Biomechanical analysis of minimally invasive crossing screw fixation for calcaneal fractures: Implications to early weight-bearing rehabilitation

Zhang, Haowei; Lv, Miko Lin; Yin, Liu; Sun, Wanju; Niu, Wen; Wong, Duo Wai-Chi; Ni, Ming; Zhang, Ming

doi:10.1016/j.clinbiomech.2020.105143

Cited by 22 publications

(14 citation statements)

References 33 publications

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“…The model has been validated previously by comparing the plantar pressure distribution of the FE prediction with that measured on the model participant in the existing study ( Zhang et al, 2020 ). The current model essentially has the same model geometry and loading case as that of our existing model, with the exception of the surgery and implant.…”

Section: Resultsmentioning

confidence: 99%

“…A sensitivity test on the coefficient of friction between bone fragments could enable the quantification of the biomechanical role of the plate. Our model was previously validated by plantar pressure in an intact state only ( Zhang et al, 2020 ). While direct validation of the fracture model with surgical interventions was the ideal case, validation experiments often came with a paradox of the necessity of simulation if physical experiments could be arranged, along with queries on ethics, feasibility, time, and cost.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, Ene et al (2013) documented the outcome of MIF using the Essex-Lopresti osteosynthesis technique with no reported cases of postoperative wound infection or skin necrosis. In a recent report, the biomechanical characteristics of MIF and ORIF were found to have similar stability performance ( Zhang et al, 2020 ).…”

Section: Introductionmentioning

confidence: 97%

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Biomechanical Analysis of a Novel Double-Point Fixation Method for Displaced Intra-Articular Calcaneal Fractures

Sun

et al. 2022

Front. Bioeng. Biotechnol.

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The development of minimally invasive procedures and implant materials has improved the fixation strength of implants and is less traumatic in surgery. The purpose of this study was to propose a novel “double-point fixation” for calcaneal fractures and compare its biomechanical stability with the traditional “three-point fixation.” A three-dimensional finite element foot model with a Sanders type IIIAB calcaneal fracture was developed based on clinical images comprising bones, plantar fascia, ligaments, and encapsulated soft tissue. Double-point and three-point fixation resembled the surgical procedure with a volar distal radius plate and calcaneal locking plate, respectively. The stress distribution, fracture displacement, and change of the Böhler angle and Gissane’s angle were estimated by a walking simulation using the model, and the predictions between the double-point and three-point fixation were compared at heel-strike, midstance, and push-off instants. Double-point fixation demonstrated lower bone stress (103.3 vs. 199.4 MPa), but higher implant stress (1,084.0 vs. 577.9 MPa). The model displacement of double-point fixation was higher than that of three-point fixation (3.68 vs. 2.53 mm). The displacement of the posterior joint facet (0.127 vs. 0.150 mm) and the changes of the Böhler angle (0.9° vs. 1.4°) and Gissane’s angle (0.7° vs. 0.9°) in double-point fixation were comparably lower. Double-point fixation by volar distal radius plates demonstrated sufficient and favorable fixation stability and a lower risk of postoperative stress fracture, which may potentially serve as a new fixation modality for the treatment of displaced intra-articular calcaneal fractures.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Biomechanical Analysis of a Novel Double-Point Fixation Method for Displaced Intra-Articular Calcaneal Fractures

Sun

et al. 2022

Front. Bioeng. Biotechnol.

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“…Patients were encouraged to start active range of motion exercises at the knee and the ankle as soon as possible. The majority of patients were encouraged to partially weight bear 21 at 2 to 3 weeks after surgery. Patients were allowed to fully weight bear when there was no pain at the fracture site and radiological evidence of bone union.…”

Section: Methodsmentioning

confidence: 99%

A nomogram for predicting post‐operative wound complications after open reduction and internal fixation for calcaneal fractures

Huang

Zhang

et al. 2022

International Wound Journal

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The purpose of our study was to determine the risk factors for post-operative wound complications (PWCs) after open reduction and internal fixation (ORIF) for calcaneal fracture and establish a nomogram prediction model. We retrospectively analysed the clinical data of patients who suffered from calcaneal fractures and had been surgically treated for ORIF in our institution between January 2010 and January 2020. Perioperative information was obtained through the electronic medical record system, univariate and multivariate analyses were performed to determine the risk factors of PWCs, and a nomogram model was constructed to predict the risk of PWCs. The predictive performance and consistency of the model were evaluated by the Hosmer -Lemeshow (H-L) test and the calibration curve. In total, 444 patients were enrolled in our study. Multivariate analysis results showed that smoking, limb swelling, angle of incision, and CRP were independent risk factors for skin necrosis. The AUC value for skin necrosis risk was 0.982 (95%CI 0.97-0.99).The H-L test revealed that the normogram prediction model had good calibration ability (P = .957). Finally, we found a correlation between PWCs and smoking, limb swelling, angle of incision, and CRP after ORIF for calcaneal fracture patients. Our nomogram prediction model might be helpful for clinicians to identify high-risk patients, as interventions could be taken early to reduce the incidence of PWCs.

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“…In previous studies, for selecting the finite foot element model load size, the value is often taken as half of the subject’s body weight [ 12 , 20 , 21 ]. To improve the realism and accuracy of the finite element model, we performed a bipedal plantar pressure analysis on the volunteer’s foot through the Footwork Pro® (Amcube, France) platform to obtain the average foot pressure on the affected limb and the foot pressure area, and calculated the actual load of the affected foot as 160 N to load the finite element model, considering the influence of the gastrocnemius-fibularis muscle on the accuracy of the finite element model of the stiff clubfoot [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

Biomechanical application of finite elements in the orthopedics of stiff clubfoot

Liu

et al. 2022

BMC Musculoskelet Disord

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Background The purpose of this study was to evaluate the effect of varying the different correction angles of hindfoot osteotomy orthosis on the biomechanical changes of the adjacent joints after triple arthrodesis in adult patients with stiff clubfoot to determine the optimal hindfoot correction angle and provide a biomechanical basis for the correction of hindfoot deformity in patients with stiff clubfoot. Methods A 26-year-old male patient with a stiff left clubfoot was selected for the study, and his ankle and foot were scanned using dual-source computed tomography. A three-dimensional finite element model of the ankle was established, and after the validity of the model was verified by plantar pressure experiments, triple arthrodesis was simulated to analyze the biomechanical changes of the adjacent joints under the same load with “3°” of posterior varus, “0°” of a neutral position and “3°, 6°, 9°” of valgus as the correction angles. Results The peak plantar pressure calculated by the finite element model of the clubfoot was in good agreement with the actual plantar pressure measurements, with an error of less than 1%. In triple arthrodesis, the peak von Mises stress in the adjacent articular cartilage was significantly different and less than the preoperative stress when the corrected angle of the hindfoot was valgus “6°”. In comparison, the peak von Mises stress in the adjacent articular cartilage was not significantly different in varus “3°”, neutral “0°”, valgus “3°” and valgus “9°” compared with the preoperative stress. Conclusion The results of this study showed that different angles of hindfoot correction in triple arthrodesis did not increase the peak von Mises stress in the adjacent joints, which may not lead to the development of arthritis in the adjacent joint, and a hindfoot correction angle of “6°” of valgus significantly reduced the peak von Mises stress in the adjacent joints after triple arthrodesis.

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Biomechanical analysis of minimally invasive crossing screw fixation for calcaneal fractures: Implications to early weight-bearing rehabilitation

Cited by 22 publications

References 33 publications

Biomechanical Analysis of a Novel Double-Point Fixation Method for Displaced Intra-Articular Calcaneal Fractures

Biomechanical Analysis of a Novel Double-Point Fixation Method for Displaced Intra-Articular Calcaneal Fractures

A nomogram for predicting post‐operative wound complications after open reduction and internal fixation for calcaneal fractures

Biomechanical application of finite elements in the orthopedics of stiff clubfoot

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