Percutaneous fixation of intraarticular joint-depression calcaneal fractures with different screw configurations - a biomechanical human cadaveric analysis.

Autor: Ivanov S; AO Research Institute Davos, Davos, Switzerland. dr.ton.ivanov@gmail.com.; Medical University Varna, Varna, Bulgaria. dr.ton.ivanov@gmail.com., Stefanov A; AO Research Institute Davos, Davos, Switzerland.; University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria., Zderic I; AO Research Institute Davos, Davos, Switzerland., Rodemund C; AUVA Trauma Center Linz, Linz, Austria., Schepers T; Trauma Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Gehweiler D; AO Research Institute Davos, Davos, Switzerland., Dauwe J; University Hospitals Leuven, Leuven, Belgium., Pastor T; AO Research Institute Davos, Davos, Switzerland.; Lucerne Cantonal Hospital, Lucerne, Switzerland., Makelov B; Medical University Varna, Varna, Bulgaria.; University Multiprofile Hospital for Active Treatment 'S. Kirkovitch', Stara Zagora, Bulgaria., Raykov D; Medical University Varna, Varna, Bulgaria., Richards G; AO Research Institute Davos, Davos, Switzerland., Gueorguiev B; AO Research Institute Davos, Davos, Switzerland.
Jazyk: angličtina
Zdroj: European journal of trauma and emergency surgery : official publication of the European Trauma Society [Eur J Trauma Emerg Surg] 2022 Aug; Vol. 48 (4), pp. 3305-3315. Date of Electronic Publication: 2022 Mar 07.
DOI: 10.1007/s00068-022-01901-6
Abstrakt: 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.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
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