Plantar versus Dorsomedial Locked Plating for Lapidus Arthrodesis: A Biomechanical Comparison

2011 ◽  
Vol 32 (11) ◽  
pp. 1081-1085 ◽  
Author(s):  
Kajetan Klos ◽  
Paul Simons ◽  
Anne-Sophie Hajduk ◽  
Konrad Leopold Hoffmeier ◽  
Florian Gras ◽  
...  
Keyword(s):  
Quantitative Computed Tomography ◽  
Initial Stiffness ◽  
Mineral Density ◽  
Compression Screw ◽  
Locked Plating ◽  
Static Tests ◽  
Significant Difference ◽  
Load To Failure ◽  
Angle Stable ◽  
Angle Stable Plate

Background: Lapidus arthrodesis with a plate and a compression screw is an established procedure in hallux valgus surgery. The present study was performed to investigate the potential benefit of a compression screw combined with a plantarly applied angle-stable, anatomically precontoured plate or a dorsomedially applied angle-stable plate. Methods: In six pairs of human cadaver specimens, one specimen each was randomized to receive a dorsomedial H-shaped plate, while the other received a plantar plate. Bone mineral density was measured with peripheral quantitative computed tomography. The specimens were loaded quasi-statically, followed by cyclic loading. Finally, they were loaded to failure. In the static tests, stiffness and range of motion (ROM) data were obtained. In the cyclic tests, the constructs' displacement was studied. In the load-to-failure test, stiffness and maximum load to failure were measured. Results: The two groups did not differ significantly with regard to BMD (p = 0.25). Any significant differences observed were in favor of the plantar constructs, which had greater initial stiffness (p = 0.028) and final stiffness (p = 0.042), a smaller ROM (p = 0.028), and a greater load to failure (p = 0.043). There was no significant difference regarding displacement (p = 0.14). Conclusion: In the static tests, the plantar angle-stable plate construct was superior to the dorsomedial angle-stable plate construct. Clinical Relevance: Plantar plating appears to offer biomechanical benefit. Clinical studies will be required to show whether this translates into earlier resumption of weightbearing and into lower rates of nonunion.

Biomechanical Comparison of Low-Profile Contoured Locking Plate With Single Compression Screw to Fully Threaded Compression Screws for First MTP Fusion

2019 ◽  
Vol 40 (7) ◽  
pp. 836-844
Author(s):  
Richard S. Fuld ◽  
Pam Kumparatana ◽  
Judas Kelley ◽  
Nicholas Anderson ◽  
Todd Baldini ◽  
...  
Keyword(s):  
Locking Plate ◽  
Matched Pair ◽  
Mineral Density ◽  
Compression Screw ◽  
Plate Group ◽  
Low Profile ◽  
Significant Difference ◽  
Load To Failure ◽  
New Generation ◽  
Screw Group

Background: Open metatarsophalangeal (MTP) arthrodesis using locked plates produces good clinical outcomes. However, arthroscopic fusion with new-generation fully threaded compression screws is emerging as an alternative. The purpose of this study was to compare low-profile contoured locked plates with fully threaded compression screws for first MTP fusion, in a biomechanical cadaveric model. Methods: The first rays of 8 matched pairs of fresh frozen cadaveric feet underwent dissection and dual-energy x-ray absorptiometry (DEXA) scanning to measure bone mineral density (BMD). The “plate” group was prepared with cup-and-cone reamers, and fixation of the MTP joint with 1 compression screw and low-profile dorsal locked plate. The matched-pair “screws” group was prepared through a simulated arthroscopic technique, achieving fixation with 2 new-generation fully threaded compression screws. The plantar MTP gap was recorded with an extensometer during 250 000 90-N cyclic loads followed by a single load to failure. Results: The screw group demonstrated significantly greater stiffness, 31.6 N/mm (plates) and 51.7 N/mm (screws) ( P = .0045). There was no significant difference in plantar gapping or load to failure, 198.6 N (plates) and 290.1 N (screws) ( P = .2226). Stiffness and load to failure were highly correlated to BMD for the screw group, r =0.79 and r = 0.94, respectively, but less so for the plate group, r = 0.36 and r = 0.62, respectively. The maximum metatarsal head height measured on the lateral view was strongly correlated with load to failure for both the plate- and screw-only groups ( r > 0.9). Conclusion: These data demonstrate that hallux MTP arthrodesis utilizing fully threaded compression screws had similar plantar gapping and load to failure when compared with the low-profile locking plate, but with significantly more stiffness. These results support an increased role of fully threaded screws for MTP arthrodesis using either the arthroscopic or open technique. However, with decreased BMD plate fixation may remain the better fixation choice. Clinical Relevance: Our data suggest that with regard to construct stability, fully threaded headless compression screws may be just as effective as low-profile locking plates, but BMD and MTP joint fluoroscopic measurements should be considered in the decision-making process for fixation.

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.

Role of Osteoclast in Preferential Alignment of Biological Apatite (BAp) in Long Bones

2006 ◽  
Vol 512 ◽  
pp. 265-268 ◽  
Author(s):  
Jee Wook Lee ◽  
Takayoshi Nakano ◽  
Satoru Toyosawa ◽  
Naokuni Ijuhin ◽  
Yasuhiko Tabata ◽  
...  
Keyword(s):  
Bone Cells ◽  
Quantitative Computed Tomography ◽  
Femoral Diaphysis ◽  
Control Group ◽  
Mineral Density ◽  
Osteoblast Activity ◽  
Significant Difference ◽  
Biological Apatite ◽  
Preferential Alignment

Absorption and formation of hard tissues are repeated in vivo by the activity of osteoclast and osteoblast, respectively. The preferential alignment of BAp or collagen fibril is thought to be closely related to the activity of the bone cells. In this study, changes in bone mineral density (BMD) and preferential alignment of biological apatite (BAp) were examined focusing on the role of osteoblast using the model of osteopetrotic (op/op) mice in which osteoblast activity was normal but the expression of osteoclast was reduced. Osteopetrotic (op/op) mice and their normal littermates aged 5, 12 and 24 weeks were analyzed. The BMD and BAp texture of femoral diaphysis were measured using peripheral quantitative computed tomography (pQCT) and a microbeam X-ray diffractometer system with a 50 µmφ diameter beam spot respectively. The decrease in osteoclast expression induced both the reduction of the skeletal system and calcification of the medullary cavity, which are typical features of osteopetrosis. As a result, the shape, BMD and preferential BAp alignment of the femur in the op/op mice were remarkably different from those in the control group. At the center of the femoral diaphysis, BMD in the cortical area showed no significant difference between the two groups, but preferential alignment of the BAp c-axis in the op/op mice group had a lower value than that in the control group. This suggests that the decrease in the number of osteoclasts suppresses normal remodeling, resulting in a decrease in bone quality, especially the preferential alignment of the BAp c-axis.

Biomechanical Analysis of Screw-Augmented Intramedullary Fixation for Tibiotalocalcaneal Arthrodesis

2007 ◽  
Vol 28 (7) ◽  
pp. 804-809 ◽  
Author(s):  
Patrick J. O'Neill ◽  
Brent G. Parks ◽  
Russell Walsh ◽  
Lucia M. Simmons ◽  
Lew C. Schon
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Pearson Correlation ◽  
Significant Negative Correlation ◽  
Biomechanical Analysis ◽  
Complication Rates ◽  
Initial Stiffness ◽  
Mineral Density ◽  
Tibiotalocalcaneal Arthrodesis ◽  
Load To Failure

Background This study compared intramedullary (IM) fixation for tibiotalocalcaneal arthrodesis with and without a tibiotalocalcaneal augmentation screw. Methods Each specimen in six matched pairs of fresh frozen cadavers underwent tibiotalocalcaneal arthrodesis with an IM nail. One specimen from each pair also received a tibiotalocalcaneal augmentation screw. Initial and final stiffness, load to failure, and construct deformation at failure were calculated with dorsiflexion loading. Bone mineral density of each pair was determined. Statistical analysis was done using a paired Student t-test and a Pearson correlation. Results Initial and final stiffness and load to failure were significantly higher for the tibiotalocalcaneal screw augmented fixation group as compared with the specimens with no additional screw (initial stiffness, 128.0 versus 78.4 N/mm, p = 0.04; final stiffness, 230.9 versus 164.7 N/mm, p = 0.04; load to failure, 875.5 versus 660.2 N, p = 0.03). There was a significant negative correlation between bone mineral density and average construct deformation in the samples without the added tibiotalocalcaneal screw ( r = –0.90, p = 0.02). Conclusions In tibiotalocalcaneal arthrodesis with intramedullary nail fixation, a tibiotalocalcaneal augmentation screw provides more stable fixation. Clinical relevance Use of an augmentation screw as described in this study may lead to lower complication rates, particularly in patients with osteopenic bone.

scholarly journals A BIOMECHANICAL COMPARISON OF SUTURE ANCHOR VS. INTERFERENCE SCREW TECHNIQUE FOR PATELLAR FIXATION FOR MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0010
Author(s):  
Dragomi Mijic ◽  
Sanar Yokhana ◽  
Kunal Kalra
Keyword(s):  
Repeated Measures ◽  
Medial Patellofemoral Ligament ◽  
Suture Anchor ◽  
Interference Screw ◽  
T Test ◽  
Mpfl Reconstruction ◽  
Initial Stiffness ◽  
Significant Difference ◽  
Load To Failure ◽  
Fresh Frozen

Background: There are numerous techniques for MPFL reconstruction, however, one single technique has not been proven to be superior to another. Suture anchor reconstruction has been shown to provide stable fixation while decreasing the risk of patellar fracture. The aim of the study was to compare the stiffness and clinical load to failure of two common MPFL reconstruction techniques. Our hypothesis was that there would be no significant difference in the stiffness and the clinical load to failure between the suture anchor and interference screw reconstructions. Methods: Eight pairs of fresh frozen cadaveric knees were randomized into two groups undergoing MPFL reconstruction using either a suture anchor technique (n=8) or an interference screw technique (n=8). Testing was performed at 0, 30, 60, and 90 degrees of flexion for the native knee, transected medial structures, and reconstructed MPFL. Next, the reconstructed MPFL specimens were tested until failure in 0 degrees of flexion. T test, One-Way ANOVA, and repeated measures of ANOVA were used for statistical analysis, P values less than 0.05 were considered significant. Results: The average stiffness for the suture anchor and interference screw reconstructions was 12.02 ± 3.96 N/mm and 14.21 ± 4.20 N/mm, respectively (t test, p = 0.27), while average clinical load to failure was 256.57 ± 54.1 N and 237.81 ± 23.82 N, respectively (t test, p = 0.38). There was no significant difference in stiffness between the suture anchor and interference screw techniques at 0, 30, and 60 degrees of flexion. Conclusions: The suture anchor and interference screw reconstruction techniques produce comparable stiffness for sub-failure testing at 0 and 30 degrees of flexion. For testing to failure, the initial stiffness for both reconstruction techniques have been shown to be concordant with previously published values for the native MPFL. Both reconstruction techniques provide greater ultimate failure loads than those reported for the native MPFL in previous studies. Clinical Relevance: Suture anchor reconstruction described in our study provides another reliable option for the reconstruction of the medial patellofemoral ligament. [Figure: see text]

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.

scholarly journals Performance of HR-pQCT, DXA, and FRAX in the discrimination of asymptomatic vertebral fracture in postmenopausal Chinese women

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Meiling Huang ◽  
Vivian Wing-yin Hung ◽  
Tsz Kiu Li ◽  
Sheung Wai Law ◽  
Yulong Wang ◽  
...  
Keyword(s):  
Vertebral Fracture ◽  
Fracture Risk ◽  
Postmenopausal Women ◽  
Bone Quality ◽  
Assessment Tool ◽  
Chinese Women ◽  
Quantitative Computed Tomography ◽  
Areal Bone Mineral Density ◽  
Mineral Density ◽  
Significant Difference

Abstract Summary Volumetric bone density (vBMD) and trabecular microarchitecture measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) can discriminate the patients with high risk of asymptomatic vertebral fracture (VF) in postmenopausal Chinese women. These findings suggested that HR-pQCT could provide additional information on bone quality of the patients with asymptomatic VF. Introduction Although there were several studies using HR-pQCT to investigate asymptomatic VF, it remains uncertain if HR-pQCT parameters can discriminate asymptomatic VF patients, especially in Chinese population. The purpose of this study was to investigate whether bone quality measured by HR-pQCT could discriminate asymptomatic VF independent of hip areal bone mineral density (aBMD) measured by dual-energy x-ray absorptiometry (DXA) and fracture risks evaluated using built-in Fracture Risk Assessment Tool (FRAXBMD). Methods This is a nested case–control study. One hundred seventy-five ambulatory Chinese postmenopausal women aged 60–79 years were retrieved from Normative Reference Standards (NRS) cohort in Hong Kong. DXA was used to identify VF from lateral spine images (VFA) using Genant’s semi-quantitative method. Major osteoporotic fracture risk was calculated using FRAX tool. HR-pQCT was used to assess vBMD, microarchitecture, and estimated strength at both distal radius and tibia. Comparison of HR-pQCT parameters between asymptomatic VF and control was performed using covariance analysis. Logistic regression analysis was performed for calculating the adjusted odds ratio (OR) with 95% confidence intervals (CI) of fracture status as per SD decrease in HR-pQCT parameters. Results Women with asymptomatic VF were older than those of the control in our NRS cohort. Nevertheless, after adjusted for covariance, asymptomatic VF showed significantly lower trabecular vBMD (Tb.vBMD) at radius but higher SMI at tibia as compared with those of the control. Tb.vBMD at radius yielded the highest value of area under the curve (AUC) as compared with total hip aBMD and FRAXBMD. However, no significant difference was found among each other. Conclusion Tb.vBMD at the radius and SMI at the tibia provided by HR-pQCT can discriminate asymptomatic VF independent of hip aBMD and FRAXBMD by DXA in postmenopausal women.

Excessive Derotational K-Wire Angulation Decreases Compression by Headless Compression Screw

2021 ◽  
Author(s):  
Joseph A. Gil ◽  
Michael D. Montague ◽  
Christopher J. Lama ◽  
Peter Brodeur ◽  
Julia A. Katarincic ◽  
...  
Keyword(s):  
Kirschner Wire ◽  
Fracture Site ◽  
Carpal Bone ◽  
Control Group ◽  
Mineral Density ◽  
Compression Screw ◽  
Headless Compression Screw ◽  
Scaphoid Fractures ◽  
Significant Difference ◽  
The Mean

Abstract Background Scaphoid fracture is the most common carpal bone fracture. Open reduction internal fixation of scaphoid fractures typically undergo stabilization by a single headless compression screw (HCS). During screw insertion, a derotational Kirschner wire (K-wire) is often placed for rotational control of the near and far fragment. Questions/purposes The aim of this study was to determine if there is an angle of derotational K-wire placement in relation to the axis of a HCS that compromises the amount of compression generated at a fracture site by the HCS. We hypothesize that increased off-axis angle will lead to decreased compression across the fracture site. Methods A Cellular Block 20 rigid polyurethane foam (Sawbones, Vashon, WA) scaphoid model was created to eliminate variability in bone mineral density in cadaveric bone. MiniAcutrak HCS screws (Acumed, Hillsboro, OR) were used for testing. Three conditions were tested: (1) HCS with derotational wire inserted parallel to the HCS (zero degrees off-axis); (2) HCS with derotational wire inserted 10 degrees off-axis; and (3) HCS with derotational wire inserted 20 degrees off-axis. Results A statistically significant difference in the mean compression of the control group (56.9 N) was found between the mean compression with the derotational K-wire placed 20 degrees off-axis (15.2 N) (p = 0.001). Conclusions Compression at the fracture site could be impeded by placing an excessively angulated off-axis derotation wire prior to insertion of the HCS. Clinical Relevance Our study adds a new detail to the optimal technique of HCS placement in scaphoid fractures to improve compression and fracture union.

scholarly journals Ordinary Cannulated Compression Screws or Headless Cannulated Compression Screws? A Synthetic Bone Biomechanical Research in the Internal Fixation of Vertical Femoral Neck Fracture

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Baokun Zhang ◽  
Jingwen Liu ◽  
Wei Zhang
Keyword(s):  
Compressive Strength ◽  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Maximum Load ◽  
Biomechanical Stability ◽  
Compression Screw ◽  
Significant Difference ◽  
Load To Failure ◽  
Neck Fracture ◽  
3D Printed

Purpose. The purpose of this study is to verify whether the headless cannulated compression screw (HCCS) has higher biomechanical stability than the ordinary cannulated compression screw (OCCS) in the treatment of vertical femoral neck fractures. Materials and Methods. 30 synthetic femur models were equally divided into 2 groups, with 50°, 60°, and 70° Pauwels angle of femoral neck fracture, under 3D printed guiding plates and C-arm fluoroscopic guidance. The femur molds were fixed with three parallel OCCSs as OCCS group and three parallel HCCSs as HCCS group. All specimens were tested for compressive strength and maximum load to failure with a loading rate of 2 mm/min. Results. The result showed that there was no significant difference with the compressive strength in the Pauwels angle of 50° and 60°. However, we observed that the maximum load to failure with the Pauwels angle of 50°, 60°, and 70° and the compressive strength with 70° of HCCS group showed better performance than the OCCS group. Conclusion. HCCS performs with better biomechanical stability than OCCS in the treatment of vertical femoral neck fracture, especially with the Pauwels angle of 70°.

scholarly journals How relevant is lumbar bone mineral density for the stability of symphyseal implants? A biomechanical cadaver study

2021 ◽  
Author(s):  
Fanny Schwaabe ◽  
Johannes Gleich ◽  
Christoph Linhart ◽  
Alexander Martin Keppler ◽  
Matthias Woiczinski ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Quantitative Computed Tomography ◽  
Mineral Density ◽  
Pull Out ◽  
Cortical Screw ◽  
Surgical Implants ◽  
Fracture Management ◽  
Significant Difference ◽  
The Stability

Abstract Purpose Osteoporotic bone tissue appears to be an important risk factor for implant loosening, compromising the stability of surgical implants. However, it is unclear whether lumbar measured bone mineral density (BMD) is of any predictive value for stability of surgical implants at the pubic symphysis. This study examines the fixation strength of cortical screws in human cadaver specimens with different BMDs. Methods The lumbar BMD of ten human specimens was measured using quantitative computed tomography (qCT). A cut-off BMD was set at 120 mg Ca-Ha/mL, dividing the specimens into two groups. One cortical screw was drilled into each superior pubic ramus. The screw was withdrawn in an axial direction with a steady speed and considered failed when a force decrease was detected. Required force (N) and pull-out distance (mm) were constantly tracked. Results The median peak force of group 1 was 231.88 N and 228.08 N in group 2. While BMD values differed significantly (p < 0.01), a comparison of peak forces between both groups showed no significant difference (p = 0.481). Conclusion Higher lumbar BMD did not result in significantly higher pull-out forces at the symphysis. The high proportion of cortical bone near the symphyseal joint allows an increased contact of pubic screws and could explain sufficient fixation. This condition is not reflected by a compromised lumbar BMD in a qCT scan. Therefore, site-specific BMD measurement could improve individual fracture management.

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