicating that braided-tape might be better suited for osteoporotic patients to avoid bone cut-out.

A biomechanical study comparing plate fixation using unicortical and bicortical screws in transverse metacarpal fracture models subjected to cyclic loading

2011 ◽  
Vol 37 (5) ◽  
pp. 396-401 ◽  
Author(s):  
R. Afshar ◽  
T. S. Fong ◽  
M. Hadi Latifi ◽  
S. R. Kanthan ◽  
T. Kamarul
Keyword(s):  
Cyclic Loading ◽  
Static Loading ◽  
Screw Fixation ◽  
Plate Fixation ◽  
Biomechanical Study ◽  
Metacarpal Fracture ◽  
Three Point Bending ◽  
Load To Failure ◽  
Fracture Models ◽  
The Mean

The use of bicortical screws to fix metacarpal fractures has been suggested to provide no added biomechanical advantage over unicortical screw fixation. However, this was only demonstrated in static loading regimes, which may not be representative of biological conditions. The present study was done to determine whether similar outcomes are obtained when cyclic loading is applied. Transverse midshaft osteotomies were created in 20 metacarpals harvested from three cadavers. Fractures were stabilised using 2.0 mm mini fragment plates fixed with either bicortical or unicortical screw fixation. These fixations were tested to failure with a three-point bending cyclic loading protocol using an electromechanical microtester and a 1 kN load cell. The mean load to failure was 370 N (SD 116) for unicortical fixation and 450 N (SD 135) for bicortical fixation. Significant differences between these two constructs were observed. A biomechanical advantage was found when using bicortical screws in metacarpal fracture plating.

scholarly journals Biomechanical Comparison of FiberTape Device Repair Techniques of Ligamentous Lisfranc Injury in Cadaveric Model

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0005
Author(s):  
Zachary Koroneos ◽  
Emily Vannatta ◽  
Morgan S. Kim ◽  
Madelaine W. Fritsche ◽  
Trevin Cowman ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Screw Fixation ◽  
Angular Displacement ◽  
Reaction Force ◽  
Interference Screw ◽  
Fixation Method ◽  
Medial Cuneiform ◽  
Second Metatarsal ◽  
Interference Screw Fixation ◽  
Cadaveric Model

Category: Trauma; Basic Sciences/Biologics; Midfoot/Forefoot; Sports Introduction/Purpose: Lisfranc ligamentous injuries are complex. Controversy exists regarding their treatment and preferred method of fixation. Fixation methods employing a FiberTape device and interference screw fixation have been described as an alternative to traditional screw fixation. The purpose of this biomechanical study was to evaluate two methods of fixation utilizing interference screw fixation with FiberTape augmentation in a cadaveric model. Methods: 9 paired cadaveric feet (mid tibia/fibula) were separated into two groups based on fixation method: FiberTape alone and FiberTape with supplementary limb into the middle cuneiform via anchor. At three joints of the midfoot (second metatarsal - medial cuneiform, intermediate cuneiform - medial cuneiform, second metatarsal - intermediate cuneiform), the diastasis and relative angular displacement between bones in the coronal plane were measured for static and cyclic loading. Measurements were obtained for the native (pre-injured), injured, and post-fixation in static loading. Fixed specimens then underwent stepwise increases in cyclic loading performed at 1 Hz and 100 cycles, at 100 N intervals from 500 to 1800 N ground reaction force. The Achilles tendon was also loaded to simulate postoperative weightbearing. Failure of fixation was defined as diastasis at the second metatarsal - medial cuneiform joint greater than 2 millimeters. Results: FiberTape specimens demonstrated diastasis failures of 3 of 9 (33%) specimens at cyclic loads of 1000 N. Conversely, FiberTape with supplementary limb specimens all survived past this loading magnitude, with 1 failing at supraphysiologic loads (>1200 N). The difference in diastasis at the second metatarsal-medial cuneiform joint was statistically significant between the two groups at forces of 1600N (p = 0.019) and 1800N (p = 0.029). There were no significant differences between the other joint diastases and relative angular displacements. Conclusion: The use of FiberTape for fixation of ligamentous Lisfranc injuries appears to provide a biomechanically viable alternative for withstanding early post-operative protected weightbearing. Furthermore, the use of a supplementary limb in addition to the FiberTape fixation method appears to enhance its biomechanical efficacy under cyclic loading especially at higher loads.

scholarly journals Biomechanical comparison of screw osteosyntheses and anatomical plating for coronoid shear fractures of the ulna

2020 ◽  
Author(s):  
Valentin Rausch ◽  
Birger Jettkant ◽  
Sebastian Lotzien ◽  
Thomas Rosteius ◽  
Eileen Mempel ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Shear Fracture ◽  
Plate Osteosynthesis ◽  
Coronoid Process ◽  
Fixation Method ◽  
Anterior Plate ◽  
Level Of Evidence ◽  
Screw Osteosynthesis ◽  
Significant Difference ◽  
Load To Failure

Abstract Introduction Among the few techniques described for the treatment of coronoid fractures, osteosynthesis techniques include screw osteosynthesis from anterior to posterior (AP) or from posterior to anterior (PA) and plate osteosynthesis. The aim of this study was to test the biomechanical stability of screw osteosynthesis and plate osteosynthesis using anatomical plates in coronoid process fractures. Materials and methods On a total of 25 biomechanical synthetical ulnae, a coronoid shear fracture including 70% of the coronoid height was simulated. Osteosynthesis was then performed using two 2.7 mm screws from anterior, posterior and with use of three different anatomical plates of the coronoid process. For the biomechanical testing, axial load was applied to the fragment with 1000 cycles from 5 to 250 N, load to failure and load at 100 µm displacement. Displacements were measured using a point-based three-dimensional motion analysis system. Results Osteosynthesis using the PA-screw showed significant more displacement during cyclic loading compared with all other osteosyntheses (0.99 mm), whereas AP-screw showed the smallest displacement (0.10 mm) during cyclic loading. The PA-screw technique showed a significant lower load to failure compared to all other osteosynthesis with the highest load in AP-screw osteosynthesis. The load for 100 µm displacement was the smallest in PA-screw with a significant difference to the AP-screw and one plate osteosynthesis. Conclusion Osteosynthesis of large coronoid shear fractures with two small-fragment screws from anterior allows stable fixation that is not inferior to anterior plate osteosynthesis and might be an alternative in specific fracture types. Posterior screw fixation was found as the weakest fixation method. Level of evidence Basic science study

Sign in / Sign up

Export Citation Format

Share Document