TY - JOUR
T1 - Percutaneous fixation of intraarticular joint-depression calcaneal fractures with different screw configurations – a biomechanical human cadaveric analysis
AU - Ivanov, Stoyan
AU - Stefanov, Aleksandar
AU - Zderic, Ivan
AU - Rodemund, Christian
AU - Schepers, Tim
AU - Gehweiler, Dominic
AU - Dauwe, Jan
AU - Pastor, Torsten
AU - Makelov, Biser
AU - Raykov, Dimitur
AU - Richards, Geoff
AU - Gueorguiev, Boyko
N1 - Funding Information: The authors are not compensated and there are no other institutional subsidies, corporate affiliations, or funding sources supporting this work unless clearly documented and disclosed. This investigation was performed with the assistance of the AO Foundation. Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Purpose: The aim of this study was to assess the biomechanical performance of different screw configurations for fixation of Sanders type II B joint-depression calcaneal fractures. Methods: Fifteen human cadaveric lower limbs were amputated and Sanders II B fractures were simulated. The specimens were randomized to three groups for fixation with different screw configurations. The calcanei in Group 1 were treated with two parallel longitudinal screws, entering superiorly the Achilles tendon insertion, and two screws fixing the intraarticular posterior facet fracture line. In Group 2 two screws entered the tuberosity inferiorly to the Achilles tendon insertion and two transverse screws fixed the posterior facet. In Group 3 two screws were inserted along the bone axis, one transverse screw fixed the posterior facet and one oblique screw was inserted from the posteroplantar part of the tuberosity supporting the posterolateral part of the posterior facet. All specimens were biomechanically tested to failure under progressively increasing cyclic loading. Results: Initial stiffness did not differ significantly between the groups, P = 0.152. Cycles to 2 mm plantar movement were significantly higher in both Group 1 (15,847 ± 5250) and Group 3 (13,323 ± 4363) compared with Group 2 (4875 ± 3480), P ≤ 0.048. No intraarticular displacement was observed in any group during testing. Conclusions: From a biomechanical perspective, posterior facet support by means of buttress or superiorly inserted longitudinal screws results in less plantar movement between the calcaneal tuberosity and the anterior fragments. Inferiorly inserted longitudinal screws are associated with bigger interfragmentary movements.
AB - Purpose: The aim of this study was to assess the biomechanical performance of different screw configurations for fixation of Sanders type II B joint-depression calcaneal fractures. Methods: Fifteen human cadaveric lower limbs were amputated and Sanders II B fractures were simulated. The specimens were randomized to three groups for fixation with different screw configurations. The calcanei in Group 1 were treated with two parallel longitudinal screws, entering superiorly the Achilles tendon insertion, and two screws fixing the intraarticular posterior facet fracture line. In Group 2 two screws entered the tuberosity inferiorly to the Achilles tendon insertion and two transverse screws fixed the posterior facet. In Group 3 two screws were inserted along the bone axis, one transverse screw fixed the posterior facet and one oblique screw was inserted from the posteroplantar part of the tuberosity supporting the posterolateral part of the posterior facet. All specimens were biomechanically tested to failure under progressively increasing cyclic loading. Results: Initial stiffness did not differ significantly between the groups, P = 0.152. Cycles to 2 mm plantar movement were significantly higher in both Group 1 (15,847 ± 5250) and Group 3 (13,323 ± 4363) compared with Group 2 (4875 ± 3480), P ≤ 0.048. No intraarticular displacement was observed in any group during testing. Conclusions: From a biomechanical perspective, posterior facet support by means of buttress or superiorly inserted longitudinal screws results in less plantar movement between the calcaneal tuberosity and the anterior fragments. Inferiorly inserted longitudinal screws are associated with bigger interfragmentary movements.
KW - Biomechanics
KW - Bone mineral density
KW - Intraarticular calcaneus fracture
KW - Screw orientation
KW - Stability
UR - http://www.scopus.com/inward/record.url?scp=85125710192&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00068-022-01901-6
DO - https://doi.org/10.1007/s00068-022-01901-6
M3 - Article
C2 - 35254460
SN - 1863-9933
VL - 48
SP - 3305
EP - 3315
JO - European journal of trauma
JF - European journal of trauma
IS - 4
ER -