Biomechanical Consequences of Proximal Screw Placement in Minimally Invasive Surgery for Hallux Valgus Correction.

Autor: So Tamil Selven D; Duke NUS Medical School, Singapore. Electronic address: dineshselven@u.duke.nus.edu., Shajahan Mohamed Buhary K; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore., Yew A; Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore., Kumarsing Ramruttun A; Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Tay KS; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore., Eng Meng Yeo N; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Jazyk: angličtina
Zdroj: The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons [J Foot Ankle Surg] 2024 Nov-Dec; Vol. 63 (6), pp. 672-679. Date of Electronic Publication: 2024 Jun 22.
DOI: 10.1053/j.jfas.2024.06.007
Abstrakt: Hallux valgus is one of the most common surgically corrected forefoot deformities. Studies evaluating clinical outcomes of minimally invasive chevron and akin (MICA) procedure have shown shorter operation time, faster recovery, and smaller scars compared to the open approach. Previous biomechanical cadaveric studies have largely focused on the open approach with minimal on MICA. To our knowledge, no studies have compared different proximal screw placements in MICA which can either be three-point fixation or intramedullary. This study aims to compare the biomechanical properties of fixation between these 2 techniques in MICA. Six matched pairs of human fresh frozen cadaveric feet were randomized to either 3-point fixation or intramedullary groups. Both procedures were performed by a single fellowship-trained orthopedic foot and ankle surgeon. Using a material testing machine, each specimen underwent 1000 cycles of plantar-to-dorsal uniaxial loads from 0 to 31 N in cantilever configuration while monitoring bending stiffness and distal fragment dorsal angulation. They were then subjected to load until failure at a compression rate of 10 mm/min. Specimens from both groups tolerated the walking fatigue test. Mean bending stiffness of 3-point fixation was 84% higher than intramedullary constructs (p = .002). Mean dorsal angulation of intramedullary was thrice that of 3-point fixation constructs (p = .008). Mean load to failure of 3-point fixation was 30% higher than intramedullary constructs (p = .001). Three-point fixation provide superior biomechanical stability compared to intramedullary proximal screw placement. The surgical technique using 3-point proximal screw fixation can offer robust fixation and lead to better clinical outcomes.
(Copyright © 2024 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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